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11080069 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10357 VISTA KNOLL BLVD CONTRACTOR:QUICK PLUMBING INC PERMIT NO: 11080069 OWNER'S NAME: JOHN WANG 1044 MARTIN AVE DATE ISSUED:08/09/2011 '"ER'S PHONE: 4082058458 SANTA CLARA,CA 95050 PHONE NO:(408)732-1220 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License C r Lic.# 1�7 2 MECH RESIDENTIAL COMMERCIAL ContractoDate I hereby affirm that censed under the provisions of Chapter 9 JOB DESCRIPTION:MAIN WATER SERVICE REPLACEMENT (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:$2000 1 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 permit is issued. APN Number:32613118.00 Occupancy Type: APPLICANT CERTIFICATION 1 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 EXPIRES 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 keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of ermit. Additionally,the applicant understands and will comply G with all no -poin ource re ul 'ons per the Cupertino Municipal Code,Section Issued by:- ��' Date: 9.18. Signature Date — 20 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,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). I 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 1 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,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 contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the &Safety Code,Sections 25505,25533,and 25534. 1 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 O er r aut i �d ag Compensation laws of California. If,after making this certificate of exemption,I Dater/f become subject to the Worker's Compensation provisions of the Labor Code,I 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.) 1 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, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION .ng of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. wan all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32613118. 00 DATE ISSUED. . . . . . . : 08/09/2011 RECEIPT #. . . . . . . . . : BS000014363 REFERENCE ID # . . . : 11080069 SITE ADDRESS . . . . . : 10357 VISTA KNOLL BLVD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . JOHN WANG ADDRESS . . . . . . . . . . : 10357 VISTA KNOLL BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1035 RECEIVED FROM . . . . : RICHARD V JOHNSON CONTRACTOR . . . . . . . : RICHARD JOHNSON LIC # 24938 COMPANY . . . . . . . . . . : QUICK PLUMBING INC ADDRESS . . . . . . . . . . : 1044 MARTIN AVE CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050 TELEPHONE . . . . . . . . : (408) 732-1220 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 2, 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 2, 000 . 00 0 .50 0 . 00 0.50 0. 00 1PPERMITFE FLAT RATE 1. 00 44 . 00 0 . 00 44 . 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 ----------------- --------------- -------------------- CHECK 152 .50 #8123 --------------- TOTAL RECEIPT 152 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION MDDRESS: 10357 vista knoll DATE: 08/09/2011 REVIEWED BY: bobs. PN: I BP#: "VALUATION: 1$2,000 °PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPWS USE: PERMIT TYPE: WORK main water service replacement. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Service 1 BPWSVCS 1 # $22 TOTALS: $22.00 Plumb.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 in ormation available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS thee Resolution 11-05h;ff. 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 G No $0.00 Travel Documentation Fee: 1 TRA VDOC $44.00 Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee B1dYStds Commission Fee: IBCBSC $1.00 $41.00 DMIN SUBTOTALS: $111.50 $41.00 TOTAL FEE: $152.50 Revised: 07/04/2011 it � 0% 0c)6Q GENERAL PERMIT APPLICATION _- MEP COMMUNITY DEVE=LOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTIN® (408)777-3228 • FAX (408)777-3333 • building(5cuDer?inG.org misc PLUi4MING ❑:.,ECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS PROTECT ADDRESSAPN m 1 03,-S-7 �(i s -�Q }4n o ( 1 l OWNER NAME l j v� PHONE20 0 /� / S-Q E-MAIL STREET ADDRESS/ ' >� \ l I S, �a �Y1 C U I I CITY, STATE,ZIP C.L" n4 I /� FAX CONTACT NAME .�� I„ �Q�) PHONE E-MAIL STREET ADDRESS/`/.(J L/,r I J COY STATE, FF t•f� ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 13 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTCR NAME ,, M LICENSE NUM�B -NST COMPANYN STREET ADDRESS q CITY TATE,ZIP lbotl �}Pq C ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME' E-Nckm FAX STREET ADDRESS CITY,STATE,ZIP PHONE .SE OF ffSFO o,-DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK TOTAL VALUATION: �. DO ��- RECEIVED BY: By my signature below,' c ch of 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 have ovided is c ect.,.I have read the Description of Work and verify it is accurate. I agree to comply�Arith all applicable local ordinances and state laws relari�tg to bui 'ng con o I authori resentatives of Cupertino to enter the above-identiEed property for inspection purposes. c =� l/ Signature of ApplicandAgedt±'1 '`-"--� Date: SUPPLEME INFO TION REQUIRED OFFICE USE ONLY W L—aVER-THE-COUNTER a ❑ EXPRESS s U W ❑ STANDARD U ❑ LARGE ❑ MAJOR NIEPMImlpp=2011,doc revised 06/21/11 Building Department City Of Cupertino La 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: /D S PERMIT# OWNER'S NAME: '1J ! �,. PHONE# GENERAL CONTRACTOR: ,`L r?'tet` 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 FIN CCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND L S2UBC TORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signat re 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 N Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date