11090053 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10220 VISTA DR CONTRACTOR:DEMPSTER PLUMBING PERMIT NO: 11090053
OWNER'S NAME: CHU YAO K AND HUEI-LAN C 1639 POMONA AVE DATE ISSUED:09/07/2011
OWNER'S PHONE: 6507764407 SAN JOSE,CA 95110 PHONE NO:(408)295-3911
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL
License Class l.J CJ Lic.# U 1) C RE-PIPE INTERIOR AND MAIN SERVICE, 16 FIXTURES
Contractor 1A.411'apt D etsl& t4— Date 712-0
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:$9000
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 APN Number:31624017.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT#E113RES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHINAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We)agree to save 180 DAYM 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 — r /
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source re 1 ons per the Cupertino Municipal Code,Section
9.18.
�ry/ RE-ROOFS:
Signature Date "C ` /�� / 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.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct 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 2550 25 33,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized agent: Date1712-0 j
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 as 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,
posts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
sting of this permit.Additionally,the applicant understands and will comply
.,h all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: Co �,>-a Vise.,- po . PERMIT# 39
OWNER'S NAME: Alteo. Yq PHONE# 106
GENERAL CONTRACTOR: &T( :,tvn d' BUSINESS LICENSE#
ADDRESS: -o".1 CITY/ZIPCODE: 7f
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V 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
f
Owner/Contractor Signature Date
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 31624017 . 00
DATE ISSUED. . . . . . . : 09/07/2011
RECEIPT #. . . . . . . . . BS000014691
REFERENCE ID # 11090053
SITE ADDRESS 10220 VISTA DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER CHU YAO K AND HUEI-LAN C
ADDRESS 10220 VISTA DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2024
RECEIVED FROM . . . . : ALLEN YU
CONTRACTOR . . . . . . . : WILLIAM DEMPSTER LIC # 31263
COMPANY DEMPSTER PLUMBING
ADDRESS 1639 POMONA AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
TELEPHONE (408) 295-3911
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, 000 . 00 1. 00 0 . 00 1 . 00 0. 00
1BPWSVCS WATER SERVICE 1 . 00 22 . 00 0 . 00 22 . 00 0 . 00
1BSEISMICR VALUATION 9, 000 . 00 0 . 90 0 . 00 0 . 90 0 . 00
1PPERMITFE FLAT RATE 1 . 00 44 . 00 0 . 00 44 . 00 0 . 00
1PRREPIPE NO OF FIXTURE 16 . 00 192 . 00 0 . 00 192 . 00 0. 00
1TRAVDOC FLAT RATE 1 . 00 44 . 00 0 .00 44 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 344 . 90 0 . 00 344 . 90 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 344 . 90 MC
---------------
TOTAL RECEIPT 344 . 90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10220 Vista Dr. DATE: 09/07/2011 REVIEWED BY: gs
APN: BP#: "VALUATION: 1$9,000
y PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPRP
USE: p PERMIT TYPE:
WORK Re i e interior and main service. 16 fixtures
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Re-Pipe Interior 1PRREPIPE 16 # $192
Water Service 1BPWSVCS 1 # $22
—7
TOTALS: $214.00
T7Plumb.Plan Check 0.0 hrs $0.00
Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs $44.00
NOTE: Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-153 Eff. 77.-%1) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $214.00
PME Permit Fee: $44.00
Work Without Permit? 0 Yes G No $0.00
Travel Documentation Fee: 1TRAVDOC $44.00
Strong Motion Fee: IBSEISMICR $0.90 Select an Administrative It�!4.,
m
Bldg Stds Commission Fee: 1BCBSC $1.00 qo
SUBTOTALS: $303.90 $0.00 TOTAL FEE:. $303.90
Revised: 07/04/2011
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• building(d,)cupertino.org MISC
CUPERTINO I
(�
PLUMBING ❑MECHANICAL ❑ELECTRICAL []MISCELLANEOUS
PROJECT ADDRESS 102"W
O2W /IS u f2-d
OWNER NAMEA I I efl\ T,A �v ^j� , / PHONE /To '774
7 7 /OV Y P7 E MAILej y ( `1
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STREET ADDRESS 1 Z3 1 V1 t'n ( �, C .(3� CITY, STATE,ZIP C� N�V a4r G/� FAX
CONTACT NAME (L ek, PHONE E-MAIL
STREET ADDRESS 01
" f ((L)Y e CITY,STATE, ZIP FAX
0�10WNER ❑ OWNER-BUILDER ❑ OWNER AGENT ')�,CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME W I��l �Q1 LICENSE Ij1JMB-ERO LICENS TYPE BUS.LIC#
COMPANY NAME 'l!)y� ��V I!1 �, E-MAIL FAX
STREET ADDRESS [`0 PD 1-nim of �D CITY,STATE,ZIP 5W �O��I PHONF41n-S40 �0Q*
ARCHITECTIENGINEER NAME 1 `J LICENSE NUMBER BUS.LIGE## 7 / O
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN �NO
YES
BUILDING: [3 COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE EI No EICHLE/R HOME?
DESCRIPTION OF WORK L o /+ ((�,�e 6 C 14�e,
Pf
TOTAL VALUATION: O t!U RECEIVED BY:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have ead this
application and the information I have provided is correct., ave ad the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constructi oni r resentatives of Cupertino to enter the above-id nytified property for inspection pu{poses.
Signature of Applicant/Agent: Date: �/ /Z f
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
❑ OVER-THE-COUNTER
❑ EXPRESS
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w ❑ STANDARD
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❑ LARGE
e,
❑ MAJOR
MEPMrscApp_2011.doc revised 06121111