13090186CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10191 YOSHINO PL
CONTRACTOR: CALIFORNIA DELTA
PERMIT NO: 13090186
MECHANICAL INC
OWNER'S NAME: JOHNNY FU
6056 E BASELINE RD STE 155
DATE ISSUED: 09/24/2013
OWNER'S PHONE: 4082032949
MESA, AZ 85206
PHONE NO: (866) 692-5273
LICENSED CONTRACTOR'S DECLAAR�ATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL EI
License Class—� Li,. #1 7
REPLACE (E) WATER HEATER WITH (N) WATER
J ,7� ��,�
�l�rc� /i�D ^2y�
HEATER,
Contractor/��'.r+ifT -
SAME LOCATION
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
Sq. Ft Floor Area:
Valuation: $994
onuance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 37503014.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work for which this
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 F 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
__- : i Date: Z ��
granting of this permit. Additionally, the applicant understands and will
ss
with all non -point source regulations per the Cupertino Municipal ion
ROOFS:
9.18.
/
Signature Date /
All roofs shall be inspected prior to y roofing material being installed. if a roof is
any r
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)
1, 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 Muni 'pal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25 , and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized age 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
9.18.
Signature Date—
OW,
CUPCIRTINO
�)'
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building ancupertino.org
PLUMBING ❑ MECHANICAL ❑ ELECTRICAI
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❑ MISCELLANEOUS
MISC
PROJECT ADDRESS V U -7N'
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OWNER NAME / �v
PHONE ' p
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E-MAIL
STREET ADDRESSDTE,
ZIP
FAX
CONTACT NAME/� a
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CITY, STATE, ZIP
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FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
kr CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRA OR NAME
C
LIC E
LICENSE TYPE
BUS. LIC #
COMPANY AME � r
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E-MAIL
FAX
ST ET ADDRESS
a L. n i/ze
CITY, STATE, ZIP
e
BSZo
PHONE
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC if
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN =DLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK L C
P M�Ire—
TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the properly owner or authorized agent t act on the owner's alf. I hav ead this
application and the information I have provided is eo have read the Description of Work and verify it is accurate. I agree to c ply w' applicable local
ordinances and state laws relating to buildin I authorize representatives of Cupertino to enter the above -identified prco�j orri/inspection purposes.
Signature of Applicant/Agent: Date:
TAL INFORMATION REQUIRED
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n
x»ca�zER W
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MEPMiscApp_2011.doc revised 06/21/11
NONE
OF CUPERTINO
I ONE FF.F. FCTIMATOR — RITILDING DIVISION
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $28
TOTALS: $28.00 imam
We Plan CyieckPlumb. Plan Check 0.0 hrs $0.00 Elec. Plan t.;heck
iLlech. Permit Fee: Plumb. Permit Fee: 1PPERMIT F.lec. Permit Fee:
Other• :19ech. Insp. I I I I Other Plumb Insp. 10.0 I hrs I $47-001 Uther Elec. Insp.
.Aaec•h. Insp. Fee: I Plumb. hrsp. Fee: I Elec. Insp. Fee.
NOTE: This estimate doesnot include fees due to other Departments (Le. Planning, ruattc wortrs, rtre, aantrary,3ewer tnsrrict, acnoor
r47s.ds ,..,. err.,...Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/113)
ADDRESS: 10191 YOSHINO PL
DATE: 09124/2013
REVIEWED BY: MELISSA
Plan Cheek Fee:
APN: 375 03 014
BP#:
`'VALUATION:
$994
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Du lex
p
$0.00
PENTAMATION PRWHEATR
USE:
PERMIT TYPE:
WORK
REPLACE E WATER HEATER WITH N WATER HEATER SAME LOCATION
SCOPE
$28.00
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $28
TOTALS: $28.00 imam
We Plan CyieckPlumb. Plan Check 0.0 hrs $0.00 Elec. Plan t.;heck
iLlech. Permit Fee: Plumb. Permit Fee: 1PPERMIT F.lec. Permit Fee:
Other• :19ech. Insp. I I I I Other Plumb Insp. 10.0 I hrs I $47-001 Uther Elec. Insp.
.Aaec•h. Insp. Fee: I Plumb. hrsp. Fee: I Elec. Insp. Fee.
NOTE: This estimate doesnot include fees due to other Departments (Le. Planning, ruattc wortrs, rtre, aantrary,3ewer tnsrrict, acnoor
r47s.ds ,..,. err.,...Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/113)
FEE
QTY/FEE
MISC ITEMS
Plan Cheek Fee:
Syppl..P(l Fee
PME Plan Check:
$0.00
Pennit Fee:
Suppl. Insp Fee
PME Unit Fee:
$28.00
PME Permit Fee:
$47.00
Construction .Tax:
Administrative Fee: 1ADMIN
$44.00
Work Without Permit? 0 Yes (j) No
$0.00
,Jeivonced Planning Fees:
Travel Documentation Fee: ITRAVDOC
$47.00
Strong: Motion Fee: IBSEISh1ICR
$0.50
Select an Administrative Item
Blda Stds Commission Fee: IBCBSC
$1.00
a
$167.501
$0.00.°�1
$167.50
Revised: 08/01/2013