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12010105 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10801 GASCOIGNE DR CONTRACTOR:GOGO ROOTER PERMIT NO: 12010105 OWNER'S NAME: TSENG TONY K 2530 BERRYESSA RD STE 509 DATE ISSUED:01/13/2012 OWNER'S PHONE: 4086441495 SAN JOSE,CA 95132 PHONE NO:(408)282-7026 ❑ LICENSED CONTRACTOR'S DECLARATIONtµµ i._.. BUILDING PERMIT INFO: BLDG ELECT a PLUMB • License Class t-` .7YLic.# 2 3'7©3 el N MECH RESIDENTIAL COMMERCIAL ' Contractor� 6-0R4&4--4-- Date 1 ^/:3 �'�D/Z_. I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SINGLE FAMILY DWELLING INTERIOR RE-PIPE (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:$9000 1 have arid 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 permit is issued. APN Number:37531027.00 Occupancy Type: APPLICANT CERTIFICATION I certifv that I have read this application and state that the above information is correct.I agree to comply with all cityand county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnity and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date: 9.18. A Signature RE-ROOFS: ❑ OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) L as owner of tine property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(x)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will Perini(is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of die work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner sows to become subject to the Worker's Own i e Compensation laws of California. If,after making this certificate of exemption,I Date become subject to the Worker's Compensa(ion provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) €certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18• Licensed Professional Signature Date CITU OF CUPERTINO j FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10801 gascoigne dr. DATE: 01/13/2012 REVIEWED BV: bobs. APN: BP#: VALUATION: 1$9,000 PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPDP USE: PERMIT TYPE: WORK sfd interior re-pipe. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTV UNITS BP FEES Piping, Area 1PREPPIPE 1 # $44 TOTALS: $44.00 Plumb.Plan Check OA hrs $0.00 Plumb.Permit Fee: IPPERMIT Ll Other Plumb Insp. 0.0 f $44.00 NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These,Lees are based on thereli�rina information available and are only an estimate. Contact the Det or addn'l in o. FEE ITEMS r.; }fay - ,1-t'.R_>Eff 1) FEE QTY/FEE MISC ITEMS L�j PME Plan Check: $0.00 PME Unit Fee: $44.00 PME Permit Fee: $44.00 Administrative Fee: 1ADMIN $41.00 Work Without Permit? 0 Ices (D No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 `lr ) motiop Fee: IBSEISMICR $0.90 Select an Administrative Item IBCBSC $1.00 SUBTOTALS: 1 $174.901 $0.00 TOTAL FEE: $174.90 Revised: 1/01/2012 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 0/ hc- PERMIT# L7 t > OWNER'S NAME: PHONE# GENERAL CONTRACTOR: 6-0 O &O � BUSINESS LICENSE# ADDRESS: I CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: .KigtWtXKe Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry P inting /Wallpaper Paving �L Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date 02 GENERAL PERMIT APPLICATION MEP La COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333• building(c5cupertino.org MISC CUPERT{NO PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROTECT ADDRESS Dv o -7 AFN#�� 5 0� OWNER NAME j P N� - /L, '�� E-MAIL f-L i STREET ADDRESS_ CITY, TATE,ZIP TFAX CONTACT NAME ! CJS PHONE UE-MAIL STRE$I'A�$�SS Al, �Y ZiP ,L. ✓ / ✓ f ❑OWNER ❑ OWNER-BUIIAER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME '-O /' I �,�,o�/ �C F U EL TLICEN TYPE BUS.LIC# COMPANY NAME (r (/' SCJ, " JE-MAIL/ FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHTTECTIENGINEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF MfFD or DUPLEX ❑ MULTI-FAMILY PROTECT IN WILDL kND ❑ YESPROTECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: (]COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: / L RECEIVED BY: By my signature below,f 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 Ain co structio d I authon�representatives of Cupertino to enter the above-identified property for inspection pu{poses. Signature of Applicant/Agent: `' Lam`//d / Date: SUPP EMENTAL O TION REQU=D OFFI ' USE ONLY OVER-THE-COUNTER c ❑ EXPRESS Y U S ❑ STANDARD U ❑ LARGE a ❑ MAJOR MEPMisc4pp_2011.doc revised 06121111