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12040092 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21020 HOMESTEAD RD CONTRACTOR:RING ENTERPRISES PERMIT NO: 12040092 LIMITED YUE T OWNER'S NAME: HING ENTERPRISES LIMITED YUE T 3627 DEER TRAIL DR DATE ISSUED:04/172012 OWNER'S PHONE: 4084251919 DANVILLE,CA 94506 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.H M ECH r RESIDENTIAL COMMERCIAL Contractor Date - I hereby affirm that I am licensed under the provisions of Chapter JOB DESCRIPTION:UNIT C-ADD WASTE/VENT AND COLD AND HOT WATER (commencing with Section 7000)of Division 3 of the Business&Professions FOR Code and that my license is in full force and effect. FUTURE(2)SINKS IN UNIT NC 1 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. I have and 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. Sq.FI Floor Area: Valuation:53500 APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is APN Number:32607020.00 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued by: SF � f7A/!/� Date: 19/ OWNER-RUILDF.R DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of RF,-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material beug installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sce.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain aCertificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of The I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the perfam once of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should 1 store or handle hazardous material. permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued.I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owo r autho,�rized agent: Date: � #I Z APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 f hereby affirm that there is a construction lending agency for the performance of work's to building constmction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep hammless the City of Cupertino against liabilities,judgments, costs,and expenses which may accme against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature G �� Date'.4' 'I Z Z Licensed Professional Tov,T APR 17 2 12 } vt to- 1,.i 3 � , o T_ - - a rl `o 30 h 0 '.n . U p° 1%0 CUP Bullding t APR 17 2012 REVIEW FOR OMP IAN �f L Reviewed By CITY. OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32607020.00 DATE ISSUED. . . . . . . : 04/17/2012 RECEIPT #. . . . . . . . . : BS000016557 REFERENCE ID # . . . : 12040092 SITE ADDRESS . . . . . : 21020 HOMESTEAD RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HING ENTERPRISES LIMITED YUE T ADDRESS . . . . . . . . . . : 3627 DEER TRAIL DR CITY/STATE/ZIP . . . : DANVILLE, CA 94506 RECEIVED FROM . . . . : YUE TUNG HING ENTER CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : HING ENTERPRISES LIMITED YUE T ADDRESS . . . . . . . . . . : 3627 DEER TRAIL DR CITY/STATE/ZIP . . . : DANVILLE, CA 94506 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 3 , 500.00 1 .00 0 .00 1 .00. 0.00 1BPFIXTURE NO OF FIXTURE 2. 00 18 .00 0.00 18 .00 0 .00 1BSEISMICR VALUATION 3, 500 .00 0 . 50 0. 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 1.00 44 . 00 0. 00 44 .00 0. 00 1TRAVDOC FLAT RATE 1. 00 44 . 00 0. 00 44 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 148. 50 0.00 148 .50 0. 00 METHOD OF .PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 148.50 #151 --------------- TOTAL RECEIPT 148. 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 FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21020 Homstead DATE: 04/17/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $3,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1RPFIX USE: PERMIT TYPE: WORK Add waste/vent and cold and hot water for future 2 sinks in unit#C. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixture or Trap iBPFIXTURE 2 # $18 TOTALS: $18.00 ..L. Plan Ch,xk Plumb.Plan Check 0.0 hrs $0.00 Elco. Plan Me* hleed. Prrwir Fee: Plumb. Permit Fee: 1PPERMIT Elec. Permit Fre; O(hrr,lfvch. LtcP. Other Plumb Insp. 0.0 hrs $44.00 Orbe).81nr. hrsp. El Meeh. hi,p. Pec: Phanh. hep. Fre: Elco. Lisp. Fec: NOTE: This estimate does not includejees due to other Departments(ie.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the relimina in ormation available and are only an estimate. Contact the Dept for addn Y info. FEE ITEMS(Fee Resalulion 11-053 F. 711111) FEE QTY/FEE MISC ITEMS Plum Check FCc: Supp/. PC Fce PME Plan Check: $0.00 Permit Fee Suppl. lu.ep Feu PME Unit Fee: $18.00 PME Permit Fee: $44.00 Cuncnvrvion Tia: Administrative Fee: (ADMIN $41.00 Work Without Permit? O Yes .0 No $0.00 Advanced Plnmring Fees: Travel Documentation Fee: ITRAVDOC $44.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Ulde Stds Commission Fee: IBCBSC $1.00 u;. SUBTOTALS: $148.50 $0.00 TOTALFEE: $148.50 Revised: 04/01/2012 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228-FAX(408)777-3333- buildina(a)cuoertino.oro Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS 2In #e APN BP# OWNER NAME fdw I� OWNER ADDRESS70 0 7 ; LL44 nn nn l Z�.f- QhI �irlr�� DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) 2v"I. I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder' building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. tiV2. 1 understand building permits are not required to be signed by property owners unless they are responsible for e construction and are not hiring a licensed Contractor to assume this responsibility. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may otect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. . I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. lV5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the lot' value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"under state and federal law. 'Ji 6. 1 understand if I am considered an"employer"under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject me t4 serious financial risk. V _7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. �. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. OirnerRmTderFoi n) 2010.doc revised 04//4/10 l -2c�� vv �7Z GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 MIS C CUPERTIN,.O-// (408)7773228•FAX(408)777-3333• buildino(aJcupertino.orp (_✓JPLUMBING AECRAMCAL CIFTFCTRICA.I. EIMISCaLANEOUS PROJECT ADDRESS Z ��/,✓,�vJ1 �FR C AFYNSZFJ -�JLa � �Qy _ E_- cp.. _FU o�p OWNFRNAA(E T� kj,U r 1 sraEfrAnoREss7 �jc �. tet -i+t0DJtr , 46`3m dlW CONTACT NAME .� xe �SrREEETADDRSSS L % L. ''/ CITY.STATE, ZO'�[.yt-.a - .t- C, AJt /0 N ❑ OWNmt. JBVpJ]IER' . ❑ OWNER AGENT ❑ CONTRACIUR ❑CONTRACTOR AOFM ❑ ARt}iIIF1.r ❑E:@rlfR ❑ orvE )PFR ❑ TENANT CONTRACTOR NAME IAZ UCENYN _T LT E BUS LICA COAD'ANYNAME J fn E-MMAI S -.FAX �' i 7�- a 7�3 srxEEr nnDRFsa / 0 L 1 n Ld'Lh�rc , -D atv.STATE.� .�t]..e Sr i z PH 7j- o ARCHITEMENGUMERR NAME LICENSE NUMBER BUS.LIC E COMPANY NAMEE-MAIL FAX STREET ADDRESS CITY.STATE,ZIP PHONE USE OF ❑SFDwDup= ❑ MULTT-FAIRY PROJECTJNWI DLWD ❑ Y6 PROTECT IN [3YESS TSTHEMMAN 13 YES BUILDING. ❑COMERaAAL URBANTNTERFACEAREA ❑ NO FLOOD ZONE ❑NO ECHIFA HOME/ ❑No DESCRIPTION OF WORK - aAj •1,�iT G- TOTAL VALUATION: O O RECEIVED BY: By my sign-Lae bdoW,I catify to each of the followhtg. I am the property owner ar antboriad agent to act oo the property owner's behalf I have read this application and the iofOrmation I have provided is couect�have read the Descriptive of Work and verify it is acuate. I agree to comply with all applicable local ortlinmrces and state laws relating to g traction. I auth repmseomtives of Cupertino to enter dee above-identified perry for inspection pu@oses. Siguahu,ofAppGcaadAgrnC l V\ C/ C Dare: �'1(7�Z ' J Z- SUPPLMW=AL INFORMAITOFIMqUMED OFFICE USE ONLY u OVER-THE-COUNTER ❑ EXPRESS u m ❑ STANDARD u 3 ❑ LARCE ❑ MAJOR MPPMrscApp 2011.dac revised 06121111