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11040018 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20941 ALVES DR CONTRACTOR:PRO ROOTER PERMIT NO: 11040018 OWNER'S NAME: JUN ZHAO 438 SAN LEANDRO BLVD DATE ISSUED:04/04/2011 OWNER'S PHONE: 4084803303 SAN LEANDRO,CA 94577 PHONE.NO:(510)670-1115 I�ICEN$�ED CONTRACTORS DECLARATIONBUILDING PERMIT INFO: BLDG r ELECT PLUMB License Class G Lic.# MECH r— RESIDENTIAL f— COMMERCIAL Contractors?/;?y dgL_C5fJ,( Date �GG JOB DESCRIPTION: INSTALL PROPERTY LINE CLEAN OUT I hereby affirm that I am licensed under the provisions of Chap er 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: t�, v^ ', Valuation:$1500 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 Numbu3 3 .0 Occupancy Type: permit is issued. 7. APPLICANT CERTIFICATION ` I certify that I have read this application and state that the above information is PE EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM 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 Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: SignatuG Date 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 I,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 25 ,255 ,and 25534. 00, Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ate:©G 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 CONSTRUCTION LENDING AGENCY 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 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, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. .ing of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228 •FAX(408)777-3333•buildin jacupertino 0- //� CU ERTINO ❑NEW CONSTRUCTION ❑ ADDMON ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT� # XPN PROJECT ADDRESS v © / / ljul !/ PHONE � � E-MAIL OWNER NAME �� FAX CITY, STATE,ZIP STREET ADDRESS PHONE E-MAIL CONTACT NAME ` FAX CITY,STATE, ZIP STREET ADDRESS ❑OAR ❑ OWNER-BUII-DER ❑ OWNERAGENT CONTRACTOR ❑CONTRACrORAGENT ❑ ARCHITECT ❑INR ❑ DEVELOPER ❑TENANT LICENSE NUMBER LICENSE TYPE BUS.LIC# CONTRACTOR NAME (jam� _ r FAX E-MAIL COMPANY NAME PHONE CITY,STATE,ZIP STREET ADDRESS BUS.LIC ik ARCHITECT/ENGINEER NAME LICENSE NUMBER FAX E-MAIL COMPANY NAME CITY,STATE,ZIP PHONE STREET ADDRESS DESCRIPTION OF WORK i m� C i Y EXIS GUSE PROPOSED LSE CONSTR.TYPE #STORIES A i EXIST NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA AREA BATHROOM KITCHEN OTHER y x REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA:❑ DETACH h ❑ ATTACH p DWELLAIG UMTS: IS A SECOND UNITC]YES SECOND STORY ❑YES BEING ADDED' ❑NO ADDITION, ❑NO ' PRE-APPLICATION ❑ YES IF YES,PROVIDE COPY OF PLANNER'S NAME: RECENED 13Y' ���. 'TgTitT,VALUA2Z01rt �; PLANNING APDL p ❑ NO PLANNING APPROVAL 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.LM-MRI have read this ble local have renesentat application and the information have provide i scorrect. I authorize ad the repriv s of Cupertino to enter the above-identified property for inspectionof Work and verify it is accurate. I agree to comply with all1purposes. orto dinances and state laws g Date: Signature of Applicant/Agent: &RpLITINTG'SETP SUPPLEMENTAL INFORMATION REQUIRED , h New SFD or Multifamily dwellings: Apply for demolition Pe OVER xaE colsi�ITER ratT DII' � vl>�w rmit for existing building(s). Demolition permit is required prior to issuance of building E7CPR3 permit for new building. r»srwaRl _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTANnARD FIREDhEG form if any Hazardous Materials are being used as part of this project. ❑ i aRCE _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJQR Q SAPFI eSRY$EWERDISTM' submittal of Building Permit application. :❑,ENuitaNn�riTI a�A'T ` BldgApp_201 Ldoc revised 03/16/11