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13010102 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10769 W ESTATES OR CONTRACFOR­T8i3--49-BH. PERMIT NO:13010102 OWNER'S NAME:HAOQIANG ZHENG a n DATE ISSUED:01/182013 OWNER'S PHONE: 4084212355 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 11 License.Class C'�(� Lic.# 927725, SEWER LINE REPLACEMENT *SEE NOTES Contractor c t C �(vr b, Date [ l 13 I hereby affirm that I am licensed under the provisions of Chapter 9 (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:$3500 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 ppN Number:36923029.00 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 WORK IS NOT STARTED correct.I agree to comply with all city and:countyordinance;and state laws relating WIT IIlV 80 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 DA F OM 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 Issued b Date: granting of this permit. Additionally,the applicant understands and will comply Y with all'non-point source regulations per the Cupertino Municipal Code,Section 9.18.;, (///�/ - p��8�� RE-ROOFS: - Signature .��/ -2—, 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. 13 - OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE concoct 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(a)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 which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. �/ Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:,�7 Date/—/'E' 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 manner so m to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation 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.) Lender'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 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION C) 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 `C�� M ' /� CUPERTINO (408)7773228•FAX(408)777-3333• buildinGCa),cupertino.orG '3 (v- PLUMBING ❑MECHANICAL /� ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS , /1 ^ q . S CXl AFN* OWNER NAME l nJ II n ` PHO &.( —z3S EMAR STREET ADDRESS CITY,STATE,ZIP FAX C•tJfVa'^6 C4- CONTACT NAMEPHO E-MAIL cJngcr`� vNO"Z joF /Ll' Zq ,rf4v-{)3' STREETADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME /I /n. 5 C o c, V q ° LICENSE NUMBER LICENSE TYPE BUS.LIC N Vl'-L ]v- .2. C .f COMPANY NAME q E-RAFAX ICA c /✓� R STREET ADDRESS CRY,STATE,ZIP PHONE ARCHrTECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF [ISM mDUPLEX E3 MULTI-FAMILY PROIECTINW]DLAND 13 YES PROJECT IN ❑YES IS 7HE BLDG AN ❑ YES BUILDING: [3 COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE EJ NO EICHLERHOMEP 0N DESCRIPTION OF WORK �Ll e/,T- TOTAL VALUATION: sD0- t5� RECEIVED BY: By my signature below,I cern to each of the following: I am the property owner or authorized agent to act on e p erty owner's behalf l have read this application and the information I h e provided is comet. I have read the Description of Work and verify it is ace . I agree to comply with all applicable local ordinances and state laws relating buildin construction. I authorize representatives of Cupertino to enter the above-identi84properry for inspection puPposes. Signature of Applicant/Agent:__ Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY lff-;V;ZTHE-COUNTER Y ❑ EXPRESS m - ❑ STANDARD U ❑ LARGE c ❑ MAJOR MEPMescApp_1011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10769 W estates dr DATE: 0111812013 REVIEWED BY: Mendez APN: . BP#: *VALUATION: 1$3,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY PENTAMATION $FD or Duplex 1 RPSS USE: PERMIT TYPE: WORK sewer line replacement SCOPE r FiaSms NNWs. s� Nfech. Non Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Chack Me ch. Perwi[Fee: Plumb.Permit Fee: IPPERMIT flee. Permit Fee: Other Afech.Insp. Other Plumb Insp. 0.0 hrs 1 $45.00 Other Elec.Insp. Li I He&Insp. Fee: Plumb. Insp. FeeElec.Insp.Fee.- - NOTE:This estimate does no[include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,.School. District etc.). Tkese fees are based on the preffinWit ht ormadon available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Et)• 7j1 Q FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Plumbing Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $23.00 IPRSEWER I Sewer, Sanitary PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee:Q Reg. Q OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 C'onsYraction Tar: Administrative Fee: IADMIN $42.00 Work Without Permit? ® Yes Q No $0.00 0 Advanced Planning Feer $0.00 Select a Non-Residential O Travel Documentation Fee: ITRA VDOC $45.00 Building or Structure i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 „ „+ , t ”„s=2 s $133.50 $23.00 TO�ALFEE $156.50 Revised: 10101/2012 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: 1,0 W C-s+ a} PERMIT# OWNER'S NAME: tPHONE# GENERAL CONTRACTOR: M�Q y f vrn en BUSINESS LICENSE# ADDRESS: '(o S q �-atewcecP - , CITY/ZIPCODE: 'UM UcV( 9 Ofs9 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL Olt FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. Nl I am not using any subcontractors: 2-- Signature Signature ate Please check applicable subcontractors and complete the following information: 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