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13060113 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10311 GREENWOOD CT CONTRACTOR:ECONOMY ROOTER PERMIT NO:13060113 OWNER'S NAME: CUPERTINO COMMUNITY SERVICES PO BOX 2252 DATE ISSUED:06/13/2013 OWNER'S PHONE: 4087173232 SANTA CLARA,CA 95055 PHONE NO:(408)249-4922 ❑ LICENSED ',S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALE] C License Class Lic.# 0 CONTRACT©ORp/�O 7 5 UNIT2-REMOVE AND REPLACE 40 GALLON WATER / O`^�"3 HEATER Contractor Fut�� ✓�c Date IN 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$750 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 APN Number:36914025.00 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 WIT=HIN 0 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 DA F 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 Date: granting of this permit. Additionally,the applicant understands and will comply Issued by: with all non-poi n ource regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date ��i l 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 Date: Signature of Applicant: 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 6.9I.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 gupertino Municipal Code,Chapter 9.12 and Health&Safe H he eaSafety Code,Sect505,25533,and 25534. I have and will maintain Worker's Compensation Insurance,as provided for by to6-I i-/.) Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent io 5Date: permit is issued. I certify that in the performance of the workfor 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 ust work's for which this permit is issued(Sec.3097,Civ C.) I hereby affirm that there a construction lending agency for the performance of become subject to the Worker's Compensation provisions of the Labor Code,I forthwith comply with such provisions or this permit shall be deemed revoked. 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 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 bQQ CUPERTINO (408)777-3228-FAX(408)777-3333-building(a)-cupertino.org MISC ❑PLUMBING [:]MECHANICAL ❑ELECTRICAL [:]MISCELLANEOUS PROJECT ADDRESS 10 J 2 It &aaN G("o / G / APN# OWNER NAME "f- PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX a 5V �,v R cl s. 1 CA . 'i V CONTACT NAME PHONE E-MAIL STREET ADDRESS 9' CITY,STATE,ZIP FAX 1:1 OWNER 11OWNER-BUILDER13 OWNER AGENT is CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# '-_01e6e 14'n-* I 6j';L0v C e 36 COMPANY NAME E-MAIL FAX L-2 STREET ADDRESS /�, CITY,STATE,ZIP PHONE `j `/!t h I LfoN AJf 5.? CA 4 r17 v �O P �� Vl 2 2 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WHALAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK / �F.► /vt TOTAL VALUATION: (0 0 RECEIVED By my signature below,I certify to each of the following: I am the property owner or authorized agent to act oW teperty o er's behalf. I have read this application and the information I have vided is correct. I have read the Description of Work and verify it is acc e. I agree to comply with all applicable local ordinances and state laws relating to bg construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 0 b—t?—1_3 SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY w ER-THE-COUNTER El x, EXPRESS U ❑ STANDARD U ❑ LARGE a ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10 1 GREENWOOD CT DATE: 06/13/2013 REVIEWED BY: MENDEZ APN: BP#: EVALUATION: $750 xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: p PERMIT TYPE: i WORK REMOVE AND REPLACE 40 GALLON WATER HEATER IN SAME LOCATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $27 TOTALS: $27.00 :L1ech.Placa Check Plumb.Plan Check 0.0 hrs $0.00 Elec..Plan(..heck klech. Permit Fee: Plumb.Permit Fee: IPPERMIT Elec.Permit Fee., FWch. Heck Insl,. Li Other Plumb Insp. 0.0 hrsOther Elec.Ind. Inds. Fee: Plumb. hal).Fee. Elec.Ind.Fee: NOTE:This estimate does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseo, -fees are based on the relimina information available and are onl an estimate. Contact the Dept or addn'1 in FEE ITEMS fFee Resolution 11-053 E . 7ff 11112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp 1. PC:f'ee . PME Plan Check: $0.00 Permit Fee: .Sul�pl. Insp P-ee PME Unit Fee: $27.00 PME Permit Fee: $45.00 Construction 747x: Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes (E) No $0.00 Advonced Planning Fees: Travel Documentation Fee:. ITRAVDOC $45.00 i Strong Motion.Feer 1BSEzsMICR $0.50 Select an Administrative Item.. Bldg Stds Commission Fee: IBCBSC $1.00 $160.50 $0.00 $160.50 Revised: 04/29/2013