12010132 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10409 MARY.AVE CONTRACTOR:BATH FITTER PERMIT NO: 12010132
NORTHERN CALIFORNIA
OWNER'S NAME: WEE DING LIM&HUAN MAO 2118 ZANKER RD DATE ISSUED:01/20/2012
OWNER'S PHONE: 4082216',•32 SAN JOSE,CA 95133 PHONE NO:(408)834-11 t t
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL®
License Class i j ic.# ` 3 INSTALL NEW SHOWER/TUB VALVE
Contractor Date /Z
I hereby aft nn rat I am licensed under the provisions of Chapter 9
(commenciug w th Section 70€14)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 fair-whichthis permit is issued. Sq.Ft Floor Area: Valuation:$1000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3100 of the Labor Code,for the performance of the work for which this
APN Number:3652047.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION ;•
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF`'FORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree.to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs.,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued byl/ - ate:
with all nor:-point ou ce,regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature - Date 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: Bate:
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 is not 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(x)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 whichthis permit is issued. will maintain compliance with the C ert• Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 50 3,and 25534. /
Section 3 700 of the Labor Code,for the performance of the work for which this Owner or authorized agent 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 mariner so as to becorne sul iect to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONST(U1CT't0"N LENDING AGENCY
become subiect to tine Worker's Cornpensation 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.)
Leader'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
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32652047. 00
DATE ISSUED. . . . . . . : 01/20/2012
RECEIPT #. . . . . . . . . : BS000015802
REFERENCE ID # . . . : 12010132
SITE ADDRESS . . . . . : 10409 MARY AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : WEE JING LIM & HUAN MAO
ADDRESS . . . . . . . . . . : 10409 MARY AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JOE NANNETTI
CONTRACTOR . . . . . . . ; BATH FITTER NORTHERN CALIFORNI LIC # 31358
COMPANY BATH FITTER NORTHERN CALIFORNI
ADDRESS 2118 ZANKER RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95133
TELEPHONE (408) 834-1111
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1ADMIN HOURS 1 .00 41.00 0. 00 41 .00 0.00
1BCBSC VALUATION 1, 000 .00 1. 00 0. 00 1 .00 0.00
1BPFIXTURE NO OF FIXTURE 1.00 9. 00 0 . 00 9.00 0 . 00
1BSEISMICR VALUATION 1, 000 .00 0 . 50 0 .00 0 .50 0 . 00
1PPERMITFE FLAT RATE 1 .00 44 .00 0 .00 44 .00 0 .00
1TPAVDOC FLAT RATE 1 .00 44 .00 0. 00 44 .00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 139 . 50 0 .00 139 .50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 139 . 50 VISA
---------------
TOTAL RECEIPT 139.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING 512 FINAL HANDI-CAP
CITY OF CUPERTINO
OFAOi
FEE ESTIMATOR—BUILDING DIVISION
ti 3r!,JJ ADDRESS: 10409 wary ave. DATE: 01/20/2012 REVIEWED BY: bobs.
APN: BP#: "VALUATION: j$1,000
PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition /Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPFIX
USE: P PERMIT TYPE:
WORK install new shower/tub valve.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixture or Trap 1 BPFIXTURE 1 # $9
TOTALS: $9.00
Plumb.Plan Check 0.01 hrs $0.00
Plumb.Permit Fee: IPPERMIT
LlOther Plumb Insp. 0.0 hrs $44.00
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the preliffina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS ''_. r , '.'+ ic?s II-40) Eff ,7 1 1]% FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $9.00
PME Permit Fee: $44.00
Administrative Fee: ]ADMIN $41.00
Work Without Permit? 0 Yes Q No $0.00
Travel Documentation Fee: ITRA VDOC $44.00
S_t+'Cri's;?I = I x r,Fee� IBSE15MICR $0.50 Setect an Administrative Item
B1 1,g.__........_ � lacasc $1.00
SUBTOTALS-7$139.501 $0.00 TOTAL FEE: $139.50
Revised: 1/19/2012
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: 10,40 11-e— PERMIT# l r Z
OWNER'S NAME " WL,- ; PHONE# -
GENERAL CONTRACTOR: ;� , BUSINESS LICENSE#
ADDRESS: Z/ Y� CITY/ZIPCODE: C)
*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 S CO TRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
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
Tile
Owner/Contractor Signature Date
CONSTRUCTION PERMIT APPLICATION
12 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildingcDcupertino.Drg ' ")
CUPERTINO 12-010
v�
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PR JEC` p, APN 7. /l v
OWTNAME / wL'G. I M PONE — E-MAIL
l- fel u'Ln M1'1�E O
STREET ADDS Ss_ STATE ZIP C FAX
V o
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ZICONTRACCOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICEN NUMERfi� „� 6"'
j „ BUS.LIC#
--(
COMPANY l _�
E-MAIL FAX .• - /
STREET�IDD,RE _ 1 CITY STATE ZIP PHO
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
/ L S r L /StgwL-12— Is'ALi vli //V -F(J I r//,A
- -F
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NEC AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA DETACH
❑ATTACH
#
DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? Ni ADDITION? yifl
PRE-APPLICATION ❑YE§ IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY. TOTAL VALUATI�T:O
PLANNING APPL# PLANNING APPROVAL LETTER EICBLER HOME? ❑NO
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf. I have read this
application and the information I have p vi S ct. I 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 b di o representatives of Cupertino to enter the above-iden . eed propepy for inspection purposes.
Signature ofApplicant(Agent: Date: CLQ l�
SUPPLEMENT ORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for �ovly TER a❑�un DINS Laly REVIEW
existing building(s). Demolition permit is required prior to issuance of building CT
permit for new building. ❑ E)(PRESS ❑ PLANNING PLAN REvmw
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure F-1STANDARD11PUBLICWORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE
❑ FIREDEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ MAJOR ❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
Bldg4pp 2011.doc revised 06/21/11