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15120190 CITY OF CUPERTINO BUILDING PERMIT . BUILDING ADDRESS: 10701 BAXTER AVE CONTRACTOR:PAYLESS WATER PERMIT NO: 15120190 HEATERS OWNER'S NAME: LYNN TANG&KAINING WANG 27919 SMYTH DR DATE ISSUED: 12/22/2015 OWNER'S PHONE: VALENCIA,CA 91355 PHONE NO:(661)775-2944 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL 50 GAL WATER HEATER REPLACEMENT AT SAME License Cla'""ss �� o Lic.# .7i �O LOCATION Contractor Date I hereby affirm that I am licensed under the provisions f 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 formance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1847 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor_Code,for the perform�ruce of the work for which this APN Number:32611092.00 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 LAST 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 Y W`o� Date: granting of this permit. Additionally,the applicant understands and will comply Issued by: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 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 tinder 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 hisurance,as provided for by the Health&Safety Code,Sections 2,,5505,2 a 5534. 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 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 f CONSTRUCTION PERMIT APPLICATION = COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CURERTi 1dC3 (408)777-3228•FAX(408)777-3333•buildinga-cupertino.org [:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION l TI ❑ REVISION/DEFERRED ORIGINAL PERM IT# PROJECT ADDRESSAPN# to 1 A9_10 OWNER NAME z n T" PHONE,JD�^ ,`I 2 E-MAIL STREET ADDRESSl 0 /70( �4.21jG"C gr' 14./,2CITY, STATE 7JC � 1d 9 J FAY V (` .' CONTACT NAME _ PHONE 971-3P � E-MAIL`- T :c+ �,/tS 16 9 d7� �J..r�t�:i� : t'1sw�Ps�( S��[►,,L S•I'RL•'L"I'ADURL•SS � �f ,d S� � C]'I'Y,S•CATE, 'LIP � ��• �•� �u(� FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 10 CONTRACTOR AGENT ❑ ARCHITECT ❑( ENGINEER ❑ DEVELOPER• ❑TENANT CONTRACTOR NAVtE�j�t /e C 5 ` �_;^� j!�` LICENSE NUMBER&2a6�i LICENSE TYPE/, �� BUS.LIC#? COMPANY NAME // ( (^f' l'(Q f E-MAIL _`- ( C'X CC-1 FAX 5"rRf?EC ADDRESS >M , j CITY.STATE,7..IP �� nCr�1 PHONE ARCHCCECTIENGINEL'•'R NAME GI LICENSE NUMBER BUS.LIC# I COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE.ZIP PHONE DESCRIPTION OF WORK � � ` )� � �' � �„•_ I i� {�e � _ 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 REMODELAREA REvMODELAREA REMODEL AREA PORCHAREA DECK AREA TOTALDECKPORCHAREA GARAGEARFA: DETACH ❑ATTACI-1 #DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY OYES BEING ADDED? []NO ADDITION? []NO PRE•APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO / () By my signature below,I certify to each of the following: I am the property owner or authorized agent to act ortthJ property owner's behalf. I have read this application and the information I have provided is correct. I h ead the escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b Iii �1/ti Jtho'. n resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicandAgent: Date: SUPP.LEMEN FORMATION REQUIRED PLANCIIECItTYPE [tooTltYc'sLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ roti�R=rF1> cotilv7TR ❑ BUILDING PLAN REVIEW: existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑;rLANlvtivc PLAN REVIEW' _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ iATANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. `EiREnErr _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ mAroR' ❑ sANtTARYSEWERDtsTI2I4T submittal of Building Permit application. ENVIRONNIENTAL HEALTH BldgApp_201 1.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10701 Baxter Ave DATE: 12/22/2015 REVIEWED BY: Phuong APN: 32611 092 BP#: '"VALUATION: 1$1,847 Y,-PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair. PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: PRWHEAT R WORK 50 al water heater replacement at same location SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1 PRWHEATR 1 # $29 1J TOTALS: $29.00 ,feeh. i R.. '.Chec' Plumb.Plan Check 0.0 hrs $0.00 -:ie,..,'i:,r {:'_'%,.,•.. bd,> ' r,.,~ F Plumb.Permit Fee: IPPERAIIIT � ru<.: . c,srzt„ �..•. ?r s,=j. Ll -L- Other Plumb Insp. 0.0 hrs NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sever District,School District,etc. . These fees are based on the preffinina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (ITee IZesolutinrr.1.1-053.fi'ft: 7,-7/.13) FEE QTY/FEE7 MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $29.00 PME Permit Fee: $48.00 Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 1 A.11 Travel Documentation Fee: ITRA VD0C $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldga Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $171.50 $0.00 TOTAL FEE: $171.50 Revised: 10/01/2015