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14020033 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10165 ORANGE AVE CONTRACTOR:GENMOR PLUMBING PERMIT NO: 14020033 OWNER'S NAME: TIM KURRECK 2552 SEABOARD AVE DATE ISSUED:02/05/2014 OWNER'S PHONE: 4088593182 SAN JOSE,CA 95131 PHONE NO:(408)855-8348 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL 0 (( WATER HEATER PLACED ON EXTERIOR SIDE YARD License Class Lic.# n73-1(.,e l (SETBACKS MIN OF Y PER PLANNING).INSTALL(N)GAS �/ LINE FOR TANKLESS&FUTURE GAS STOVE Contractor mt Date I hereby affirm that I am licensed under t 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:$7000 ()1,rk 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:35716059 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 EERVIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter LED INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the sued by: Date: �i S granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 918. RE-ROOFS: Signature n a e 197 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 Date: Signature of Applicant: 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 Owner or authorized agent: DatO�fi 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 n^� O"1 IMGENERAL PERMIT APPLICATION n u ME P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O V 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERT#N (408)777-3228•FAX(408)777-3333•building(@cupertino.org \ misc KWLUMBING ❑MECHANICAL [—]ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS 1Len \(�w�Ajb< 7PN „,��ttt�� yyy�� OWNER NAME ,��,^ ^ PRO qsq E-MAIL STREET A Y v v� 1gLAa, C , STA yZIP FAX CONTACT NAME '�'"�^`”`,'C'_� PHONE409)9) _Q _I-MAIILJ STREET ADDRES r/(� C)QAOnn�/J CITY TATE,ZIP �� . �� FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT IN'Y M4ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRAC O NAME LICENSE .59 u 1 �/�6E TYP BUS.LIC# COMPANY NAME,_ `' 1^; E-MAIL /�, \�A}ti/AJ/r) FAX STREET ADDRES Y�T YJ CITY, TATE,ZIP/�1 r V1J I � .�iIG I PHONE `i(J BSS -65 ARCHITECTIENGINEER NAME LICENSE NUMBER "l ✓ BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN W ILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME' NO DESCRIPTION OF WORK TOTAL VALUATION: By my signature below,I certify to each of the(following: I am the property owner or aut razed agent to act on the pro r 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 accurate. 1 agree to comply with all applicable local ordinances and state laws relating to building cons. I authorize representatives of Cupertino to enter the above-id ntifi d property for inspection purposes. Signature of Applicant/Agent: ' Date: SUPPLEMENTAL INFORMA ION REQUIRED OFFICE USE ONLY I%aw ER-THE-COUNTER a F xx ❑'EXPRESS U x ❑ STANDARD „V LARGE El a MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10165 ORANGE AVE DATE: 02/05/2014 REVIEWED BY: MELISSA APN: 357 16 059 BP#: `VALUATION: 1$7,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION 1 RPRP USE: SFD or Duplex PERMIT TYPE: WORK COPPER RE-PIPE THROUGHOUT HOUSE & REPLACE E WATER HEATER WITH N TANKLESS SCOPE WATER HEATER PLACED ON EXTERIOR SIDE YARD (SETBACKS MIN OF T PER PLANNING). p APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $14 Water Heater 1PRWHEATR 1 # $28 Piping, Gas <=4 Outlets 1PGASRES 1 # $70 TOTALS: $112.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $47.00 tis,�. F 171mb. Insp, F'ce; NOTE: This estimate does not include fees 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 Elf.' 711113) FEE QTY/FEE MISC ITEMS Stipr`.7x`'.. P .'.ecce PME Plan Check: $0.00 PME Unit Fee: $112.00 PME Permit Fee: $47.00 Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes 0 No $0.00 ¢ .i7.c„rt`e'tr'i'tLrrtirirr<�T'+<'e'S': Travel Documentation Fee: ITRAVDOC $47.00 i Strong Motion.Fee: IBSEISMICR $0.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $251.701 $0.00 TOTAL FEE: $251.70 Revised: 01/15/2014