15120068P4
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10535 METEOR PL
CONTRACTOR: AAA FURNACE & AIR PERMIT NO: 15120068
CONDITIONING
OWNER'S NAME:
SAN JOSE, CA 95125 PHONE NO: (408)293-4717
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
pp 2� �% Q�J
ab
6�U l
REPLACE (E) WATER HEATER, SAME LOCATION
License Class4 � Lic. �` (
Contractoro�
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) 6f 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
Sq. Ft Floor Area:
Valuation: $1155
performance of the work for which this permit is issued.
ve and will maintain Worker's Compensation Insurance, as provided for by
W�1
Se tion 3700 of the Labor Code, for the performance of the work for which this
APN Number: 32644009.00
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 IT 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 D ROT "T 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
Date:
granting of this permit. Additionally, the applicant understands and will comply
-
J
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
d" ��
RE -ROOFS:
Signatur 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 stricture 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 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,
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
CITY OF CUPERTINO
FFF F4TTMATOR — RTTTLDTNG DIVISION
10535 METEOR PL
FEE ID
FDATE: 12/08/2015
REVIEWED BY: MELISSA
liaADDRESS:
APN: 326 44 009
BP#:
'EVALUATION: $1,155
*PERMIT TYPE: Plumbing Permit
I PRWHEATR
PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Du lex
p
#
PENTAMATION' PRWHEATR
USE:
....
I ei grit 1"eL':
PERMIT TYPE:
WORK
REPLACE E WATER HEATER
SAME LOCATION
$171.501
$0.00
Plumb. Permit Fee:
SCOPE
PME Permit Fee:
ft i'. 1'er'ttrip J'Y(r'
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Ad1'LiT1G`e4-1 Plannii?g .I"e£'s
Water Heater
I PRWHEATR
Plan Check
1
#
$29
$0.50
TOTALS:
$29.00
TOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, Lire, January 3ewervislrlc6, Jcnool
District, etc.). These_fees are based on the preliminary information available and are only an estimate. Contact the Dept for aaan't info.
FEE ITEMS (Fee Resohition 11-053 E . 7/1/13)
FEE
QTY/FEE
MISC ITEMS
phin ("hech.I � e
;'!ct ("heckPlumb.
Ad1'LiT1G`e4-1 Plannii?g .I"e£'s
A.SfuppL
Plan Check
0.0
hrs
$0.00
$0.50
....
I ei grit 1"eL':
Bldg Stds Commission Fee: 1BCBSC
$1.00
e
$171.501
$0.00
Plumb. Permit Fee:
1PPERMITl
PME Permit Fee:
ft i'. 1'er'ttrip J'Y(r'
r:>i ,
;f:>t h...,,;•o,.
Other Plumb Insp.
Fo.0
hrs
$48.00
t)rltz3 1:i«. =.°I>.
1P.Sf). 1'r'r.':
1'3/!!t'7't1f'.:�il,i{!. 1 :'8:
, ,.
�.1t'C:. It'?.S)J. '2�'.-- - -- -
TOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, Lire, January 3ewervislrlc6, Jcnool
District, etc.). These_fees are based on the preliminary information available and are only an estimate. Contact the Dept for aaan't info.
FEE ITEMS (Fee Resohition 11-053 E . 7/1/13)
FEE
QTY/FEE
MISC ITEMS
phin ("hech.I � e
Ad1'LiT1G`e4-1 Plannii?g .I"e£'s
A.SfuppL
Travel Documentation Fee: ITRA VDOC
$48.00
PME Plan Check:
$0.00
$0.50
....
I ei grit 1"eL':
Bldg Stds Commission Fee: 1BCBSC
$1.00
., SUBTOTALS:.'
$171.501
$0.00
PME Unit Fee:
$29.00
PME Permit Fee:
$48.00
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes : No
$0.00
Ad1'LiT1G`e4-1 Plannii?g .I"e£'s
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$0.50
Bldg Stds Commission Fee: 1BCBSC
$1.00
., SUBTOTALS:.'
$171.501
$0.00
Select an Administrative Item
TOTAL FEE.$171.50
Revised: 10/01/201