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B-2016-1213 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1213 22850 STONEBRIDGE ST CUPERTINO,CA 95014-5643(342 13 038) AFFORDABLE WATER HEATERS OWNER'S NAME: MORRONE PETER M AND LINDA M TRUSTEE DATE ISSUED:01/19/2016 OWNER'S PHONE:408-873-1240 PHONE NO:855-345-9087 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# Contractor AFFORDABLE WATER HEATERS Date X BLDG _ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X;RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REPLACE 40 GALLON WATER HEATER SOME LOCATION IN I hereby affirm under penalty of perjury one of the following two declarations: GARAGE 1. 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.. 2. 1 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. Sq.Ft Floor Area: Valuation:$1441.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number Occupancy Type: information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby 342 13 038 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,costs,and PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code,Section 9.18. Issued by:1444 Signature Date Date: OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the. All roofs shall be inspected prior to any roofing material being installed.If a roof is following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1. I,as owner of the property,or my employees with wages as their sole inspection. compensation,will do the work,and the structure is not intended or offered for sale(See.7044,Business&Professions Code) Signature of Applicant: 2. I,as owner of the property,am exclusively contracting with licensed Date: contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations:. ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. 1 will by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the this permit is issued. Health&Safety Code,Section 25532(a)should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued,I material. Additionally,should I use equipment or devices which emit-hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and Worker's Compensation laws of California. If,after making this certificate of the Health&Safety Code,Sections 25505,25533,and 25534. exemption;I become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall ,Owner or authorized agent: be deemed revoked. Date' APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws , of work's for which this permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date U11161ZU16 14:SU (FAX) P.UUZIUUZ GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MIS (408)777-3228•FAX(408)777-3333-buildingcupertino.ora UPERTING building(@-cupertino.org rs/PLUMBING ❑ME HANICA [—]ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS „, APN N OWNERNAME GD PHONE /t'�p) e 1 3 I ZA E-MAIL (� STREET ADDRESS C• CITY,STATE,ZIP C LAe ell n o �.` CR' FAX 2 S0 e Cts Q� `� 501 CONTACT NAME Y 01 PHONE E-MATL STREET ADDRESS - - CITY,-STATE,ZIP _ FAX ❑OWNER ❑ OWNER-BUILDER. ❑ OWNERAGENT ❑ .CONTRACTOR L\LCON7RACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONT CENSE NUMBER LICENSETYPE BUS.LTC 9 RBBf'dble Water Heaters&Plulrl; ,`enc, 7--1 .3u g` C 3 COMPANY NfkL3fJ58-Constellation Road.Ste 698 - E-MAIL - FAX t Le V i ) IS`T— - w Go cc Ss In STREET ADDRESS - CITY,STATE,ZIP PFION Ir J S- 3 A O ARCHiTECTIENGINEER NAME LICENSE NUMBER BUS.LIC#, COMPANYNAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF EXFDOVIDUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES. ISTHEBLDGAN ❑YES. BUILDING: COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑.NO EICHLER HOME? ❑NO DESCRIPTION OF WORK 0 oLt w 0 _2 TOTAL VALUATION: By my signature below,[tertify to each of the following- I am the property owner or authorized agent to act on the property owner's behalf I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. T agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identifil d grope for inspection purposes, Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED r%,. •- ❑ .S`F1lND#liil" t _ 9��rs7tr3E Y 1 1L 1~ MEPMiscApp_2011.doc revised 06121111 PERMIT FEE RECEIPT Case # B-201671213 �uPlaeTlNo Date Printed: 01/19/2016 CITY OF CUPERTINO FEES RECEIPT ry Permit . Case Number:. B-2016-1213 Permit No: Project Valuation: 1441.00 Date Submitted: 01/19/2016 Permit Type: Building Address/APN: 22850 STONEBRIDGE ST CUPERTINO,CA Receipt#: 200778 95014-5643'(342 13 038) Scope of Work: REPLACE 40 GALLON WATER HEATER SOME LOCATION IN GARAGE Contacts • Contact Type: Applicant Company Name: AFFORDABLE WATER HEATERS AND PLUMB Full Name: Address: VALENCIA,CA 81355 Contact Type: Contractor Company Name: AFFORDABLE WATER HEATERS AND PLUMB Full Name: Address: VALENCIA,CA 91355 Contact Type: Property Owner Full Name: MORRONE PETER M AND LINDA M TRUSTEE Address: 22850 STONEBRIDGE ST CUPERTINO CA 950 "e Inrir �� n�� .: � �� ✓� Plumbing Water Heater Fee $29.00 Strong Motion Category 1 $0.50 Travel and DocumentationFee $48.00 PME Permit Fee $48.00 Bldg Stds Commission Fee $1.00 t _ Plumbing Water Heater Fee 01/19/2016 AFFORDABLE WATER HEATERS Credit Card $29.00 Strong Motion Category 1 01/19/2016 AFFORDABLE WATER HEATERS Credit Card $0.50 Bldg Stds Commission Fee 01119/2016 AFFORDABLE WATER HEATERS Credit Card $1.00 Travel and Documentation Fee 01/19/2016 AFFORDABLE WATER HEATERS Credit Card $48.00 PME Permit Fee 01/1,9/2016 AFFORDABLE WATER HEATERS Credit Card $48.00 FEE TOTAL ' IR10. AMOUNT PAID $126.50 BALANCE DUE --� - a , - . o o - t7 vs m .fir w H ��