12030142 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10135 MCLAREN PL CONTRACTORi-THB"TOTiFT)Fft RMINED PERMIT NO: 12030142
OWNER'S NAME: LEE HOWARD 11 AND CHANG WENDY WEI-CH JC t d MSI DATE: ISSUED:031292012
OWNER'S PHONE: 5104272147 1 PHONE NO:
❑ LICENSED CONTRACTOR'S
_DE/C?L/A/RATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class I J Lic.N V S `� /
��,f/I �II,,nn��,I� MECH r RESIDENTIAL r COMMERCIAL r
Contractor R�Q 4,61WDate
1 hereby affirm that I am licensed under the provisionsof ChapChapterr99 JOB DESCRIPTION: REPIPE E=XISTING RESIDF-NCUCI IANGE TO COPPER PIPE
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby affirm under penally of perjury one of the following two declarations:
I have and will maintain a ccnifcale of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
perfannance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,az provided for by Sq.Ft Floor Area: Valuation:$9600
Section 3700 of the labor Code,for the performance of the work for which this
permit is issued.
APN Number:31621052.00 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 stale 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 fur 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 source regulations per the Cupertino Municipal Code,Section
9.18. Issued by: �ELIi✓ ATG/ Date: 3-c2f'/,9,
Signature a�L= Dale
❑ OWNER-BUILDER DECLARATION RF--ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,1 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)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Husiness&Professions Code). ALL 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 Workers 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 Ilealth&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I stare 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
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 perfomnance of the work for which this permit is issued,I shall I Iealth&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 Califomia. If,after making this certificate of exemption,I Owner or authorized a
become subject to the Worker's Compensation provisions of the Labor Code,I must n Dater
furthwith 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 habil ities.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 ARCHITECT'S DECLARATION
with all 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 31621052 . 00
DATE ISSUED.. . . . . . : 03/29/2012
RECEIPT #. . . . . . . . . : SS000016394
REFERENCE ID # . . . : 12030142
SITE ADDRESS . . . . . : 10135 MCLAREN PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . ... .
OWNER LEE HOWARD H AND CHANG WENDY W
ADDRESS . . . . . . . . . . : 20401 WILLIAMS AVE
CITY/STATE/ZIP . . . : SARATOGA, CA 95070
RECEIVED FROM . . . . : DC DESIGN & CONS
CONTRACTOR . . . . . . . : TBD - 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, 9, 600.00 1. 00 0. 00 1.00 0. 00
1BSEISMICR VALUATION 9, 600.00 0.96 0.00 0 .96 0. 00
1PPERMITFE FLAT RATE 1.00 44.00 0.00 44 .00 0.00
1PRREPIPE NO OF' FIXTURE 1 .00 12.00 0.00 12 .00 0.00
1TRAVDOC FLAT RATE 1.00 44.00 0 .00 44 .00 0. 00
TOTAL PERMIT 142.96 0.00 142 .96 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 261. 96 #2080
---------------
TOTAL RECEIPT 261. 96
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10135 Mcleare Street DATE: 03/29/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $9,600
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition I Repair
PRIMARY SFD or Duplex PENTAMATION 1RPRP
USE: PERMIT TYPE:
WORK epipe existing residence/change to copper pipe.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 1 # $12
TOTALS: $12.00
)h•:h. Ply,,, ra,.�,;< Plumb.Plan Check 0.0 hrs $0.00 E1,-r:. Nan Ch,'r,
�A•:d. I'rnun Fa•r: Plumb. Permit Fee: 1PPERMIT Pier. 11:rndr l4•,::
Urh," M",h. his!" Other Plumb Insp. 0.0 hrs $44.00 Ofhe, Ei �.e1.,..p. ET
Pluuh, h"p.
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary•Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the Dept for adrin'1 info.
FEE ITEMS (Fee Re.salntion 11-053 E/1 7/1//1) FEE QTY/FEE MISC ITEMS
l'It n Ch,uJr /'rc:
Snppl. PCF(111
PME Plan Check: $0.00
Snpp/ Insp lrr,,•
PME Unit Fee: $12.00
PME Permit Fee: $44.00
C onslrurtiun Tay.
Administrative Fee: InDMIN $41.00
Work Without Permit? 0 Yes 0 No $0.00
,I rh aural Plu,unim, I res:
Travel Documentation Fee: iTRAVDOC $44.00 A
Strom! Motion Fee: IBSEISMICR $0.96 Select an Administrative Item
Bldtt Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $142.96 $0.00 TOTAL FEE: $142.96
Revised: 1/19/2012
1 -2-03 I I y 2-
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DNISION
10300 TORRE AVENUE•CUPERTINO,CA 950143255 M I
CUPERTINO (408)977-3228 l�
FAX(408)777-3333•buildinOcuoettino.orD
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FROIFIT ADDRESS Lr I AFNF2/� '' /— Is
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IDNIR.ICTOR NAME '?DtV l DLCffA>ti LICENSE NUMBER ?/,/ D
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USE OF aD[R'IF]t ❑ MVLTFFAMD.Y. PROIERINWEDIAND ❑ Y6 PROIECTIN ❑YES LS THE BIJX AN ❑YES
BVBDING: COMMERCLV. URBAN INTERFAQ AREA ❑ NO FLOOD ZONE ❑NO OaD.R HOME/ ❑NO
DESCRIPTION OF WORK
1 , t o � ✓ �. I
TOTAL VALUATION: Ou t RECEIvm BY: `A _ /
By my signature below,I airtify to each of the following I=the property owcer or authorized agent to act on the property o ces behalf I have read this
application and the iaformarion I have provided is come:c d 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 buil ' Drize representatives of Capertino to enter the above-identified property far inspection purposes.
Signature of Applicant/Agent Darr: I
ALTINFORMATION REQUIRED OFFICE USE ONLY
y OYER-THE-COUNTER
6
❑ EXPRESS
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m ❑ STANDARD
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❑ URGE
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❑ MAJOR
M&PAftrcApp 2011.doc revised 06121/11