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15030071 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10226 VISTA DR CONTRACTOR:PAYLESS WATER PERMIT NO:15030071 HEATERS OWNER'S NAME: GUO YIHONG AND WANG HONGYI TRUSTEE 27919 SMYTH DR DATE ISSUED:03/11/2015 OWNER'S PHONE: 4082215526 VALENCIA,CA 91355 PHONE NO:(661)775-2944 lb LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL REMOVE AND REPLACE 40 GAL WATER HEATER IN License Class C%V b Lic.# 83(O a.l u SAME LOC Contractor �{rM eS S Date 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:$1500 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:31624018.00 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 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 DAYS FROM ST CALLED 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. �/ RE-ROOFS: Signatur� Date 3'��' J 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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,Se tions 25505, 5533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 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 918. Signature Date GENERAL PERMIT APPLICATION MEP Ila COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ') I 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 U CUPERTINO (408)777-3228•FAX(408)777-3333•building(&-cuDerfino.org misc PLUMBING MECHANICAL.. .. . EIRWMCAL MISCELLANDOUS F:� S �ry Z f `S i1/ APN# V 1p is ' / ZOO/8•�' ��Q ` PHOTDSfp EMAIL STREET ADDRESS I U Z Z(p CITY,STAT$23P C 2r+-+;16 G�SQ 1 f FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX 19 OWNER ❑ owrme-mmimR ❑owNERAmNT ❑cmrmcrm ❑mmxACmRAGENT ❑ ARCHITEcr ❑ENC um ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME l QSS I�\aur " &MAII. FAX STREET ADDRESS l V� iJ�j �� CITS.sr �� a 13 a � PHONE ARCH[TECT/FNG]NEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME EMAIL FAX STREET ADDRESS CrrY.STATE.ZIP PHONE USE OF ISSFDOrDUPLEX ❑ NMI-1-FAMILY PROJBCTIN WUJN-4ND ❑YES PROJECT IN ❑YES IS 111E BDG AN ❑YES BUDIANCK ❑COMMEMAL URBAN RIrERFACEAREA ❑ No FLOODZONE ❑No EICHLERHOME4 ❑No DESCRIYIIONOF WORK of TOTAL VALUATION: I 'J 0 O ,U BECEIVED$Y: By my signature below,I certify to each c f e followbW I on the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 1 have p ovided is comocL I have rad the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ding I r R esentatives of Cupertino to enter the abo2ve identified pyoperty for inspection purposes- Signature ofApplicant/Agent Date: "PLEMENTAL INFORMATION REQUIRED OMCevSE ONLY 0 OVER-TM-00VMZat 0`1 EXPRESS 0 STANDARD GD JAARGK a Q, MAJOR A",W eApp 201Ldocrevised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10226 vista dr DATE: 03/10/2015 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$1,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: PRWHEAT A WORKremove and replace 40 al water heater in same loc SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $29 TOTALS: $29.00 ,lle(A Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check ilech. Permit Fee Plumb.Permit Fee: IPPERMIT Glec. Permit 1,1�e Other-1lec*. /nsp. Other Plumb Insp. 0.0 hrs $48.00 thker,Elec. Insh�, El--L- 114ech, Irish. Tee: Phintb. hasp. Tee: Elee.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prellmina information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS(Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: S'1,1pp1. .P(::'P,ee PME Plan Check: $0.00 Permit Tee: suppl. Insp Pee PME Unit Fee: $29.00 PME Permit Fee: $48.00 Construction Tax.- Administrative ax:Administrative Fee: 1ADMIN $45.00 Work Without Permit? ®Yes (E) No $0.00 A(.1vaneed Planning Fees: Travel Documentation Fee: ITR,4VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission.Fee: 1BCBSC $1.00 $171.50 $0.00 � TO' $171.50 , Revised: 02/14/2015