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14010092CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10094 JUDY AVE CONTRACTOR: CALIFORNIA DELTA PERMIT NO: 14010092 MECHANICAL INC OWNER'S NAME: 6056 E BASELINE RD STE 155 DATE ISSUED: 01/15/2014 OWNER'S PHONE: MESA, AZ 85206 PHONE NO: (866) 692-5273 19 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ 71 License Class CTl Lic. # �) `C!� / REPLACE (E) 40 GAL WATER HEATER WITH (1) TANKLESS WATER HEATER. UPGRADE 22 LINEAR FT OF (E) 1/2" Contractor Date -- PIPE TO 3/4 PIPE I hereby atli m 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 Sq. Ft Floor Area: Valuation: $3800 Relformance of the work for which this permit:is issued. �Vfiave and will maintain Worker's Compensation Itisurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 37511010.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that tlie�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 authorize4epresentatives of this city to enter upon the above mentioned property for inspection, purposes. (We) agree to save 180 DAYS D 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 a bY� Date: S / y granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulati s per the Cupertino Muni Code, Sec 918. ✓ 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) 1, 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 Section 3700 of the Labor Code, for the of the work for which this the Health & Safety Code, Sections 25505 33, and 25534. /01111_ / performance Owner or authorized agen Date: permit is issued. � 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 918. Signature Date UN V GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION \ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 I (408) 777-3228 • FAX (408) 777-3333 • building (a�cupertino.ora """��� C 11= F -I MTCCFT J.ANF.nT IS Ln-UA'W1Nk' LJ 1VIZr-KIPUNL.tSL L --j-- ----- PROJECTADDRESS APN# 3 ---)- y — , / — C) / O OWNTER NAME E MAIL STREET ADDRESS CTI 2 ems` FAX CONTACT NAME J , r/(7 vV PH �© EMAIL STREET ADDRESS O / L1 CITY, ST P ^ i D FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO CTT�RNAME LICENSE E LICENS TYP BUS. LIC# CO -)el7'0 E-MAIL. FAX ST © S�, CITY, STATE ZIP ` 2a PHONE _ 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 WIIALAND ❑ YES PROJECT IN ❑ YES ❑ NO IS THE BLDG AN ❑YES EICHLER HOME? ❑ NO BUMDING: ❑ COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE DESCRIPTION OF WORKnCP cP 3 K lG L S i Z< ��-✓ O a ,; �� v TOTAL VALUATION: g max.. s .,..fik dux MINE By my signature be W, I certify to each of the following: I am the property owner or authori to ac pro wrier' . I have r application and the information I have provided is.correct. I have read the Description of Wo and verify it is accu e. I agree to y with all applicable loca ordinances and state laws relating to building c ction. I authorize representatives of Cupertino to enter the above -i/denti operty/foorr inspection purposes. Signature of Applicant/Agent: Date: SUPPLE NTAL INFORMATION REQUIRED �x of us> or%r _�� 9V 211, � STAi\'DARD �� •_; `I� JOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FF.F ESTIMATOR — BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 10094 JUDY AVE QTY/FEE DATE: 01/15/2014 REVIEWED BY: MELISSA BP FEES APN: 3751:101.0 BP#: 1 PRWHEATR "VALUATION: 1$3,800 *PERMIT TYPE: Plumbing, Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex ;' USE: .Permit Fee: PENTAMATION PRWHEATR PERMIT TYPE: WORK REPLACE E 40GAL WATER HEATER WITH N TANKLESS WATER HEATER. UPGRADE 22 SCOPE LINEAR FT OF (E) 1/2" PIPE TO 3/4" PIPE APPLIANCE / EQUIP TYPE FEE ID. QTY/FEE QTY UNITS BP FEES Water Heater 1 PRWHEATR 1 # $28 .Permit Fee: S'uppl. Insp Fee PME Unit Fee: $28.00 PME Permit Fee: $47.00 i.ons/rtiction Ta : Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 TOTALS:, A Travel Documentation Feer : ITRAvDoC $28.00 Strong Motion Fee: IBSEISMICR Mech. Plan Check-'heckPlumb. Plan Check 0.0 hrs $0.00 Elec-. Plan -17,& Perinit Fee Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: Other Afecrh. Insp. Other Plumb Insp.0.0 hrs $47.00 Other Elec. Insp. Alech. Insp. Fee: Plumb. Insp. Fee: Elee. Insp. Fee: NOTE: This estimate does not includeJees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 E f 711113) FEE QTY/FEE MISC ITEMS Plan Cheek Fee: Suppl. PC Fee PME Plan Check: $0.00 .Permit Fee: S'uppl. Insp Fee PME Unit Fee: $28.00 PME Permit Fee: $47.00 i.ons/rtiction Ta : Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 Advanced Planning Fees: A Travel Documentation Feer : ITRAvDoC $47.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 % $167.50 $0.00 -s r $167.50 Revised: 01/15/2014