13070193 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESSi it 09 nnrn.TRRlII(F Atm -k-j- CONTRACTOR*+Bl}ffe-BE PERMIT NO: 13070193
1✓t.>liL R-'71!/L) LJ e-+
OWNER'S NAME: IRVINE COMPANY LLC w/kher O- DATE ISSUED:07/30/2013
OWNER'S PHONE: 9497205685 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11COMMERCIALO
License Class Lic.# 0( 4 Q, BLDG 64ST FLOOR REMOVE AND REPLACE 11 WATER
I�� n - -Z� C -5 HEATERS UNITS
Contractor l� Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$8000
e and will maintain Worker's Compensation Insurance,as provided for by
e tion 3700 of the Labor Code,for the performance of the work for which this APN Number:31606037.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION �.° •fin
I certify that I have read this application and state that the above information is PER.
IRjvi S IF VV8MAWWMIRTED
correct.I agree to comply with all city and county ordinances and state laws relating WIDA T ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We)agree to save 180O L SYXI)INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the REVIEWS FOR CODE COAD t :eNCE
granting of this permit. Additionally,the applicant understands and will comply Issued by:
with all non-point source regulations per the Cupertino Municipal Code,Section Reviewed By:
9.18.
—1 RE-ROOFS:
SignatrrtP - Date- / All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorizeZ • - Date:'O
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION o�,�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ^0
CUPERTfNO (408)777-3228•FAX(408)777-3333•building cx-cupertino.orq0lV
MISC
RI PLUMBING MECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS y APN# 'n 0 6�
19500 Pruineridge Ave `14 1
CX
OWNERNAME PHONE E-MAIL
The Irvine Company Apartment Communities, Inc. 949-720-5685
STREET ADDRESS CITY,STATE,ZIP FAX
110 Innovation Dr. Irvine,CA,92617 949-720-5466
CONTACT NAME PHONE E-MAIL
Ben Thomas 408-202-7391 ben@lhourdrain.com
STREET ADDRESS CITY,STATE,ZIP FAX
1260-A Yard Ct. San Jose,CA,95133 408-521-0101
❑OwNER ❑ OwNER-BUILDER ❑ owNERAGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHIIECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER NSE TYPE BUS.LIC#
Gallaher Company Inc. 1946359 TCL13C6E
COMPANY NAME E-MAIL FAX
ben@lhourdrain.com 408-521-0101
STREET ADDRESS CITY,STATE,ZIP PHONE
1260-A Yard Ct. San Jose,CA,95133 408-202-7391
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF El SFD,.DUPLEX ® MULTI-FAMII.Y PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: COMMERCIAL URBAN INTERFACE AREA E3 NO FLOOD ZONE [3 No EICHLER HOME? ❑NO
DESCRIPTION OF WORK
ers
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on e p erty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is c . I agree to comply with all applicable local
ordinances and state laws rel ction. I authorize representatives of Cupertino to enter the above-identi?ed property for inspection purposes.
Signature of Applic Date: _2
SUPPLE INFORMATION REQUIRED '
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MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19500 Pruneridge ave DATE: 07/30/2013 REVIEWED BY: Mendez
APN: BP#: "VALUATION: 1$8,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: PRWHEAT
WORK BLDG 6-1ST FLOOR REMOVE AND REPLACE 11 WATER HEATERS UNITS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 11 # $308
TOTALS: jw == $308.001
Xfec:h. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec..Plan Check
v kch.Permit Fee: Plumb.Permit Fee: IPPERMIT Elcc. Permit Fee:
Other Alech.Insp._ Other Plumb Insp. 0.0 hrs $47.00 Other Elec.Insp. Li
Allech.Insp.Fe=.e: Plumb. Insp.Feta: Elec.Insp.Fee:
NOTE:This estimate doesnotinclude fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These-W are based on the prefindna in ormadon available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS(Fee Resolution 11-053 E . 7ff 11112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sul PC Fee
PME Plan Check: $0.00
Permit.Fee:
Suppl. Insp I ee
PME Unit Fee: $308.00
PME Permit Fee: $47.00
Consiruction Tax.
Administrative Fee: )ADMIN $44.00
Work Without Permit? ® Yes (E) No $0.00
Advancer/Plarming Fees:
Travel Documentation Fee: ITRAVDOC $47.00
Strong Motion.Fee: 1BSEISMICR $0.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$447.80 $0.00 $447.80
Revised: 07/01/2013