The URL can be used to link to this page

14050069 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20222 JOSEPH CIR CONTRACTOR:PREFERRED PLUMBING PERMIT NO:14050069 &DRAIN OWNER'S NAME: CAMARDA PETER J AND EVELYN M T 1980 OLIVERA RD STE F DATE ISSUED:05/12/2014 OWNER'S PHONE: 4082074007 CONCORD,CA 94520 PHONE NO:(925)676-2143 Ef LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ C 3 / �SG y7 REPLACE (E)WATER HEATER,SAME LOCATION License Class 6 Lic.# 7 ContractorY I �j�Date Z I hereby affirm that fr �censed�►�Aer the provisions of Chapt r 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:$1330 KVI 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:31624049 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 DA IT 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 DA 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 ate: granting of this permit. Additionally,the applicant understands and will comply a with all non-point source regulations per the Cupertino 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 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 505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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 CONSTRUCTI N 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 O MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION mff Amok 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 is (408) 777-3228-FAX(408)777-3333•buildina a)cuoertino.org PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANTEOUS PROJECTenr nrcc I APN# 3 Ifo �J � I 0 Q( 2vZ o � r _ 'V l/ OWINTERNANM PONE E,LAI STRx"ETADDRESS' �Z a CI Y, STATE.ZIP_ , -To I FAX 14- CONTACT NAMEPH NE STREET ADDRESS ciz,STATE,ZY FAX CK ❑ oWA'ER .13oF,NER.BUII.DER ❑ o-Ar .,kGEI,-r IT CONTRACTOR ❑CONTRACTORAGEI.? [IARCHITECT ❑ENGIIMR ❑ DEVELOPER ❑TEA`ANT CO GTO T LICEN E NUNBE LICENSE E BUS.LIC 4 COMPAA`YN � � E-MAIL FAX STREET ADDRESS V.( TATE,ZIP T I PHONE � ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC COMPANY NAME &MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF KSFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WHDL.AND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YPS BUILDING: ❑COhIMMCIAL - I URBAN IN`rERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK r-. P am a �© O c N TOTAL VALUATION: �� DB ' v By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prope ehalf. 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. I agree to comply with all applicable local ordinances and state laws relating to ilding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. S ignature of Applicant/Agent: Date: StIPLEMENITAL IIQFORM?.TION REQUIRED - sa am GcEISERUST ONSOB rt Nilo« I3Ir<OOL2,T�R�`�: v CRESS TSD HIMc — ` A1jEFMsa4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20222 JOSEPH CIR DATE: 05/12/2014 REVIEWED BY: MELISSA APN: 316 24 049 BP#: *VALUATION: 1$1,330 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: PERMIT TYPE: WORK REPLACE E WATER HEATER SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $28 TOTALS: $28.00 OW 21"A-11 �1° iL?ed?, Plan ChcckPlumb.Plan Check W c. l'r m C�,"c0lr'.rr„!t 1�ee: Plumb. tOther Plumb Insp. 1up lis%er.imp,Plumb. hasp. /,C(? c.Ins") 1;'e: 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 Dept for addn'1 info. FEE ITEMS jEee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check I ef',: 'trip/7/. P(. Fee PME Plan Check: $0.00 Yerinif Fee: .{suppl, Inp P'Ge PME Unit Fee: $28.00 PME Permit Fee: $47.00 (",o12S1r11r'rIOj 7 1 TVA Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes (j) No $0.00 clLT�errci:r( 'fir 2arirt< 1,ees: Travel Documentation Fee: ITRAVDOC $47.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 t w a '° $167.501 $0.00 " TOTAL $167.50 �n.. Revised: 04/01/2014