11090141CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10840 ALDERBROOK LN
CONTRACTOR:
ERMIT NO: 11090141
OWNER'S NAME: YOO HYUNG MO & JEONG SOO
In / ✓ ,eo
DATE ISSUED: 09/20/2011
OWNER'S PHONE: 4084469560
7 j ,s J
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
C��
( ✓ &61_ / r— F
CJ GJ�J�
BUILDING PERMIT INFO: BLDG ELECT PLUMB
//
License Class Lic. #
Contractor l(( t fCJDI 'Date / "� `1
MECH RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: PROPERTY LINE CLEAN OUT FORS WE
(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
9,
performance of the work for which this permit is issued.
4
Sq. Ft Floor Area:
Valuation: $1500
I have and will maintain Worker's Compensation Insurance, as provided for by
a
J
Section 3700 of the Labor Code, for the performance of the work for which this
I
Ulf
APN Number: 36920037.0
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
f
'
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
PERMIT E'2ES IF WORK IS NOT STARTED
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and kee harmless the City of Cupertino against liabilities, judgments,
180 DAYS FROM LAST CALLED INSPECTION.
costs, and expens which may accrue against said City in consequence of the
granting of thisierfriit. Additionally, the applicant understands and will comply
with all non -p urce regulations per the Cupertino Municipal Code, Section
Issued ba . Date::
9.18.
c
r � �/
Signature
Date //
RE- ROOFS:
OWNER- BUILDER DECLARATION
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
by affirm that I am exempt from the Contractor's License Law for one of
inspection.
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
Signature of Applicant: Date:
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self - insure for Worker's
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Compensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
performance of the work for which this permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additi ally, should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code, for the performance of the work for which this
c mta ants as defined by the Bay Area Air Quality Management District I will
permit is issued.
mai a• compliance with the Cupertino Municipal Code, Chapter 9.12 and the
He h e, Sections 25505, 25533, and 25534.
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 as to become subject to the Worker's
or' agent:
/
Compensation laws of California. If, after making this certificate of exemption, I
Date: U
become subject to the Worker's Compensation provisions of the labor Code, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
I certify that I have read this application and state that the above information is
Lender's Name
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
Lender's Address
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
ARCHITECT'S DECLARATION
g—ling of this permit. Additionally, the applicant understands and will comply
1 understand my plans shall be used as public records.
i! non -point source regulations per the Cupertino Municipal Code, Section
'
Licensed Professional
Signature Date
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408 - 777 -3333
JOB ADDRESS: /
PERMIT # %
OWNER'S NAME: ,/�
PHONE #
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS: -
CITY /ZIPCODE: e
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPA CY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUB NTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
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
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36920037.00
DATE ISSUED.......: 09/20/2011
RECEIPT #.........: BS000014807
REFERENCE ID # ...: 11090141
SITE ADDRESS .....: 10840 ALDERBROOK LN
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OWNER ............: YOO HYUNG MO & JEONG SOO
ADDRESS ..........: 10840 ALDERBROOK LN
CITY /STATE /ZIP ...: CUPERTINO, CA 95014
OPERATOR: suew
COPY # : 1
RECEIVED FROM ....: PROS PLUMBING
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
- - - - --
---- - - - - --
lADMIN
------- - - - - --
HOURS
---- - - - - --
1.00
---- - - - - --
41.00
---- - - - - --
0.00
---- - - - - --
41.00
----
0.00
1BCBSC
VALUATION
1,500.00
1.00
0.00
1.00
0.00
1BSEISMICR
VALUATION
1,500.00
0.50
0.00
0.50
0.00
1BUSLIC
FLAT RATE
1.00
115.00
0.00
115.00
0.00
1PPERMITFE
FLAT RATE
1.00
44.00
0.00
44.00
0.00
1PRSEWER
UNITS
1.00
22.00
0.00
22.00
0.00
1TRAVDOC
FLAT RATE
1.00
44.00
0.00
44.00
0.00
- - --
TOTAL PERMIT
---- - - - - --
267.50
---- - - - - --
0.00
---- - - - - --
267.50
---- - -
0.00
METHOD OF PAYMENT
--------------- --
CHECK
TOTAL RECEIPT
AMOUNT
---------------
267.50
---------------
267.50
VOICE ID DESCRIPTION
-- - - - - -- ---------------------- - - - - --
106 SEWER & WATER
301 ROUGH PLUMBING
507 FINAL PLUMBING
REFERENCE NUMBER
--------------- - - - --
5336
VOICE ID DESCRIPTION
-- - - - - -- ---------------------- - - - - --
202 UNDERFLOOR PLUMBING
400 SEWER /LATERAL
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildinge- cupertino org
LURING ❑ MECHANICAL ❑ ELECTRICAI
MEP
MISC
I MTS('FT.T.A'VPnT IC
PROJECT ADDRESS
APN #��
- - - - - -
OWNER NAME
Q �/j/9`ONE V �U l
/
E-MAIL
STREET ADDRESS
S �_-
STATE, ZIP
I
FAX
r
CONTACT NAME
PHONE
E-MAIL
STREETADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME /
LICENSE ER
LICENSE TYP
BUS. LIC #
COMPANY NAME
E-MAIL
FAX y �y
STREET ADDRESS / p
CITY, STATE, ZIP
�/ %
PH _//(9 /
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME '
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF FY ❑ -77_pA y
BUILDING: ❑ COMMERCIAL
pROJECT IN WILDLAND ❑YES
URBAN INTERFACE AREA NO
PROJECT Al ❑YES
FLOOD ZONE ❑
IS THE BLDG AN El YES
❑
NO
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
/� ✓r � /7 Pi
er'
TOTAL VALUATION:
RECEIVED BY:
G
By my signature below, I certify to each
f e followi I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have o
ordinances and state laws relating to
i cone .�� have read the Descri lion of Work and verify it is accurate. I agree to comply
with all applicable local
T]
g c
ng cc on. I representatives o upe ter the abo 'dentified property fo inspection pufposes.
Signature of Applicant/Agent:
Date: —
UP LEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
OVER - THE - COUNTER
a
❑ EXPRESS
U
w
❑ STANDARD
U
❑ LARGE
c
❑ MAJOR
MEPMTscApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
iaADDRESS:
10840 alderbrook In
--7DATE:
09/20/2011
REVIEWED BY: bobs.
BP FEES
APN: , % G Ci�
BP #: Ile/ ' 9vl
"VALUATION: 1$1,500
°PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
$22
PENTAMATION 1 RPSS
PERMIT TYPE:
WORK
install property line clean out
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY/FEE
QTY
UNITS
BP FEES
Sewer, Sanitary
1 PRSEWER
1
#
$22
PME Unit Fee:
$22.00
PME Permit Fee:
$44.00
Administrative Fee: IADMIN
$41.00
Work Without Permit? 0 Yes Q No
$0.00
TOTALS:
A
Travel Documentation Fee: ITRAVDOC
$22.00
Strom Motion Fee: IBSEISMICR
Plumb. Plan Check 10.0 1 hrs $0.00
Plumb. Permit Fee: 1PPERMIT
Other Plumb Insp. 1 0.0 1 hrs 1 $44.00 1
NOTE: This estimate does not include fees due to other Depts (i.a Public Works, Sanitary Sewer District, School District, etc.).
These fees are hated on the nrelindnary intormation available and are only an estimate_ Contact the Dent for addn'l info_
FEE ITEMS (Fee Resolution 11 -053 Elf. 7'711)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
PME Unit Fee:
$22.00
PME Permit Fee:
$44.00
Administrative Fee: IADMIN
$41.00
Work Without Permit? 0 Yes Q No
$0.00
A
Travel Documentation Fee: ITRAVDOC
$44.00
Strom Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bl.diy Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$152.50
$0.00 TOTAL FEE.T
$152.50
Revised: 09/02/2011
113—, ev �6,1—
�9 & , SZ)
DISTRICT MANAGER-ENGINEER
MARK THOMAS & COMPANY, INC
RICHARD K. TANAKA
DISTRICT COUNSEL
ATKINSON . FARASYN. LLP.
HAROLD S. TOPPEL
September 22, 2011
City of Cupertino
Building Department
10300 Torre Ave.
Cupertino, CA 9501.4 -3202
SNNITA
v �
to
4Bl IS NEO 1�h
20833 STEVENS CREEK BOULEVARD, SUITE 104
CUPERTINO, CALIFORNIA 95014-2154
(408) 233.7071 PHONE • (408) 2535173 FAX
www. cupertin osenitaryd istrict, CDM
Subject: Residential. — Install. property line Clewi Out
Name: N/A Residence
Address: 10840 Ald.erbrook Lane
APN: 369 -20 -037
Permit No. 110901.41
BOARC) OF DIRECTORS
WILLIAM A. 130SWORTI -I
JOHN M, GATTO
STEVE C. ANDREWS
WENDELL H. KERR, JR.
CHRISTOPHER C. LCE
File: CSD — MOP
Building Dept. — Cupertino
The Cupertino Sanitary District has reviewed the plans for the subject project:
■ Sanitary sewer is not provided by the District to the subject location, please contact:
City of Sunnyvale — One Stop Center
456 West Olive Avenue
Sunnyvale, CA 94086
(408) 730 -7444
Yours very tnlly,
MARK THOMAS & COMPANY, INC.
District Manager- Engineer
for Richard K. Tanaka
C*" V(4
V Of2r
If you have any questions or need additional information, please call Nichol Bowersox at
408.253 -7071.
S \W( N, Li I I IIRtiIII(111.1)IN(] OF111 1.1 '1 11 {I0\NO'I ICI I I II, 1)1'lI RI('I%,i uv 1)isnlci 7.011 \11040111 NII) 10340 AI(ICIblook
I n Ni.ih 1 NID 09.2). -2011 dog:
SUPPLYING SANITARY SEWERAGE SERVICES FOR: CITY OF CUPERTINO, PORTIONS OF THE CITIES OF SARATOGA, SUNNYVALE, LOS ALTOS AND
SURROUNDING UNINCORPORATED AREAS