13100030CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10296 ALPINE DR
CONTRACTOR: PENNINGTON
PERMIT NO: 13100030
PLUMBING SERVICE
OWNER'S NAME: HOLMES BAYARD S AND IDA J TRUSTEE
1261 LINCOLN AVE STE 215
DATE ISSUED: 10/03/2013
OWNER'S PHONE: 6504652429
SAN JOSE, CA 95125
PHONE NO: (408) 217 -8352
B�
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALS
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # `�92-
REPLACE (E) WATER HEATER, SAME LOCATION
Contractor // , �,/ . / =— Date /,o bar ( 3
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: $1000
I have 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: 32615070.00
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 180 DAYS OF 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
DAYS F AST LED 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
C d 3 o
granting of this permit. Additionally, the applicant understands and will pl
ue
with all non -point source regulations per the Cupertino Municipal Code, on
9.18.
�� "r
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 . Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cuper ' o unicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
for for this
the Health & Safety Code, Sections 2 5 , and 25534. Z
0 yd
Section 3700 of the Labor Code, the performance of the work which
Owner or authorized agent: Date: / J
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildingCokupertino.org
MEP
MISC
LYIPtUMBING LJMECHANICAL LJELECTRICAL LJMISCELLANEOUS
PROJECT ADDRESS 10'2-1 `I Q ` V AC O (` n . APN # � q - 15; - O J�
OWNER NAME C P" k` ` � PHO g (P 2Laot E-MAIL
U u (/
STREET ADDRESS 1 2� A • ,` yt • CITY, STATE, ZIP 0" O FAX
CONTACT NAME V �J• PHONE 21 E L (n co
STREET ADDRESS i 1 2
CITY, STATE, ZIP 2
FAX
❑ OWNER 11 OWNER- BUILDER 13 OWNER OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME n
(1'
E.MAILI6n l� '_
FAX
(•
STREET ADDRESS `y t��tc✓
aN �" ``
CTTY, STATE, ZIP
_& „^• (��- �
J (� !
'H( '4o6) -2'? - G3�
jJ
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS.. L(IC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI - FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN =DLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK - I
TOTAL VALUATION: W WIN.
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner' : al ve read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state la�relt' building co struction. I author' representatives of Cupertino to enter Identified property for inspection purposes.
Signature of Applican ate: 16--a-13
SUPPLE NTAL INFORMATION RE RED
MEPMiscApp_2011.doc revised 06121111
�� CITY OF CUPERTINO
I FF. FCTIMATOR — RITII,DINE: DIVISION
t
ADDRESS: 10296 ALPINE DR UNIT B
DATE: 10/03/2013
REVIEWED BY: MELISSA
MISC ITEMS
APN: 32615 070
BP #:
"VALUATION:
1$1,000
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
p
PME Plan Check:
PENTAMATION PRWHEATR
USE:
Perinit .Fee:
PERMIT TYPE:
WORK
REPLACE E WATER HEATER SAME LOCATION
SCOPE
PME Unit Fee:
APPLIANCE / EQUIP TYPE 'FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $28
TOTALS: r = $28.00 rg, ,d
Xfech. Flan Check Plumb. Plan Check 10.0 1 hrs $0.00 F_lec. Plan Check
Lfech. Permit Fee: Plumb. Permit Fee: 1PPERMIT Elec. Permit Tee:
Other .wech. Insp. Other Plumb Insp. 0.0 hrs $47.00 Other Elcc. Insp.
Alcch. Insp. Fee: ftrnb. hash. Fee: Elec, Insp, Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Worics, tire, sanitary sewer Uisirict, acnooi
District, etc ). These-fees are based on the relimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 E . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suerpl. PC Fee
PME Plan Check:
$0.00
Perinit .Fee:
Suppl. Insp Irce
PME Unit Fee:
$28.00
PME Permit Fee:
$47.00
Construction Tar:
Administrative Fee: IADMIN
$44.00
Work Without Permit? ® Yes (j) No
$0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion. Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldk Stds Commission Fee: IBCBSC
$1.00
$167.501 $0.0 $167.50
Revised: 08/01/2013