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11110036 ry CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10670 MORENGO DR CONTRA - ------- — D PERMIT NO: 11110036 OWNER'S NAME: CHANG SSU-CH1A AND LIU KAOWEN �,L> DATE ISSUED: 11/072011 OWNER'S PHONE: 6508617020 G) PHONE NO: LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class L3�0 Lie.4 60310x10 �nnI�� /�, 7—�� MECH r RESIDENTIAL r COMMERCIAL r ContractorDate - 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 30B DESCRIPTION:WATER HEATER REPLACEMENT,40 GALLON (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: 1 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$1200 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:37534058.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN Igo 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 rr� 9.18. (y��/(///��yyfr(�/I�.,l '7 Issued b Date: Signature A — '" -"""" Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material berg installed.If a roof is ly,affirm that I 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(Sce.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). ALI.ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I 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. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,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 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I 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 California. If,after making this certificate of exemption,I Ow rK(�{�/(Opf th riz a t: become subject to the Worker's Compensation provisions of the Labor Code,1 must Date: l forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work'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 liabilities,judgments, co and expenses which may accrue against said City in consequence of the Mag of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION 14WIl non-point source regulations per the Cupertino Municipal Code,Section I 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 . . . . . . . . : 37534058 . 00 DATE ISSUED. . . . . . . : 11/07/2011 RECEIPT #. . . . . . . . . : SS000015255 REFERENCE ID # . . . : 11110036 SITE ADDRESS . . . . . : 10670 MORENGO DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHANG SSU-CHIA AND LIU KAOWEN ADDRESS . . . . . . . . . . : 10670 MORENGO DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : IE INC CONTRACTOR . . . . . . . : THD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . TELEPHONE . . . . . . . . : • 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 1, 200 .00 1. 00 0. 00 1. 00 0.00 1BSEISMICR VALUATION 1, 200.00 0.50 0. 00 0 .50 0. 00 1PPERMITFE FLAT RATE 1.00 44 . 00 0. 00 44 .00 0. 00 1PRWHEATR UNITS 1.00 26. 00 0 . 00 26 . 00 0. 00 1TRAVDOC FLAT RATE 1. 00 44 . 00 0 . 00 44 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 156 .50 0.00 156 .50 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER • IIII Jv3lo GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M ' SC �UPERTINO (408)777-3228 • FAX(408)T77-3333• buildinalcbcuoerdno.oro PLUMBING N4ECHANICALFIRTRCMCAL �j /� MIS7CULANEOUS PROJECT ADORE53 0— • APNa /� h C.�' D G-1� OWNER �O W .. U d-- 5�-�sj- eAONB (' �—l1✓8,la 1 e! E-`MAEf I J CRY, STATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CRY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BORDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCErmcr ❑FNGwm ❑ oevELOPER ❑TFNAM CONTRACTOR NAME LICENSE NUMBBERLICENsE TYPE BLS.LIC# COMPANY E-MAE. FAX STREETADDRESS CITY.STATE,78 PHONE I _ zt2 4 ARCM R CHTTECTJENOINEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CrrY,STATE,ZIP PHONE OF ❑sPo m DDFLEx ❑ MULTr.FAMILY PROJECT BI WILDEAND ❑ vFJH PROJECTDJ ❑YES 19 TtiH BLDG Art ❑YES INE,: COA4DBlCTA1 URBAN D.RERFACE AREA NO FLOOD ZONE ❑NO EICHLLERHOMET [3 NO DEBCR7nON OF WORK C_ TOTAL VALUATION: ( L-- 1, RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property awaces behalf. 1 have read this application and the information I have provided is correct)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 constmctiom I authorize representatives of Cupertino to enter the above-idead9ed property far inspection pu@oses. Signature of App$canVAgentr Dau: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OYER-TEE-COUNTER 6 ❑ =PRESS Y s ❑ STANDARD U ❑ LARGE r ❑ MAJOR MEPMtscApp 2011.doc revised 06121111 r r ^I CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION • ADDRESS: 10670 morengo dr DATE: 11/07/2011 REVIEWED BY: larrys APN: BP#: "VALUATION: $1,200 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: PERMIT TYPE: WORK water heater replacement, 40 gallon SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $26 TOTALS: $26.00 tfe,h. Na,C:hecl, Plumb.Plan Check 0.0 hrs $0.00 Clea_Alms Chcck V,c,A Parw';t New,: Plumb.Permit Fee: 1PPERMIT tae.. Perm¢Fee: • ihher.dlr 1r.Imp. Other Plumb Insp. 0.0 hrs $44.00 other tilec harp. EI Afad,.Ince. f'ee. PluurL. hlyp.t'ee; Eiee.Ince. Pee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelindna Information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Pee Resohnion 11-053 G . 7/1/11/ FEE QTY/FEE MISC ITEMS Plan Check Pec: Suppl. PC.°r<^„ PME Plan Check: $0.00 Permit Fee: Suppi, /ta.,ap Flee PME Unit Fee: $26.00 PME Permit Fee: $44.00 Construction Tax Administrative Fee: (ADMIN $41.00 Work Without Permit? 0 Yes Q No $0.00 A h ance;d Planning Fees: Travel Documentation Fee: 1TRAVDOC $44.00 Strong Motion Fee: IBSEISMICR $0,50 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $156.501 $0.001 TOTALIZE $156.50 Revised: 10/01/2011 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 JOBADDRESS: 6(010 (Moferlo Pr PERMIT# OWNER'S NAME: L I U v SS4 r h lrn 'aha PHONE# (05� 86l • 7020 GENERAL CONTRACTOR: less Wa'tw I ve e✓ BUSINESS LICENSE# ADDRESS: dY5g5 AMOLk2 fort eej�L✓ CITY/ZIPCODE: e0. 9f35! *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 CUPERTINO f BUSINESS LICENSE. I am not using any subcontractors: 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 Owner/Contractor Signature Date