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11080135 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10340 WESTACRES DR CONTRACTOR:GENMOR PLUMBING PERMIT NO: 11080135 OWNER'S NAME: TSAI GRACE TRUSTEE&ET AL 2552 SEABOARD AVE DATE ISSUED:08/17/2011 t"`-'ER'S PHONE: 4082531592 SAN JOSE,CA 95131 PHONE NO:(408)855-8348 �I LICENSED CONTRACTOR'S DECLARATION //J�((�� (^ BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# lV I j�/�((�J �n � -611 � MECH RESIDENTIAL COMMERCIAL Contractor Iy r 11"'V r V' 1►' C� 1 if I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COPPER REPIPE,40FT OF WATER SERVICE (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: 1 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:$4000 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 ch thjs permit is issued. / APN Number:35914018.00 Occupancy Type: APPLICANT CERTIFICATION 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 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 FRPM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the grantingIthis dditionally,the applicant understands and will comply �_// with all urce r ulations per the Cupertino Municipal Code,Section Issued by• bC ��' Date9.18. •`671 111 SignaturDate `) RE-ROOFS: i 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 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(x)should I store or handle hazardous material. I 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 [certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's a thori d a Compensation laws of California. If,after making this certificate of exemption,I Date: 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.) 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, 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. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35914018 . 00 DATE ISSUED. . . . . . . : 08/17/2011 RECEIPT #. . . . . . . . . : BS000014474 REFERENCE ID # . . . : 11080135 SITE ADDRESS . . . . . : 10340 WESTACRES DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER TSAI GRACE TRUSTEE & ET AL ADDRESS . . . . . . . . . . : 10340 WESTACRES DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : GENMOR PLUMBING, IN CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101 COMPANY GENMOR PLUMBING ADDRESS 2552 SEABOARD AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 855-8348 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 4, 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 4, 000 .00 0.50 0. 00 0 .50 0.00 1PPERMITFE FLAT RATE 1 .00 44 . 00 0. 00 44 .00 0. 00 1PRREPIPE NO OF FIXTURE 1. 00 12 .00 0. 00 12 .00 0. 00 1TRAVDOC FLAT RATE 1. 00 44 . 00 0. 00 44 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 164 .50 0 . 00 164 .50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 164 .50 #9070 --------------- TOTAL RECEIPT 164 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10340 westacres dr DATE: 08/17/2011 REVIEWED BY: larry s APN: BP#: VALUATION: 1$4,000 R'PERMITTYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPRP USE: PERMIT TYPE: WORK �co er re i e 40 feet of water service SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $12 Water Service 1 BPWSVCs 1 # $22 TOTALS: $34.00 Plumb.Plan Check 0.0 hrs $0.00 . T 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 addh 7 info. FEE ITEMS (Fee Resolution II-053 1,.. ?1.-11) FEE QTY[FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $34.00 PME Permit Fee: $44.00 Work Without Permit? 0 Yes No $0.00 Travel Documentation Fee: ITRA VDOC $44.00 A Strong Motion Fee: 1BSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: 1BCBSC $1.00 $41.00 ]ADMIN SUBTOTALS: $123.50 $41.00 TOTAL FEE: $164.50 Revised: 07/04/2011 ltlok6l� y GENERAL PERMIT APPLICATION MEP LM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•building(akupertino.org MISIC CUPERTINO LUUM�Bf INNGG ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS / PROJECT ADDRESS M1 A P N# J y 0 OWNER NAME / P 'c)G - ( E-MAIL STREET ADDRESS 1 �� W CTf A/a DL CIT , STAT Pno C _ I FAX CONTACT NAME 1/ PHONEf06 _& _Q?I f E-MAIL STREET ADDRESS 201 bwot 4vel CITY E„QIP /N FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME /'�/Jnr A4 y �,/ �I ,JLICENSE NU /^ LICENSF/f�P�� BUS.LIC# COMPANY NAME !L`/'/r '�( �r �(/' E-MAIL (J(J (� FAX STREET ADDRESSa5(4$ Ta{ Dal-a the CITY, E, IP ^ • PHONE I C6 ARCHITECT/ENGINEER NAME LICENSE NUMBER U BUS.LIC# 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 ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME'? ❑ NO DESCRIPTION OF WORK cow r� �r 'g, and 11W---ilorfi 4>710 wpvice, (,f cam TOTAL VALUATION: 4 RECEIVED BY: By my signature below,1 certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information 1 have provi correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating I con r tion. I authorize representatives of Cupertino to enter the aboI6e-i entifi d property for inspection purposes. Signature of ApplicanUAgent: Date: b h I SUPVZ,E NTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER eL F' ❑ EXPRESS x ❑ STANDARD U a ❑ LARGE a [E] MAJOR MEPMiscApp_2011.doc revised 06/21/11 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: PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# '3r4 VI ADDRESS: a CITY/ZIPCODE: y r "Our municipal code requires all businesses working in the city to have a City of Cupertino b iness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU TORS HAVE OBTAINED ACITY F CUPERTINO BUSINESS LICENSE. l� I am not using any subcontractors: S' nature Date 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