13080163 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1157 YORKSHIRE DR CONTRACTOR:MIKE COUNSIL PERMIT NO: 13080163
PLUMBING INC
OWNER'S NAME: SHANNON RAYMOND M AND BARBARA 1915 O'TOOLE WAY DATE ISSUED:08/22/2013
OWNER'S PHONE: 4089968402 SAN JOSE,CA 95131 PHONE NO:(408)272-4900
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS
License Class Lic.# 6 -1 1�16�01 REMOVE AND REPLACE WATHER HEATER AND MAIN
/' ` WATER
Contractor4C ( o��+Stl Iy�., Date SERVICE
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:$7500
ave and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36207024.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN D SOF PERMIT 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 DAY R LAST CALLED INS PE TI N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-po' urce regulations upertino Municipal Code,Section
9.18.
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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,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 ode,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, ions 25505,25533 2553 .
Section 3700 of the Labor Code,for the performance of the work for which this �7 J
permit is issued. Owner or authorized agent: Date•
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 �� M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 6\
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 h�
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinciCcDcuaertino.org v misc
CLIMBING ❑MECHANICAL [-]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS Cj S�I e t ' APN# (1:f 0-7 (�/ham
n Y)�
OWNERNAME w PHONE0� - -��}as[k E-MAIL
�+
STREET ADDRESS ��)) CITY STATE,ZI O FAX
04& ir,c w e leo CA
CONTACT NAM J, 1( c PHO Q _ 51 b _' S.10
E-MAIL
STREET ADDRESS bJ CITY TATE,ZIP FFAX
vSr
❑OWNER ❑ OWNER-BUn.DER OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME I C rs LICENSE NUMBER LICENSE TYPG- 7/ BUS.LIC#
COMPANY NAME i i E-MAIL F 0
STREET AD RESS. p% CITY,ST TE,ZIPOfd
PHO E
d
ARCHITECT/ENGI ER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF IIASFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WHALAND ❑ YESPROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLERHOME? I,a'NO
DESCRIPTION OF WORK
0
TOTAL VALUATION: GOO RECEIVED Y
By my signature below,I certify to each of the following: I am the property owner or authorized agent to aoffnfe property owner's behalf. I have read this
application and the information I ha �vlded is correct D�1a�read the Description of Work and verify it is urate. I agree to comply with all applicable local
ordinances and state laws relaf to building construc'�t z-1 a e¢fe entatives of Cupertino to enter bove- entifie property for inspection purposes.
Signature of Applicant/Agent: Date: D
sUr EMENTAL INFORMATION REQUIRED OFFICE USE ONLY
w VER-THE-COUNTER
❑ EXPRESS
U
❑ STANDARD
U
z ❑ LARGE
a
❑ MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 1157 yorkshire DATE: 08/22/2013 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$7,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: PRWHEAT
WORK remove and replace wather heater and main water service
SCOPE
.;
19ech. Ilan Check Plumb.Plan Check 0.0 hrs $0.00 Elec..Plan Check
Ltech.Perinit Fee: Plumb.Permit Fee: IPPERIwT Elc:c.. Permit Fee:
Other:-9ech.Insp. Other Plumb Insp. Ef�!j
Other Elec.Insp.
1�ech_Insp.Fee: Plumb. hasp.Fee Elec.Insp. Fee:
NOTE.This estimate does nottinclude fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelinmdina information available and are only an estimate. Contact the Dept for addn'1 info,
FEE ITEMS (Fee Resolution 11-053 E . 7/11122 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Plumbing
Suppl.PC Fee:. 0 Reg.. ® OT FO.0 1us $0.00 $28.00 IPRWHEATR I Water Heater
PME Plan Check: $0.00 F7 # Plumbing
Permit Fee: $0.00 $24.00 1 IBPWSVCS Water Service
Suppl. Insp. Fee G Reg. Q OT 0.0 Ins $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Construction uction Tar:
Administrative Fee: IADAffN $44.00
Work Without Permit? 0 Yes (j) No $0.00 (F)
Advanced Planning Fee. $0.00 Select a Non-Residential 0
Travel Documentation Fee: 1TR4VDOC $47.00 Building or Structure
i
Strong Motion.Fee: IBSEISMICR $0.75 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$139.75 $52.00 $191.75
Revised: 07/01/2013