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14050141 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 8080 PARK VILLA CIR CONTRACTOR:CUPERTINO PLUMBING PERMIT NO: 14050141 OWNER'S NAME: SCOTT T SPENCER 2784 S BASCOM AVE DATE ISSUED:05/23/2014 OWNER'S PHONE: 4082554085 CAMPBELL,CA 95124 PHONE NO:(408)253-0618 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] REPLACE(E)WATER HEATER,SAME LOCATION p License Class '3 Li..# �CZ��y� Contractor (� 1 (" Date S'2 3— 7 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:$0 J-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:35610022.00 Occupancy Type: permit is issued. APPLICANT i 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 D PE T 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 OM LAS LLED 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 Z 3 granting of this permit. Additionally,t4 applicant understands and will comply Y ate: with all non-point so u ' ns rothertino Municipal Code,Section 9 18. 151 RE-ROOFS: Signature Date _1'_273 1 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 Cupertin ipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections ,255 ,an 4. Section 3700 of the Labor Code,for the performance of the work for which this Z 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 — `O (408)777-3228•FAX(408)777-3333•building aacupertino.org \ CUPERTINO ❑NEW CONSTRUCTION 1❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED `1 ORIGI AL�P7ERMIT# P T DD SS "4,`l \�t l.l� CCI•• APN# v / OWNER NAME Y• PFj()N�:� ,.,,,..7` V055 E-MAIL C04 STREET ADD SS /_ G 3 CITY, TATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONT OR NAME ��/ �� `- LIyC�TIS�BElt o LICEIE TYE BUS.LIC# Q lL �o i- 7U COMPAN NAME ! E-MAIL FAX W STREET ADDRESS 0d" CITY,STATE,ZII e � PHONE I I ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES 1 USE TYPE OCC. SQ.FT. VALUATION EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA It PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH O` []ATTACH #DWELLING UNITS: IS A SECOND UNiT ❑YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? []NO \ PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN _ TO VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOM NO By my signature below,I certify to each of the following: I am the property owner or auth ed agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bing contra �ie ertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: — 2 SUPPLEMENTALATION REQUIRED r>aiv cl3Ecx TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for VER1HFcCOUNTER ❑ BUILDINGPLAN existing building(s). Demolition permit is required prior to issuance of buildingKUM- permit for new building. �a r xrxs ❑ PL 4NNIN�PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ rUBLIC�YORxs form if any Hazardous Materials are being used as part of this project. 0 LA�xG ❑ FII2EDEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ sANITARY SEWER , submittal of Building Permit application. 4F+' �5 ❑- NVIRONMENTAL1EALTH.. BldgApp 201 Ldoe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR BUILDING DIVISION ADDRESS: 8080 PARK VILLA CIR DATE: 05/23/2014 REVIEWED BY: MELISSA APN: 35610 022 BP#: ONLINE 14050115 `VALUATION: Iso *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: PRWHEAT 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 W'�-,;i,. P Ur',(hek Plumb.Plan Check 0.0 hrs $0.00 bfeeil Permit Fee: IPPERMIT ?Ec 01.1wr.lIcch, hrslo Other Plumb Insp. 0.0 hrs 1 $47.00 °r-ria Iac�1�r, Fvc� Phalli'), I isp. 111!e" I,s}> 1"I"c. NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn'1 infix FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS ,SVI)1�1. PCFLFL , PME Plan Check: $0.00 Pek °rail PME Unit Fee: $28.00 PME Permit Fee: $47.00 Administrative Fee: ]ADMIN $44.00 Work Without Permit? 0 Yes Q) No $0.00 1 C VtPi "CU, JClIrTrj7?fir t`c'.e.S: Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 iso $166.00 $0.00 _ TOTAL FEE: $166.00 Revised: 04/01/2014