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11080017 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10265 MENHART LN CONTRACTOR:TATS INC DBA MR PERMIT NO: 11080017 ROOTER PLUMBING OWNER'S NAME: LAI KEN KAUNG AND LIN SHU FENG 44777 S GRIMMER BLVD STE C DATE ISSUED:08/02/2011 !ER'S PHONE: 4082182441 FREMONT,CA 94538 PHONE NO:(408)271-2822 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT' PLUMB License Class Lic.# f MECH r— RESIDENTIAL� COMMERCIAL � Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 2 JOB DESCRIPTION: INSTALL NEW PROPERTY SEWER LINE&PROPERTY (commencing with Section 7000)of Division 3 of the Business&Professions LINE CLEAN OUT 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. 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 Sq.Ft Floor Area: Valuation'$5000 permit is issued. r '""A APPLICANT CERTIFICATION APN Number: 2 $0Q Occupancy Type: 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 PERMIT EXPIRES 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 of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of thisermit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non- m source re tions per the Cupertino Munici IC d ,Se i 9.18. 'f Issued bya' Date•. n �• Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an 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 offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I 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 Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminantas defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain c defined 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 Health& ety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner t ri e a e t: � C71-.� forthwith comply with such provisions or this permit shall be deemed revoked. 0/4�ate: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I 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 work's correct.I agree to comply with all city and county ordinances and state laws 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 save -nnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the giwiting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional GENERAL PERMIT APPLICATION � MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTIN® (408)777-3228 • FAX (408)777-3333 • building(c.cuDertino.org misc ❑PLUNIBING ❑_vECHAr1ICAL ELECTRICAL. ❑NGSCELLA11TE0US PROJECT ADDRESS /\ �/ �"� 1�e pi A m 7 fib. J� D OWNER NAME P OJ _ E-MAIL _-vl N 1 H h Y STREET ADDRESS CITY, STATE,ZIP FFAX CONTACT NAME PHONE E-MAIL i STREET ADDRESS CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER.BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACT OR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMET W 4^ fo(A Z$41`� LIC E,f 3r0 ; t,— LICENSE TYPE BUS.LIC# COMPANY NAME J E-MAIL ) FAX n_ �i STR1E?'ADDRESS / 7`� S. r P� �� CITY,STATE, ,�,.�a ` PHO z L� _ ` C.? N v�f- T 7 ARC=CT/ENOINEEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME" E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE JSE OF ❑SFD or DUPLEX ❑ MULTI-FANS Y PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUIIAING. ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK kA r /J,- f ��,, � l; � us �.-. '�., � •ter d} TOTAL VALUATION: j RECEIVED BY: By my signature below,I certify to the following: 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 h e prove d is co4�B; ad the Description of Work and verify it is accurate. I agree to comply atith all applicable local ordinances and state laws relating to uilding onstruze repres tatives of upertino to enter the above `nifedrroperty fo(in=Cdonpuipcses. Signature of Applicant/Agent Date: SUPP EMENTAL INFORMATION REQUIRED OFFICE USE ONLY w ❑ OVER-THE-COUNTER ❑ EXPRESS U ca ❑ STANDARD U ❑ LARGE ❑ MAJOR :1IEP!Lfisc 4pp_2011.doc revised 06121111 CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY ## 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37515027. 00 DATE ISSUED. . . . . . . : 08/02/2011 .RECEIPT #. . . . . . . . . : BS000014278 REFERENCE ID # . . . : 11080017 SITE ADDRESS . . . . . : 10265 MENHART LN SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . : OWNER LAI KEN KAUNG AND LIN SHU FENG ADDRESS 10265 MENHART LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JUAN GUZMAN CONTRACTOR TATS INC LIC # 23496 COMPANY TATS INC DBA MR ROOTER PLUMBIN ADDRESS . . . . . . . . . . : 44777 S GRIMMER BLVD STE C CITY/STATE/ZIP . . . : FREMONT, CA 94538 TELEPHONE (408) 271-2822 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 5, 000 .00 1. 00 0 . 00 1 .00 0. 00 1BSEISMICR VALUATION 5, 000 . 00 0 .50 0 . 00 0 .50 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 152 . 50 0. 00 152 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 152 .50 VISA --------------- TOTAL RECEIPT 152 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING Building Department City Of Cupertino 91 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CU PERTI NO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: ERMIT# l OWNER'S NAME: ,�� V� PHONE # GENERAL CONTRACTOR: A- BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCAUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND AL S BC TRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. —� ( � I am not using any subcontractors: - Signature Date Please check applicable subcontracto and complete the following for &/ 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 FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10265 menhart In. DATE: 08/02/2011 REVIEWED BY: bobs. APN: I BP#: "VALUATION: 1$5,000 °PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPSS USE: I PERMIT TYPE: WORK install new property sewer line and property line clean out. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Building 1PRSEWER 1 # $22 TOTALS: F T $22.00 Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $44.00 NOTE: Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (hie Resolution.11-0531j-f l.-%1) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $22.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 A Strony- Mention Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee B1d(7 Stds Commission Fee: 1BCBSC $1.00 $41.00 IADMIN SUBTOTALS: $111.501 $41.00 TOTAL FEE: $152.50 Revised: 07/04/2011