14080268f'A
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10257 NILE DR
CONTRACTOR: PACIFIC PLUMBING
PERMIT NO: 14080268
OWNER'S NAME: DEBOO FAROKH J
2138 O'TOOLE AVE
DATE ISSUED: 08/28/2014
OWNER'S PHONE: 4087829564
SAN JOSE, CA 95131
PHONE NO: (408)452-8633
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REMOVE AND REPLACE WATER HEATER
9
License Class Lic.��#
Contractor P 40( FIe 01XO`%eDate
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: $1400
I 4ave and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36948030.00
Occupancy Type:
Vection 3700 of the Labor Code, for the performance of the work for which this
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
WIT 0 DAYS F 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
180 DA FRO T CALLED INSPYCTIPN.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date: 42SA/
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
for
9.18.
Signature_ Date e64 1
installed without first obtaining an inspection, I agree to remove all new materials
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
the Health & Safety Code, Sections 25505 255339 d 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
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
C^UPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildiinngC�cupertino.orcl
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ORTGTNAT. PFRMIT #
PROJECT ADDRESS j � � !� � � i� I 1 I �' (�1� � �p �
A^PN #
OWNER NAMEiPHONE
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STREET ADDRESS \
CITY, STATE, ZItJ1v4Z / {' f (11, l 1 FAX
CONTACT NAME J� MJ,�..`� `, J� T i
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E-MAIL
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR NTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER DDEVEEL�O(PEER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER
` 1 f
LICENSE TYPE
pr
BUS. LIC #
2.2
COMPANY NAME �Jf CSI'] . ta/!
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E-MAILV
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FAX
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STREET ADDRESS ,
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CITY, STATE, Z
51535
PHONE /
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L A C
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK LKW e,.,— D t�-7 L� tYq C W _ _` _
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
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
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE ARBA: DETACH
I
[]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 ❑ YES
CL 41.
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
? .lt•
,,..
By my signature below, I certify to each of the following: I am the property owner or authorized age act on t owner's behalf. I have read this
application and the information I have provided is correct. I haver d the Description of Work and i Is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bui ing nstructi9K. I/I 'ze r presentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL FORMATION REQUIRED
RouTINc SLIP .
OVER -T OUNTERT;BUMDINGPLANREVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
RE31 EXPRESS
❑'j�PLANNING PLAN REVIEW.,:
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure{]
RF
STANDARD :'
i
❑'•['PUBLIC WORKS
_
form if any Hazardous Materials are being used as part of this project.`
`
M LARGE
❑ %^FIRE
DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
MAJOR'
❑;SANITARY SEWER DISTRIe `
submittal of Building Permit application.
❑==ENVIRONMENTAL HEALTH-'
B1dgApp_2011.doc revised 06/21111
�Al
CITY OF CUPERTINO
IVU Ti C'T7M A 9rnD — RTTII ,IANC_' IIIVIRI0N
LaiADDRESS:
10257 nile dr
DATE:
REVIEWED BY:
UNITS
APN:
BP#:
*VALUATION: $2,500
xPERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
___[_PENTAMATION
PRIMARY SFD or Du lex
USE: p
#
PRWHEATR
PERMIT TYPE: i
WORK
remove and replace water heater.
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Water Heater
1 PRWHEATR
1
#
$29
PME Unit Fee:
$29.00
PME Permit Fee:
$48.00
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
TOTALS:
i
Travel Documentation Fee: 1TRAVDOC
$29.00
Strong Motion Fee: IBSEISMICR
Plumb. Plan Check 0.0 hrs $0.00 1. Cc,
Plumb. Permit Fee: IPPERMIT
LiOther Plumb Insp. ETrs $48.00
1111w1h Msp. Fee: �-icc�. ip � Vec
NOTE: This estimate does not inetude fees due to other uepartments (i.e. rtammng, ruauc rr ulna, i'crc, J.- y rw.c• �• . y
_ L _ _a _ .z ,.r. Us .t: .an610 null ora nnhi nn ocfimnto_ Contact the Dent for addn'i info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fc�C:
PC P'ce
PME Plan Check:
$0.00
PME Unit Fee:
$29.00
PME Permit Fee:
$48.00
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
Ic"rpt'€%i7C'<'Lj I'1C1171I7
i
Travel Documentation Fee: 1TRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldy, Stds Commission Fee: IBCBSC
$1.00
>i�
> PN
$171.50
$0.00 TOTAL FEE:
$171.50
Revised: 08/20/2014