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11120026 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10835 MINETTE DR CONTRACTOR:PRO ROOTER PERMIT NO: 11120026 OWNER'S NAME: LEE KIM WAI AND SHINOHARA YUKA 438 SAN LEANDRO BLVD DATE ISSUED: 12/052011 OWNER'S PHONE: 4085066396 SAN LEANDRO,CA 94577 PHONE NO:(510)670-1115 LICENSED CONTRACTOR'S DECLARATION r r r /' /' C�c / /' /� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Classl 3Y Lic.H CRX3 b 3 bbsZ- MECH r RESIDENTIAL r COMMERCIAL r Contractor I7YO (ZOV+-e/t Date / 2 O S // 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE SEWER LINE AND PROPERTY LINE CLEAN OUT (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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.IT Ar, : Valuation:$3200 Section 3700 of the Labor Code,i'or the performance of the work for which this permit is issued. APPLICANT CERTIFICP be 32058.00 Occupancy Type: ATION 1 certify that I have read this application and state that the above igfor"atioN?ter ' correct.I agree to comply with all city and county ordinances and`` ate law to building construction,and hereby authorize representatives of thrara oPERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We) ee indemnify and keep harmless the City of Cupertino against liabilities," encs, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ;�// 9.18. Issued by Date;//x^ S=f 7 ' Signature�.f,�� ¢ T-45 pp111IZ222L Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code), ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE. 1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Cade,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califamia. If,after making this certificate of exemption,I Owner or authorized agenC become subject to the Worker's Compensation provisions of the Labor Code,I must 'kt Wt 1.1�-(r LC C Date:I do SA I forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the performance of ssork's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabil ipes,judgments, co and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION g of this permit.Additionally,the applicant understands and will comply I non-point source regulations per the Cupertino Municipal Code,Section 1 understand my plans shall be used as public records. 9,18. Licensed Professional Signature Date • CITY OF CUPERTINO 6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37532058. 00 DATE ISSUED. . . . . . . : 12/05/2011 RECEIPT #. . . . . . . . . : BS000015483 REFERENCE ID # . . . : 1.1120026 SITE ADDRESS . . . . . : 10835 MINETTE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LEE KIM WAI AND SHINOHARA YUKA ADDRESS . . . . . . . . . . : 10835 MINETTE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : HECTOR CORONADO CONTRACTOR . . . . . . . : JIN OH DBA PRO ROOTER INC LIC # 24097 COMPANY . . . . . . . . . . : PRO ROOTER ADDRESS . . . . . . . . . . : 438 SAN LEANDRO BLVD CITY/STATE/ZIP . . . : SAN LEANDRO, CA 94577 TELEPHONE . . . . . . . . : (510) 670-1115 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1 .00 41.00 0 .00 41 .00 0. 00 1BCBSC VALUATION 3,200 . 00 1.00 0.00 1 .00 0. 00 1BSEISMICR VALUATION 3, 200 .00 0.50 0.00 0.50 0. 00 1PPERMITFE FLAT RATE 1.00 44.00 0.00 44 .00 0. 00 1PRSEWER UNITS 1 .00 22. 00 0. 00 22.00 0. 00 1TRAVDOC FLAT RATE 1 .00 44. 00 0.00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 152. 50 0. 00 152 .50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING • CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION • ADDRESS: 10835 minette dr. DATE: 12/05/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: $3,200 *PERMIT TYPE:. Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex Pp1RPSS USE: PERMIT TYPE: WORK re lace sewer line and property line clean out. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $22 TOTALS: $22.00 v . $0.00 Elegy ! n ' 1t p F'hu;Choc,c Plumb. Plan Check 0.0 hre n Check Meeh. Panna 14;e: Plumb. Permit Fee: IPPERMIT Dec. Permit Fre: • Olher dfech.Insp. Other Plumb Insp. 0.0 hrs $44.00 Other S1cc. hnsn. LLJ Moch. Incl;. Fitt: I'lurub.]n.r'p. Ped: /ilei.lnV). Feer NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelinina information available and are onlp an esthnata Contact the De ! or addn7Info. FEE ITEMS (Fee Resohilion 11-053 Eff 7/1111) FEE QTY/FEE MISC ITEMS Flan Check P r c: Supp/. PC Fr( PME Plan Check: $0.00 Pc l-mit p'ae: ,Supp/. /rasp Fee PME Unit Fee: $22,00 PME Permit Fee: $44.00 Construction 7rix Administrative Fee: ]ADMIN $41.00 Work Without Permit? () Yes 0 No $0.00 I1ii1ancedAlanminr,;1'1de: Travel Documentation Fee: ITRA VDOC $44.00 Strong Motion Fee: IBSE]SMICR $0.50 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $152.50 $0.001 TOTAL FEE: $152.50 Revised: 10/01/2011 ► j , a oo � � GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinG(8,cupertino.orG • CUPERTINO MIS C ;PLUMI3ING MECH1AMCAL ELECTRICAL MISCELLANEOUS PROTECT ADD B I .}F APN a ,,�.�-3rl5-3a-0 5 OWNER NAME � 1 , PHONE 6 6 326 EMAl7. STREETADDRESS CITY, STATE,ZIP FAX CONT NAME ^ n �lnPHONE 6 E-MAIL e STREET ADDRESS CTTY,STATE. ZIP FAX ❑OWNER ❑ OWNER-BUDDER ❑ OWNER AGENT XMNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME LI ENSE NUMBER LICENS LMS i n BUS.LIC a 9t a 4-et/L ETP COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHTTECTIENGINEFR NAME LICENSE NUMBER BUS.LIC a COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE ZIP PHONE USE OF SFO mDUPLE]t ❑ MVLTI-FAhOLY PROIE ]N WID[AMl ❑ YES PROIEf-TIN ❑YES LST BLDGAN ❑YES BUIIDINO: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONH ❑NO EICNLER HOME? ❑NO DESCRIPTION OF WO O H poise— O L � TOTAL VALUATION: "Z�.v RECEIVED BY: By my signature below,I certify to each of the following: I son the property owner or authorized agent to act on the prop owner's behalf. I have lead this application and the information I have provided is correctLj have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to,enter the above-id 'Sed pro erty for inspection pu(�oses. Signature ofApplicanHAgenC Date: Z d S SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY Ly'6VER-THE-COUNTER 6 ❑ EXPRESS Y U _ ❑ STANDARD u ❑ LARGE 6 ❑ MAJOR MEPMiscApp 201 Ldoc revised 06121111 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: S -e PERMIT# GZ OWNER'S NAME: L C 2 PHONE#4r,,&' 06 GENERAL CONTRA OR: pliz, c• BUSINESS LICENSE# ADDRESS: 479 5ast Le CITY/ZIPCODE: (fQ kS 7 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPER INO BUSINESS LICENSE. / am not using any subcontractors: ,Z �� !1)'d'!/�- c c-9S Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock /Tile 2v Qc zt-' Owner/Contractor Signature Date