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14120020 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10134 RANDY LN CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 14120020 CONDITIONING OWNER'S NAME: LESAICHERRE PIERRE-YVES AND MIDORI 1712 STONE AVE DATE ISSUED: 12/03/2014 OWNER'S PHONE: 4082098447 SAN JOSE,CA 95125 PHONE NO:(408)293-4717 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL nn�� r (Ce � REMOVE AND REPLACE WATER HEATER License Class(a w Lie.# D'� Contractor r 11A1�'C C—Date I hereby affirm that I am licensed under the provisions o 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:$1891 1 have 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:31623071 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 DAY M 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 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: wit �tsouce r g lahons per the Cupertino Municipal Code,Section 18. 7 /� RE-ROOFS: Signature Date < <i 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 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 compl' �e Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health& ty Code,Sectio_ 255 533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this f Owner o authorized agent: Date:l 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 SENSRAL PERMIT APPLICATION ATO is .. COMMUNITY DEVELOPMENT OEPARTMENT'�>J ,IIDING DIVISION (c i• 10300 TORRE AVENUE , CUPERTINO; CA 950143255 r1�3 FAX 408 777.3333 buildingCa�cuoertino.org [/ CURE TI'N4 (408)777-3228 F ( ) \LA r . '� .......... PLUNONG lyMCHAMCAL ELECTRICAL OUS 1v[ISCEi i AN$ APN# f LD 2-3 b-1 . OWKEY,'NAME V 1�t PH (! aII S,r, .FAX 9I RJLfTADOPc gIv \n ILCalV1fJ ^V ,�/I f �C/ COIYTAC l NAME PHONE E-M'S' 9TREb"i ADDR?SS CFCY,STATE; ZIP PAX -. I] t)EVgIOPER ❑TENANT ❑ awxsn ' � owN$tt•BtnLtiER ❑ owNBR AMT _ otrrnncroR C1coNTRAcroR�oerrr ❑ nRCHnzCr ❑eNocN�tt. LICENSE NMUMN09 ( ucEN9E Iyn(4bk Bus,uc 1 63 ;to TIM 1 to COWANY NAME A �-LCU1 -W34.W34 STREET ADDRESS nrz�ftrto Av - �M .�. -2U5- 4- y ..'g?RNAAQ1 Ll I NUMBER 819.UC �. .. E-MAIL EAX CM,STATE,ZIP PHONE USE oPFD or Duplex ❑ Multi-Family PROJECT W WII 04AND PROJECT IN F-_U F: O Commercial tM URBAN ERPACE AREA C3 �A- FLOOD zONE O Ye�6 o DF-... :;:- � ,.•�� lac�P `�isti�a ;�0 C��II�Iny��;�ear Y10.�,t�fiY TQ-rkL VALUATION: bw,1 certify to h of the following: lam the propeTty owner or authorized agent to act on Uie pcopeYty owner bekej° I this eaclaPi on ar:..: ::.:infurmad I have ed is correct. •I hav ead the Dweripdon of Work and vcrify t is accvrvc. I agrcc to cc r c r.d c:c Iawa relating t0 Ilding CO tru n, u rize entatives of Cupertino t:'^'er ohe atiovP-identif ed prop v 'rrlicanVAgcnt; Date: - :... SUPPLE NTAL WFORMATION UQVIUD � {- CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10134 randy In DATE: 12/03/2014 REVIEWED BY: Mendez APN: BP#: EVALUATION: $1,891 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY PENTAMATION PRWHEATR USE: SFD or Duplex PERMIT TYPE: WORK remove and replace 50 gallon water heater SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1 PRWHEATR 1 # $29 TOTALS: $29.00 511 Plumb.Plan Check 0.0 hrs $0.00 Alec- P/vCilwor _L 11-11*_ 1'e-ilt t Fee Plumb.Permit Fee: IPPERMIT fnV', Other Plumb Insp. 0.0 hrs $48.00 F 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'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS Plan Check 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 (F) No $0.00 :1t "v€�ttt'<.'�l1 ,ctYt1P7€ig Travel Documentation Fee: ITRAVDOC $48.00 A Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg,Stds Commission.Fee: IBCBSC $1.00 $171.50 $0.00 - TOAL FEE: $171.50 E r h Revised: 10/01/2014