13070188 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19500 PRUNERIDGE AVE CONTRACTOR: PERMIT NO: 13070188
.PEtEIMMIED
OWNER'S NAME:•acvngc iv V1f7"�'r+-��1 G_ �d� A— �� r DATE ISSUED:07/30/2013
OWNER'S PHONE: 9497205685 W 4c:pJ LL PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class Q, Lic.# l q(r-,•3�r'1� BLDG 1-1ST FLOOR REMOVE AND REPLACE 10 WATER
// ` _ HEATERS UNITS
Contractor(,,,,��Vl9�f C b Date - �Gj �7
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
have and will maintain Worker's Compensation Insurance,as provided for by
ection 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
COPERTINO
I certify that I have read this application and state that the above information is ,T EXPIRE§3I#*0WNW6ff STARTED
correct.I agree to comply with all city and county ordinances and state laws relating 1=M91tALLED
FPERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter INSPECTION.
upon the above mentioned property for inspection purposes. (We)agree to save S
indemnify and keep harmless the City of Cupertino against liabilities,judgments, REVIEWED costs,and expenses which may accrue against said City in consequence of the IVIEWED FOR CODE COMPLIA
ssue'cE
granting of this permit. Additionally,the applicant understands and will comply y:
with all non-point source regulations per the Cupertino Municipal Code,Section RPvioyrh��a �✓-4
9.18.x_—_,
Z RE-ROOFS:
Signature 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 Date: •2 •1
Owner or authorized not.
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 CONSTCTION LENDING AGENCY
RU
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 95014-325511-91 (408)777-3228-FAX(408)777-3333-building(a)cupertino.org
CUPERTINCI 6 (��3 misc
PLUMBING MECHANICAL ELECTRICAL MISCELLANEOUS
PROJECT ADDRESSAPN
19500 Pruineridge Ave
OWNERNAME PHONE E-MAIL
The Irvine Company Apartment Communities,Inc. 949-720-5685
STREET ADDRESS CITY,STATE,ZIP TFA;
110 Innovation Dr. Irvine,CA,92617 949-720-5466
CONTACT NAME PHONE E-MAIL
Ben Thomas 1 408-202-7391 ben@1 hourdrain.com
STREET ADDRESS CITY,STATE,ZIP FAX
1260-A Yard Ct. San Jose,CA,95133 1408-521-0101
❑OwNER ❑ OwNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ®CONTRACTOR AGENT ❑ ARCHrrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
Gallaher Company Inc. 946359 TC3C
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 WB.DLAND ❑ YES 7PROOlICTIN ❑YES IS TIE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO D ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
erS
TOTAL VALUATION: tr� EsEL e
By my signature below,I certify to each of die following: I am the property owner or authorized agent to act nroperty 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-iden6 ed property for inspection purposes.
Signature of Applic Date: �? -,7�, ��
SUPPLE INFORMATION REQUIRED
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MEPMiscApp_2011.doc revised 06121111