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13070189 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19500 PRUNERIDGE AVE CONTRACTORrff"&="QBE PERMIT NO:13070189 OWNER'S NAME �-�h'� �� tr �Q� DATE ISSUED:07/30/2013 OWNER'S PHONE: 9497205685 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE] License ClassC-3Cz Lic.# "l —� BLDG 2-1ST FLOOR REMOVE AND REPLACE 10 WATER ( HEATERS UNITS Contractor at l�G� lV-�r Date 72^ '�� 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 jjiave and will maintain Worker's Compensation Insurance,as provided for by tion 3700 of the Labor Code,for the performance of the work for which this APN Number Occupancy Type: permit is issued. APPLICANT CERTIFICATION Bul dIt1�DQ I certify that I have read this application and state that the above information is PE S IF WORK iaNlR &TED correct.I agree to comply with all city and county ordinances and statelawsrelating WIW'DAYFP �T ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 M LAS A D INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, REVIEWED FOR CODE COMPLIANCE costs,and expenses which may accrue against said City in consequence of the Issued by: GO` D�e' granting of this permit. Additionally,the applicant understands and will comply Reviewed $ with all non-point source regulations per the Cupertino Municipal Code,Section Y• 9.18. RE-ROOFS: Sign Signat V Date °�L � 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 Co Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age, Date: 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 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228-FAX(408)777-3333-building0cupertino.org Ot MISIC 21 PLUMBING EINMCHANICAL EIELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# ' O -3 -1 19500 Pruineridge Ave OWNERNAME <S1PHONE 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 1 408-202-7391 ben@lhourdrain.com STREET ADDRESS CITY,STATE,ZIP FAX 1260-A Yard Ct. San Jose,CA,95133 1408-521-0101 ❑OwNER ❑ OWNER-BUIIAER ❑ oWNERAGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# Gallaher Company Inc. 1946359 C36 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 ❑SFD or DUPLEX ® MULTI-FAmiLy PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK ers TOTAL VALUATION: ; M By my signature below,I certify to each of the following: I am the property owner or authorized agent to ac on 00roperty 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 ac ate. 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: SUPPLEMENTAL INFORMATION REQUIRED "g oyEx Ts��coucq R kxEss g{ ' -��'; �'` ". A ©�FMATO)C ; 1 s MEPMiscApp_201 Ldoc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 19500 Pruneridge ave DATE: 07/30/2013 REVIEWED BY: Mendez 91APN: BP#: I "VALUATION: 1$8,000 %PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION SFD or Duplex PRWHEATR USE: PERMIT TYPE: � WORK I BLDG 2-1ST FLOOR REMOVE AND REPLACE 10 WATER HEATERS UNITS SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1 PRWHEATR 10 # $280 TOTALS: $280.00 L _. N _ klech. Man Check Plumb.Plan Check 0.0 1 hrs $0.00 Elec.flan Check 1leclr.Permit Fee: Plumb.Permit Fee: IPPERMIT £tc:c. Aermit Fee: Other•;llech.Imp. Other Plumb Insp. 0.0 hrs $47.00 Other Elee.Insp. Alle:ch. Insp.Fee: Plurnb.Insp.ree: Elee.Insp.Fc:e: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Theseees are based on the prelinmdina information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check 14'ee: Sttpp1. PC Fee PME Plan Check: $0.00 Perinit.Fee: Suppl. Insp Fee PME Unit Fee: $280.00 PME Permit Fee: $47.00 Construction :Tix: Administrative Fee: IADMIN $44.00 Work Without Permit? 0 Yes iq No $0.00 A(Jvuncecl Planning Fees: Travel Documentation Fee: ITRAVDOC $47.00 Strom Motion Fee: IBSEISMICR $0.80 Select an Administrative Item.. Bldg Stds Commission Feer 1BCBSC $1.00 05aP $419.80 $0.00 ' O $419.80 3 .t Y .. Revised: 07/01/2013