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15040011 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10265 BRET AVE CONTRACTOR:AAA FURNACE&AIR PERMIT NO:15040011 CONDITIONING OWNER'S NAME: KUMNOONSATE SOONTHORN AND DARUWUN 1712 STONE AVE DATE ISSUED:04/02/2015 OWNER'S PHONE: 4087189195 SAN JOSE,CA 95125 PHONE NO:(408)2934717 L LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] °7 (� 614( REMOVE AND REPLACE WATER HEATER License Class/� �Cl Lic.# Contractor A 4A ONA"C e 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1887 have and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:37510016.00 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 AF 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 FRO T CALLED INSPE TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the S� granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all t source re ulati ns per the Cupertino Municipal de,Section 91 . RE-ROOFS: ignature 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 Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain colance with the upertino mcipal Code,Chapter 9.12 and ,pigI have and will maintain Worker's Compensation Insurance,as provided for by the Health& afety Code,Sections505 3,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: Z 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 918. Signature Date 4eN:E-RAL PERMIT APPLICATIONME (� . , COMMUNITY DEVEI.OPMENT DEPARTMENT"IIUILDING DIVISION IXI 103100 TORRE AVENUE - CUPERTINO; CA 95014-3255 ' (408) 777-3228 , FAX(408)777.3333 buildinq(5.cuoer6o oro CU�E'Tl�y`4 ' PLUTvMTNG �7 El MECHANICAL' ELECTRICAL N1I5t+EL1 A. OUS PROJECT ADDRESS {' '()✓ ►/�� f l°1'l U`� APN M 377G710 0IV,0 OWNER'NAME': oft✓1 ' PHONE STREET ADOPS3 v 1 � ` /. ' 1� �,1 1 . ATE, �.'u r,� ' �/I -✓O I I� .PAX COl'61'ACT NAA v v PHONE V " 1 VB•tKAIL Trklt 'ADDR PSS CITY,STATE, ZIP PAX c. Cl OWNER 0 OWNIIR•BVIL09R ❑ OWNER AGENT CONTRACTOR ❑CONTRACTORVAOENr ❑ ARCHITECT Cl INOt m, 06YELOPER Cl Tw7 CONTIL,\CTC".„•_�^Ey� LICENSEN`"ER" I„ LI C'a BUS.Uc I � 11 COMPANY NAME IB•nlAa 1( FAX A �VyC mzT 0'DRS9 C , Astn/ V G ,yet' 1I1�Q c / C nn/ LICENSE NV?azR BUS.UC I FAX .• CITY,STATE,ZIP PHONE USE of SFD or Duplex O Multi-Family PROJECT W WILDLAND PROJECT tri S?.UC'IJRP.: ❑ COtpIIICTCTaI URBAN MWACE AREA O Yes No PLooD:oNE D Yes u vv/) v �`1 TOTAL VALUATION: P 'ow,i certify to each of the rollowing; i am the property owner or authorized agent to act on the prb'pzYty owner's beha° I* ^Thu . .:euon Bi.:. e.information I have provided iS correct. •1 have read the Description of Work and Yc.^y iagrees to cc-- .,..cz!rid laws relating t buildi rutruction, I authorize repm34ntativea of Cupertino V,cr.icr Lie >_1ovP identifcl pr - UP FLEMENTAl II(FORMA f`tON REQUIRED CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10265 bret ave DATE: 04/01/2015 REVIEWED BY: mendez APN: BP#: VALUATION: 1$1,887 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: p PERMIT TYPE: WORK remove and replace water heater SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1 PRMEATR 1 # $29 TOTALS: $29.00 Tech. Plan Check Plumb.Plan Check 0.0 1 hrs $0.00 F..�lee. 111a,£'heck iL1e1,11. fermi!Eee Plumb.Permit Fee: 1PPERMIT 111c Permit Fee: Other Alech. IrisT- r1her'Plumb Insp. 0.0 hrs $48.00 Other Elegy.Insh. 51eclz. Insp. Fee: Insp. Fee: 0ec.Inch. Pee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). 77tese _f -fees are based on the relimina information available and are only an estimate. Contact the Detor addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check P'eco: .Sr,ppl. PC-'I to PME Plan Check: $0.00 Permit Pee: Sacop/. bisp I ee. PME Unit Fee: $29.00 PME Permit Fee: $48.00 C'onstructl"ren 1 a:r: Administrative Fee: ]ADMIN $45.00 Work Without Permit? ®Yes (E) No $0.00 �4dvaiieed Planning Fees: Travel Documentation Fee: 1TRAVD0C $48.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 J F T $171.50 $0.00 iu mii -� fro{' § L $171.50 K,.,, Revised: 02/14/2015