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12010066 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7844 JEANETTE CT CONTRACTOR:TRIPLE A PLUMBING PERMIT NO: 12010066 SERVICES OWNER'S NAME: TZOU SEAN H AND WANG LILLIAN PO BOX 5144 DATE ISSUED:01/09/2012 OWNER'S PHONE: 4085686138 SANTA CLARA,CA 95056 PHONE NO:(408)245-4940 ❑ LICENSED CONTRACTOR'S DECLARATION 3 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 3� Lic.# 4f4,3 l MECH RESIDENTIAL COMMERCIAL Contractor '� � ,`'�'M � Date / rte' I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALLING PROPERTY LINE CLEANOUT AND CHECK (commencing with Section 7000)of Division 3 of the Business&Professions VALVE 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$3800 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36217034.00 Occupancy Type: APPLICANT CERTIFICATION 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 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 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 souTcegulations per the Cupertino Municipal Code,Section9.18. Issued by;, �- Z DateSignature Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby 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. 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, 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 HAZARDOUS MATERIALS DISCLOSURE declarations: 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. 1 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 I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will 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 Owner or authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: 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, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all 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 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36217034 . 00 DATE ISSUED. . . . . . . : 01/09/2012 RECEIPT #. . . . . . . . . : BS000015714 REFERENCE ID # . . . : 12010066 SITE ADDRESS . . . . . : 7844 JEANETTE CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : TZOU SEAN H AND WANG LILLIAN ADDRESS . . . . . . . . . . : 7844 JEANETTE CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4153 RECEIVED FROM . . . . : TRIPLE A PLUMBING CONTRACTOR . . . . . . . : MARCO A REGALADO LIC # 29716 COMPANY . . . . . . . . . . : TRIPLE A PLUMBING SERVICES ADDRESS . . . . . . . . . . : PO BOX 5144 CITY/STATE/ZIP . . . : SANTA CLARA, CA 95056 TELEPHONE (408) 245-4940 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, 800 .00 1 .00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 3, 800 .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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 152 .50 #10400 --------------- TOTAL RECEIPT 152 .50 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: 7844 jeanette ct. DATE: 01/09/2012 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$3,800 "PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: I I PERMIT TYPE: WORK install property line clean out and check valve. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $22 TOTALS: $22.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs 1 $44.00 Lj 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 prelindina information available and are only an estimate. Contact the De t or addn7 info, FEE ITEMS (Fee Resolution 11-053I 7-1.,'11) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $22.00 PME Permit Fee: $44.00 Administrative Fee: 1ADMIN $41.00 Work Without Permit? Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 Strong -?Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bld Stds Commission Fee: IBCBSC $1.00 SUBTOTALS; $152.50 $0.00 TOTAL FEE; 1 $152.50 Revised: 1/01/2012 Building Department City Of Cupertino ILE] 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST "ADDRESS: C'0 e f') t✓�',�c: PERMIT# : US�i`^� �'� PHONE# RACTOR: (e '. �vmhi v► (BUSINESS LICENS # +�`+�� c ls�G+r , 4iW CITY/ZIPCODE: 49 *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 SCONTRACTORS HAVE OBTAINED A CITY OF UPERTINO BUSINESS LICENSE. ^O I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V 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 IE Tile Owner/Contractor Signature Date /� 0/ C)(---,-)(,0 Co GENERAL PERMIT APPLICATION MEP La COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333- building(5cupertino.org misc CUPERTINO ®,PLUMBING ❑MECHANICAL ❑ELECTRICAL / ❑MISCELLANEOUS PROJECT ADDRESS. �! (_f �jqC(tj �# OWNER g�V1`I �v .HONE E-MAIL � - S��'- (G1 3 D STREET, CITTA7�,, FF CONTACT NAME PHONE E-MAIL -7 STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT /\ CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# Ck 4D 1 4- E-MAIL FAX r lipIP 1+ ✓V i E, 54i, I tp S �D �l �WN art J n. TATEA114 11 Non, (f, r. PHONE ARCHITECTIENGINEER 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 WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK ns ///'I . o jVVQ 0bej,- ei i t t u TOTAL VALUATION: .�' RECEIVED BY: C By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have vided is correct.j 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 i ding constru ' n."I authorize representatives of Cupertino to enter the above-id�' ed perry for inspection pu{poses. Signature of Applicant/Agent Date: 1 SLVPLEb,MNTAL INFORMATION REQ=D OFFICE USE ONLY OVER-THE-COUNTER ❑ EXPRESS Y U W ❑ STANDARD T U Z ❑ LARGE a ❑ MAJOR A EPMiscApp_201 Ldoc revised 06121111