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15070026 � CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 951 MILLER AVE CONTRACTOR:GIANT PLUMBING,INC PERMIT NO: 15070026 OWNER'S NAME: KOJNOK ALENA A TRUSTEE 21 I I DRY CREEK RD DATE ISSUED:07/06/2015 O��'NER'5 PHONE: 4087821732 SAN JOSE,CA 95124 PHONE NO:(408)445-8507 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL � COMhtERC1AL � � REPIPE DUPLEX(949& 951 MILLER AVE)AND INSTALL 2 License Class � �� Lic.# ��J`� � I -40 GALLON WATER HEATERS C�G � Contractor �I/}-IJ'� �(�(� � �� Date � � — ��J' I hereby aftirm that 1 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 hvo declarations: I have and will maintain a certificate of consent[o self-insure for Workers 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:$4500 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 permit is issued. APN Number:36919050.00 Occupancy Type: 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.1 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 au[horize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 S FROM LAST CALLED INSPECTI N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, �y costs,and expenses which may accrue against said City in consequence of the �j�_�(��C' �� ''�`- � ��1,� granting of this permit. Additionally, e applicant understands and will comply Issued by: Date: / with all non-point source regulations the Cupertino Municipal Code,Sec[ion 9.I 8. RE-ROOFS: Signature � ate �� ' � All roofs shall be inspected prior to any rooting material being installed. If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ O��'NER-BI�ILDER DECLARATION Signature of Applicant Date: I hereby affirm that 1 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 owncr 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) l,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS M11ATERIALS DISCLOSI�RE constn�ct 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. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Nlunicipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous 1 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 A1anagement 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,Sec ' +�s 25505,25533,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: l 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 LEND AGENCY become subject to the Worker's Compensation provisions of the Labor Code,1 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 APPI.ICANT CERTTFICATION Lender's Address 1 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 relatin� to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 applican[understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date � GENERAL PER�I�fIT APPLICATlON ��0� . .. COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION � � 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333 � buildina(a�cupertino.orq � �UPERTtNO PLUMBING ❑MECHAMCAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECTADDRESS �/J f 3 ��/ l �!� „`p .e.PN± �� r`�� ' � l r�� OVTt�'ERNAME , D n!I � � V � FFi"('�•^ 1 �� {�� E-Ni,4IL -L �,� .� STREET.4DDRESS CITY, ST.ATE,Z1P FAX COI�'TACT N.SIvIE ��C�n PHONE y�l�.._�ZC,_ ��C �'�Z4IL 2 � �� 7 srxEsr aoDxEss /1 111 �f C�-�e k � �� crn,STATE, z��^ �b�� l�I Fax d � OR'?�'ER ❑ OV�'1��ER-BUII.DEFt ❑ OW?�rERAGE!�T � COA'TR.ACTOR ❑CO?�"IRACTORAGENT ❑ ARCHITECT ❑ EtvGL'."EER ❑ DEVELOPER ❑ TE?�A.�'T COI�'TRACTOR TAh� , ��u rn r U LIC�ENSE:vUr4BER��/'�� LICEI�SE TYPE �� BLS.LIC= J COMP.<.I�'Y 1�AME/ ��Nm� 11 �� E MAIL� I um b�!� l� � FAX l�J�A►J'C t Q4v �,- STREETADDRESS ^, ` I � � ` lC• /� CITY,STATE,ZIP�^ .�� t�� PHOI�E bS-.-J '\ O� J � O�"'�� aLCJ ARCHITECT/ENGII�`EER NAT4E LICEIvSE I�'UMBER BUS.LIC R COMPANY NAME E-MAIL FAX STR.EET ADDRESS CITY,STATE,ZIP PHO;�'E USE OF ❑SFD or DUPLEX ❑ MliLTI-FA1�III.Y PROTECT IN WII.DLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES BUII..DL�G: �COMMFRCLAL URBP.N A'TERFACE AREA � NO FLOOD ZO?�B ❑ TO EICHLER HOME? ❑ NO DESCRIPTION OF WORK � �U � � S � � � � � � � _ � � TOTAL VALUATION: �� RECEIVED Bl � j„( 5� �.:��.,� �� , By my sio-nature below,I rtify to each of tt�e foilo�i�in�: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and t}�e inforu�ation I h ve provided is correct. I have read the Description of Work and verify it is accurate. I a�ree to comply�i ith all applicable local ordinances and state]aws relatin� uildins construction I a thorize representatives of Cupertino to enter tl�e abov -identified property fo inspection pur�>oses. Si�nature of ApplicandA�ent: Date:�_�.'___(� _ SUPPLEMENTAL II�'FO ATION REQUIRED � �� orricr i;sr oni,i� - �O�EF SI3E'_(OC,\"IfR -___ - J E\PF.E�S — u sr_��il->>.n � � = �I.:�tiC�'_ � .. � � ?� �sn�ox �� A7EPA1iscApp_2011.doc rei�ised 06/21/11 CITY OF CUPERTINO 1✓D�C��:�� FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 951 MILLER AVE DATE: 07/06/2015 REVIEWED BY: PAUL � - APN: 369 19 050 BP#: �VALUATION: $4,500 `PERJIIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPR� WORK Re i e Du lex 949 & 951 Miller Ave and Install 2 - 40 Gallon Water Heaters SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $14 Water Heater 1 PRWHEATR 2 # $58 TOTALS: $72.00 Plumb. Plan Check 0.0 hrs $0.00 Plumb. Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $48.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,Schoo! District,etc. . These ees are based on the relimina in ormation available and are on! an estimate. Contact the De t or urldn'1 in o. FEE ITEMS �r�� Resoh�r�on 1�-os3 r� %%�1%�13) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 0 ,. PME Unit Fee: $72.00 PME Permit Fee: $48.00 Administrative Fee: �.��t�tlN $45.00 Work Without Permit? � Yes � No $0.00 Travel Documentation Fee: �T�v�oC $48.00 � Strong Motion Fee: �BSE�SM�CR $0.59 Select an Administrative Item Bldg Stds Comn�i�sion Frc: IBCBSC $1.00 SUBTOTALS: $214.59 $0.00 TOTAL FEE: $214.59 Revised: 07/02/2015