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12070252 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 907 S STELLING RD CON"I'RACPOR:ABLE SEPTIC PERMIT NO: 12070252 OWNER'S NADTE: YUEN ALEX AND MABEI, P O BOX 24819 DATE ISSIJED:07/312012 OWNEWSPIIONE: 4082527701 SAN.JOSE.C\ 95154 PHONENO:(408)377-9990 ❑ LICENSED COSI'RAC`f0R'SDECLARATION BUILDING PERiMIT INFO: BLDG r r ELECT PLUMB r.— License Class C y 7 Lie.p i� 1 IQ 775 r r r ,Z AIF,CII RRESIDENTIALCCOMMERCIALContractor ABLE CP�I1 le i 0 N� Date a-31 1 hereby affirm that Into licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALLATION OF BUILDING SEWER AND PROPERTY (commencing with Section 7000)of Division e e the Business S Professions LINE Cute and that my license is in lull force and c!lect. CLFANOl1T 1 hereby affirm ander penally 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 perfommnce of the work Ibr which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,fur[lie performance of the work fonvhich this Sq.FI Floor Area: µluation:$3700 pennit is issued. v ,Us application and state that the ANNNumber:35906016.0� � Occupancc'I)pc 1 cenilythm I have real this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating v to building construction,and hereby authorize representatives of this city enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT 'PI , I.S' IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence ofthe WITHIN 180 NYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 3�'I2 .{l,, �� I ' Issued by: ,IG/T� Date: 7 3I-�� SignaWrc Dam ❑ OWNER-BUILDER DECLAR,%TION RE-ROOFS: 1 hereby affirm that I am exempt from the Contractor's License Law fur one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following nvo reasons: installed without first obtaining rut inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection, will do the work and the structure is not intended or oD'ered for sale(Sec.7044, Business B Professions Code) Signature of Applicant: Date: I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business K Professions Code). ALL ROOF COVEIRLNGS1'0 HE CLASS"A"OR BTI ITR hereby affirm under penalty of perjury one of the following three declandions: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate ofConscnt to self-insure for Worker's Compensation.as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health S Safety Code,Sections 25505,25533.and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth S Section 3700 of the Labor Code,for the performance ol'the work for which this Safey Code.Section 25532(x)should I store or handle hazardous material. Additionally,should 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the[fay Arca Air Quality Management District I will m• I certify that in the performance of the work for vhich this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Ilealth S Safety Code,Sections 25505,25533.and 25534. Compensation laws of Cali forma. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must O -er or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. S o5 C L_ Cut✓Z )air: 7 Z I ' �' CONS-1'RIICI'10N LENDING AGENCY APPLICANT CER1'IFICATION 1 certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of cork's correct. I agree to comply with all city and county ordinances mid state Imus relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to smc indemnify and keep harmless the City of Cupertino ag.unst liabilities,judgments, Lender's Address costs,and expenses mvhich may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCUITECI"S DECLARA'T'ION with all non-point source regulalias per the Cupertino Municipal Code,Section 9.18. I understand my plus shall be used as public records. Signature Date Licensed Professional 1 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 907 So. Stelling Road DA'Z'E: 07/31/2012 REVIEWED BY: Sean \ APN: BPq: 'VALUATION: $3,700 *PERMPrT\'PE: Plumbing Permit PLAN CIIECK'1'\'PE: Alteration /Addition / Repair At PRIMARYPENTAMATION USE: SFD Or Duplex PERMITTI'PE: 1RPS WORK Installation of building sewer and property line clean out. SCOPE APPLIANCE/EQU11'TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 2 # $46 TOTALS: $46.00 Meth. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Fl,,. Plan Check Afech.Permit Fee: Plumb. Permit Fee: IPPF-R,i11T Dec.Permit Fee: Other Afech.Imp. Other Plumb Insp. 0.0 hrs $45.00 Otter Elev.1nsp. El ,Neth.Insp. Fee: Plntnh. Insp. ree:. Elec.Insp.Fee: NOTE: This esdinate Anes not include fees due to other Departments(i.e. Planning, Public(Yorks, Fire,Sanitary Sewer District,School District,etc.). These feev are based on the lrelitninarl information available and are only an estimate. Contact the Dept for nrldn'(in n. FEE ITEMS (Fee Resolution 11-053 Ln' LLLI U FEE QTY/FEE MISC ITEMS Plan Check Fee: Seppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $46.00 PME Permit Fee: $45.00 Construction Tax Administrative Fee: (ADMIN $42.00 Work Without Permit? O Yes (j) No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRA I'DOC $45.00 Strone Motion Fee: IRSEIS,HICR $0.50 Select an Administrative Item Blde Stds Commission Fee: IRCBSC $1.00 SUBTOTALS: $179.501 $0.001 TOTAL FEE: $179.50 Revised: 07/01/2012 ('-6 7,4-)-T J ZS Z GENERAL PERMIT APPLICATION M E P Em COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 I p� CUPERTINO (408)777-3228 • FAX(408)T77-3333 •buildinc(c)CUDenno.org tl v ®1 �LLUMBLNG ❑\fECI=aNiCAL ❑ELECT2:CA.L ❑wscaLe YE0U5 FROESCT ADDRESS O 3 C. lo cA W .{•W �� 'o — OI V/ OWNERNAME U V(le ?HONE Z 7 I E-MAR SIAEETADORESS CRT. STATE,ZIP FAX CONTACT NAME PHONE E-MAIL �J d STREET ADDRESS CRY,STATE ZIP FAX ❑OWNER 11OWNER-BU11DR ❑ OWNER At, , CONTRACTOR ❑CONTRACfok ACEM ❑ ARCmECr ❑ENGINEER ❑ DEVELOPER ❑ �YANr CONTRACTOR NAME LICENSENUMBER V I / I LICENSE TYPE BUS.L'CP COMPANY NAME 46Z i E-MAB- FAX L STRFf7 ADDRESS CTTY.STAT a - C?S I PHO O O ARCHIT'_C IYENOLYEEt NAME LICENSE NUMBER / BUS.Lic l s 774 7S COWANY NAME' I E-MAR b FAX L c u STREETADDRESS I =.STATE,ZIP I PHONE USE OF EX C] MULTI FO m DUPL -F.NDT-Y PROIECT IN WRYES DLAND ❑ I PROTECT IN ❑YES I IS TIL 3LDG AN ❑ YES IN BUTI_DO: Ip COMMERCIAL tIR3AN P'TFRFACE AREA p NO FLOOD ZONE ❑No S(MEIk HOME.' ❑ No DESCRIFMON OF WOR.Y ''`` , a / y�OVT � i sew ,r le TOTAL VALUATION: 3 RECEIVED BY:� By my signa^_.-e below,I cartify to each of ie following: I ata the proper..,owner or authorized agent m act on the property owner's behalf. I have toad this application and the[nunnation I have provided is W=CL I have told the Descipdon of Work and verify it is accurate. I agree io comply wii all applicable local ordinances and state laws relating to building consavc5om II authorize mprescnIatives of Cupertite:_enter the above.ideadfiedprcpc.y for inspection pu:�cscs. Signatvte of Applicant/Ageec �[r e. L \ `(-V C Dam: '� 7 S) - A SUPPLEN, =AL.]INFORMATION AT•iON REQUIRED OFFICE USE ONLY y OVER-THE-COUNTER } ❑ E aFtEss 1 U y ❑ STANDARD V Z ❑ LARGE 5 ❑ NWOR T1g'PMuc.4pp_2011.doc revised 06/?I/11