No preview available
15060108 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10171 LOCKWOOD DR CONTRACTOR:SBL ENTERPRISES,INC. PERMIT NO: 15060108 OWNER'S NAME: O'MEARA MICHAEL G PO BOX 362 DATE ISSUED:06/16/2015 OWNER'S PHONE: 4082555845 SARATOGA,CA 95071 PHONE NO:(408)973-9101 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ REPLACE(E)40 GAL WATER HEATER,SAME LOCATION License Class C : _ Lie.# � ��� Contractor SA4 F.��Date � �6/ 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:$1200 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 APN Number:34214032.00 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 1 ERMIT 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 AY ALLED INSPECT ON. indemnify and keep harmless the City of Cupertino against liabilities,jud costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. RE-ROOFS: Signature ,"� 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. ElOWNER-BUILDERDECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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. 1 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,Section 505,25533,anp 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: /f 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 ............. GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE®CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333 -building(c cupertino.org CuPERTINQ PLUMBING MECHANICAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS / / © DO� At, APN n OWNER NAME / l i PH01� E-MAIL f t(-Age1 'y1% 4' em b �� ��2��"l STREET ADDRESSo 17 ®G`c G� �� A CE TATE,ZIP I FAX olr l_ CONTACT NAME PHOT D �f�. E-MAIL F67-66) D i n C ` v U STREETADDRESS CITY,STATE, ZIP FAX C� ❑ OW ER ❑ 01AINER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑COATRACTORAGENT ❑.ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENA-Mr CONTRACTOR NA1 �7 wM&ER / D LICENSE TYPE BUS.LIC' � -/ COMPANYNAME,T {� / /// E-MAIL FAX 0 NNl r/ /L1 //J/!1 STREET ADDRESS C�r CITLED Y,STATE, P ' 7 ARCHITECTIENGINED-RNAME LICENSE NUMBER BUS.LIC COMPANY NAME E-MAIL FAX STREETADDRESS CITY,STATE,ZIP PHONTE USE OF ❑SFD or DUPLEX ❑ MULTI-FAnffi.Y PROJECT IN WILDLAND ❑ YES PROJECT IN ❑ ITS IS THE BLDG AN ❑YES BT=ING: ❑COMNID2CLAL URBAN INTERFACE AREA El NO FLOOD ZONE ElNO EICHLERHOME? E3 No DESCRIPTION OF WORK17 a e TOTAL VALUATION: /)©! '#tECEI. BY By my signature below,I ertify to each of the following: I am the property owner or authorized age act on ner S e al, ave �.ad this ry application and the information I have provided is correct. I have read the Description of Work I p y with all applicable ocah� ordinances and state laws relating to uildmg constructs n. I authorize representatives of Cup I mo to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: �1/-t°iYl� Date: SUPPLEMENTAL INFORMATION REQUIREDarLN A1EPA1iscApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10171 LOCKWOOD DR DATE: 06/16/2015 REVIEWED BY: MELISSA APN: 342 14 032 BP#: *VALUATION: 1$1,200 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: PRWHEATR WORK REPLACE E 40 GAL WATER HEATER SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1 PRWHEATR 1 # $29 TOTALS: $29.00 K k ;Yeah. Nart Check Plumb.Plan Check 0.0 hrs $0.00 F,lec.Plan Check ibleclr. 11errrai1 Fele Plumb.Permit Fee: IPPERMIT Ilea Permit Fee: Other Alech.Insp. Other Plumb Insp. 0.0 hrs $48.00 Oilier Elec.Imp. Li A1ech. hup.Fee: Phirnb, hasp. Tec:: Flee.Imp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These -f -fees are based on the relimina information available and are onlyan estimate. Contact the Detor addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff.' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp/,X, Fee PME Plan Check: $0.00 Permit Fee: Suppl, I.rtsr)Fee PME Unit Fee: $29.00 PME Permit Fee: 7-1 $48.00 Construction Tax: Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Nees: Travel Documentation Fee: ITR,4VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 w . =`SUBTOTALS'1$ 171.50 $0.00 TOTAL°FEE: $171.50 Revised: 05/07/2015