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14090207 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10159 S BLANEY AVE CONTRACTO r / PERMIT NO: 14090207 OWNER'S NAME: LAKE BILTMORE APARTMENTS DATE ISSUED:09/30/2014 OWNER'S PHONE: 4082558787 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL �0 REPLACE(E) 100 GAL WATER HEATER& CONNECTIONS License�Class Lic'# & .�„�� ``-- .- VENT Contractor),t�k Date 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$6000 'Vhave and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:36903008.10159 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 WITIIIN 180 DAYS OF P]+ SUANCE 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 18 INSPECTION. indemnify and keep harmless the ity of Cu ertino against liabilities,judgments, costs,and expenses which ma crue a st said City in consequence of the Date: d granting of this permit. Ad ' Wally, ap licant understands and will comply y' with all non-point source r ulatio er a Cupertino Municip Code,Section 9 18. RE-ROOFS: Signature i' Date 3 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 1,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 under penalty of perjury one of the following three maintain compliance with the Cupertino Municip de,Chap r 9.12 and the declarations: Health&Safety Code,Section 25532(a)should it e or ha hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipmen o device ich emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area ' Quali anagement District I performance of the work for which this permit is issued. will maintain compliance with the Cuperti unic' Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 , 553 , 255 . 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 C INSTRU ON 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 "('M E P GENf= L PcMIT APPLICATION ION (� k COI✓MUNITY DEVELOPMENT DEPAR I MEN T•BUILDING DIVISION � V 10300 T ORRE AVENUE• CUPERTINO, CA 95014-3255 , 7-3228•FP.X x!03 7777-3333-buildinal-cuD=tno.Dra PLL7�3NG ❑h Crz�iC. ❑ti,7 1 CaT ❑iascmI.A1\-OUS MoMaADD?.ESSuw Fy0?y 9-7 I =1✓4i 1o CONTACT Itis i,r W` •��'� ( P~04-�/ I =l✓_e T -A-- STP-=l ADDP 5 I CTY,STS 1'n, ZIP OC,� ❑ OV,* -BL?_JER ❑ 0 I .4C�"I ❑ Cam c OR ❑COI, SCTOP.AChT ❑ 4�C aCI ❑iTiC� ❑ D1 P? ❑ -? LST cm,-1-k=0-k- G?,-1 hCiOR?41✓� �.�,L LiC=1 5's?TJI✓3- I LIC�'�S=TY?= j B, LICr Rt e CO1.�R1,Ylhs1./= �yV 1 avwry i2.� i�.L,-4—ie�: 60--7 N 9 l f Z1 ,Z- Y E DD?a5 Q f J� A 1 Q I CITY,STAT"-,Z PS `Vul VJ1 1 J�F ONES fi�CIv1ECi(n'�GII=EP hAIJ�= LiCENSF Null3ER. I BUS.LIC r CONPAh'Ylwhm I B-IVLA_T, FAX S sit=;.-I ADr)?MS I CITY,STA717,ZIF F iOI USB ar ❑_SD or DUPT-ZX ❑ MJLTI-rAt SII Y I PRoj-E L*Iw]LDLQ,'D ❑ YES I PRO=nCT IIA ❑Y'S I IS Tr BLDG AST ❑1:S BUILD—NG ❑colzamcaL LRB ND,1=RiAC=AP.A ❑ NO FLOOD?.OIS ❑No i=CP.=.-ta02l'? ❑ ?"O DBSCP.IPTIOhT Or'RORK eva MMM�dm TOTFT VAL-JATION: s r fir= By my sis a ire belo",I certify to each of the follo I u-n the?- pe e. or zutho-iz d z_ent to act ,ner's bel applic€tion and the info,lnation I have provided is met I have--ad` s .ption of Work and ver-; it is aec�-at I a_ee t y vrith all applicable loca ordina Ices and _tela;,+s rel.ins to buildine c ;u n _o;' p- entaaves of Cupe tino to eater he above id�r fP�*roDt7ty for oses. S I�at'+Se OI ApphCant+'.•`�.Pent: _ e: MAY IRS: _ ' REIMER GE - hd EP1✓tsclpp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10159 S BLANEY AVE DATE: 09/30/2014 REVIEWED BY: MELISSA APN: 369 03 008 1 BP#: *VALUATION: 1$6,000 YPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARYBuilding is PENTAMATION PRWHEATR USE: Multi-Family Dwelling >3 Stories 0 Yes No PERMIT TYPE: i WORK REPLACE E 100 GAL WATER HEATER & CONNECTIONS &VENT SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1 PRWHEATR 1 # $29 TOTALS: $29.00 y ' ' ` ,�....:.. . Plumb.Plan Check 0.0 hrsJE / Prt-Cha_car ('erruit Fee: Plumb.Permit Fee:0" /rer°ihvh, 7Yfsr,- Other Plumb Insp. 00 hrsiber'1.4:(_h-sf, NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc . These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef 711113) FEE QTY/FEE MISC ITEMS P( PME Plan Check: $0.00 PME Unit Fee: $29.00 /PME Permit Fee: $48.00 7'1tvI L Administrative Fee: ]ADMIN $45.00 Work Without Permit? ® Yes (E) No $0.00 40ib't7f}C'e'.I,/ Travel Documentation Fee: ITRA VDOC $48.00 i Strong Motion Fee: ]BSEISMICR $0.78 Select an Administrative Item Bldg Stds Commission Fee: ]BCBSC $1.00 $171.78 $0.00 TOTAL FEE: $171.78 Revised: 08/20/2014