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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20488 STEVENS CREEK BLVD UNIT 1607
CONTRACTOR: RICHARD R JONSON & PERMIT NO: 15120083
RACHELSANTOS
OWNER'S NAME: RICHARD R JONSON & RACHEL SANTOS
20488 STEVENS CREEK BLVD UNIT 1607 DATE ISSUED: 12/08/2015
OWNER'S PHONE: 6502798549
CUPERTINO, CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E]
REPLACE (E) WATER HEATER, SAME LOCATION
License Class Lic. #
Contractor 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: $3344
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: 36953167.00
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 18 . S -OF -P RMIT 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
18 MD -S-FR - LLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
City in the
costs, and expenses which may accrue against said consequence of
I /� ' Date:
granting of this permit. Additionally, the applicant understands and will comply
Y -/-
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.
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)
„ 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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 25505, 25533, and 25534.
Date oCAJ�iJ� /a
Owner or authorized agent
per. it is issued.
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. �'IVl� l a J
Signatu � 1� �~�
/J
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
APPLIANCE EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater J 1PRWHEATR 1 # $29
TOTALS: $29.00
Ale, h. Ilan Plumb. Plan Check 1 0.0 1 hrs $0.00 Plo,-1 Check
Plumb. Permit Fee: IPPERMIT Te(�.
Other Plumb Insp. 0.0 hrs $48.00 0"'her
AIech, 11 e:
NOTE.- This estimate does not include fees due to other Departments (i.e. Planning, Public worxs, itre,,Yanitarysewer vtsrrict,,Nciiooi
n—'.. i Irl, nc.n inn n h—dnm ilia nralimi""ri) i"fnrmatinn 17vailahloand aro nnhy an ovfimatp- 1-nntart the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
ADDRESS: 20488 STEVENS CREEK #1607
DATE: 12108/2015
REVIEWED BY: MELISSA
Plan Check 1e`ee:
APN: 369 53167
1 BP#:
*VALUATION: 1$3,344
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PME Plan Check:
PENTAMATION PRWHEATR
F -PERMIT TYPE: A
WORK
REPLACE (E) WATER HEATER, SAME LOCATION
SCOPE
L --
SUPPI,
APPLIANCE EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater J 1PRWHEATR 1 # $29
TOTALS: $29.00
Ale, h. Ilan Plumb. Plan Check 1 0.0 1 hrs $0.00 Plo,-1 Check
Plumb. Permit Fee: IPPERMIT Te(�.
Other Plumb Insp. 0.0 hrs $48.00 0"'her
AIech, 11 e:
NOTE.- This estimate does not include fees due to other Departments (i.e. Planning, Public worxs, itre,,Yanitarysewer vtsrrict,,Nciiooi
n—'.. i Irl, nc.n inn n h—dnm ilia nralimi""ri) i"fnrmatinn 17vailahloand aro nnhy an ovfimatp- 1-nntart the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check 1e`ee:
Suppl. PC.Fe, e
PME Plan Check:
$0.00
SUPPI,
PME Unit Fee:
$29.00
PNM Permit Fee:
$48.00
("Onsiructhni 71�x-
Administrative Fee: JADMIN
$45.00
Work Without Permit? 0 Yes (E) No
$0.00
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS: 4
$171.50
$0.00 TOTAL FEE:
$171.50
Revised: 10/01/2015