13070197 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19500 PRUNERIDGE AVE CONTRACTOR: PERMIT NO:13070197
OWNER'S NAME: fW00W tm e 'l r CQ ` DATE ISSUED:07/30/2013
OWNER'S PHONE: 9497205685 &J 4,-Ao LC e- PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
License Class C 7 C. Li,.# -[ �— -q BLDG 10-1ST FLOOR REMOVE AND REPLACE 11 WATER
HEATERS UNITS
Contractoj��,,e,c C o 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:$8000
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 Numbe0 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION B u i Id i ngg
I certify that I have read this application and state that the above information is PER '][RES IF WORK7�I�I�TED
Will r`' DA-A LO
correct.I agree to comply with all city and county ordinances and state laws relating �a
to building construction,and hereby authorize representatives of this city to enter E T ISSUANCE OR
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS OM LAST C ED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, REVIEWED FOR CODE COMPLIANCE
costs,and expenses which may accrue against said City in consequence of the Issued by: Dote:
granting of this permit. Additionally,.the applicant understands and will comply iGW(,
with all non-point source regulations per the Cupertino Municipal Code,Section Y'
9.18.
c��- Q j RE-ROOFS:
Signature _.__ Date'. ' �— _`- 1� 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 isnot 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. 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 the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or author' 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 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.
Signature Date
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �I
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildin4Mcupertino.org O� misc
1�
PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
[PROJECT ADDRESS e O APN#
19500 Pruineridge Ave
OWNERNAME PHONE E-MAIL
The Irvine Company Apartment Communities, Inc. 949-720-5685
STREET ADDRESS CITY, STATE,ZIP FAX
110 Innovation Dr. Irvine,CA,92617 949-720-5466
CONTACT NAME PHONE E-MAIL
Ben Thomas 1 408-202-7391 ben@lhourdrain.com
STREET ADDRESS CITY,STATE,ZIP FAX
1260-A Yard Ct. San Jose,CA,95133 1408-521-0101
❑OwNER ❑ OWNER-BUILDER ❑ owNERAGENT ❑ CONTRACTOR ®CONTRACTOR AGENT ❑ ARCHITECT ❑INGINEER ❑ DEvELoPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
Gallaher Company Inc. 1946359 C36
COMPANY NAME E-MAIL FAX
ben@ 1 hourdrain.corn 408-521-0101
STREET ADDRESS CITY,STATE,ZIP PHONE
1260-A Yard Ct. San Jose,CA,95133 408-202-7391
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD oc DUPLEX ® MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN U47ERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
ers
TOTAL VALUATION: / O est RECEIVBDBI ; , s ` rr '
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on th pro owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurat agree to comply with all applicable local
ordinances and state laws rel ction. I authorize representatives of Cupertino to enter the above-Identi ed property for inspection purposes.
Signature of Applic Date:
SUPPLENTNTAL INFORMATION REQUIRED
r
STAIYDIiRD -- 41(} s 4
MEPMiscApp 2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 19500 Pruneridge ave DATE: 07/30/2013 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$8,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: PRWHEAT i
WORK BLDG 10-1ST FLOOR REMOVE AND REPLACE 11 WATER HEATERS UNITS
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 11 # $308
• s r
TOTALS: y" a $308.00
:Lte(A Plan Check" Plumb.Plan Check 0.0 Ins $0.00 Elec.Plan Check
Mech.Permit free: Plumb.Permit Fee: IPPERMIT lElee. Permit Tee:
C)ther Mech.Insn. Other Plumb Insp.
0.0L
.0 hrs $47.00 Other Flee.Inch.
�9�exh.Insp.Fee., Plmnh. hrsp.Fee: Elec.Insp.Fee
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn'1 in o.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
SuPpl. PC I ce
PME Plan Check: $0.00
Permit.Fee:
Suppl. Insp Fee
PME Unit Fee: $308.00
PME Permit Fee: $47.00
Consl�-action :Tax:
Administrative Fee: IADMIN $44.00
Work Without Permit? 0 Yes (E) No $0.00
Advancecl Plcinazing Fees:
Travel Documentation Fee: ITRAVDOC $47.00 A
Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
�, °; F ,. $447.80
�� d� �,= $447.80 $0.00
Revised: 07/01/2013