15010035 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7456 DE FOE DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 15010035
CONDITIONING
OWNER'S NAME: BOWNAS DOUGLAS R 1712 STONE AVE DATE ISSUED:01/07/2015
OV^ER'S PHONE: 4082550617 SAN JOSE,CA 95125 PHONE NO:(408)293-4717
X LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
`a_ 43 '4692)-1- 1 REPLACE(E)50 GAL WATER HEATER,SAME LOCATION
License Class A r/Lic.#
Contractor �4 A CNA-C /� Date 1 141</
I hereby affirm that I am licensed under the provision 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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1400
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:35924038.00 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 OKXX+ 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 DAYS F S 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
granting of this permit. Additionally,the applicant understands and will comply s ate:
hl–
with al n-point source r gula ions per the Cupertino Municipal Code,Section
/7 9
RE-ROOFS:
Signature Date d 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 wi Cupertino Mu icipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Co ,Sections .5505 5 33 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorize 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 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
GeNSRAL PERMIT APPLICATION
COMMUNITY OVELOPMENT 0EPARTMENT`'�e"1!iJ.IIDING DIVISION�OA
i. 10300 TORRE AVENUE - CUPERTINO; CA 95014-3255 C
408 777.3333 buildinaCa�cu�ertlno.ora MIS
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(408)777-3228 , FAX( )
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PROJECT IN
USE OF or Duplex C Multi-Family PROJECT IN WG DLAND
ST".UC". E: O Commercial
URBAN WtE1tYACE AREA C Ye910 FLOODZONE O YesNo
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a�TO-:',AL YAJ.UATION:
Pr p rtT I F,
!ew,i cerfify to each of the following: lam the property owner or authorized agent to act on the o' e M owntr r be 'this
on an elo", ovlded la a
cc have read the Deacripcion of Work and Ycn.`y it is accu ea. t a fire to cc
ro buil. 'ng co e n l authorize rapreaentarlve3 ofCupertino t:.."cr'he atiovidentif dprop-
Date:
cnt:
SUPPLI:MEN'rAI:TNFORMA�"ION REQ U1 iED
z
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7456 DE FOE DR DATE: 01/07/2015 REVIEWED BY: MELISSA
APN: 359 24 038 BP#: "VALUATION: 1$1,400
xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Duplex PENTAMATION PRWHEATR
USE: PERMIT TYPE:
WORK REPLACE E 50 GAL WATER HEATER SAME LOCATION
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1 PRWHEATR 1 # $29
TOTALS: $29.00
hecb. 111(in Cher i, Plumb.Plan Check 0.0 hrs $0.00 11/ec.f idn Oz,-ck
:b/ech_ Tc>vrriit Fee: Plumb.Permit Fee: IPPERMIT r�;Iec` t'arparii f'�z,.
r")ri�r,.aicrc,�:. hsp Other Plumb Insp. 0.0 hrs $48.00 t)wr t_:eE-1;np.
Fee. Lief'.. Msp.
NOTE: This estimate does not include fees due to other Departments(Le.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'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7ft /1/13) FEE QTY/FEE MISC ITEMS
Plan Check 1 ee:
PME Plan Check: $0.00
Pennil Fee:
Supp/, h i s J>Fe,_
PME Unit Fee: $29.00
PME Permit Fee: $48.00
("onsfr uchOn Tax
Administrative Fee: ]ADMIN $45.00
Work Without Permit? ® Yes No $0.00
r!t/L'€d?ZL'e'Lf ft'/C 17?7IlY1t?1`e'E':S':
Travel Documentation Fee: ITRAVDOC $48.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$171.50 $0.00 TOTAL FEE: $171.50
Revised: 01/06/2015