11060220 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18856 ARATA WAY CONTRACTOR:DRAIN DOCTOR PERMIT NO: 11060220
OWNER'S NAME: KIMOON KIM&CHO MIN KYUNG 480 ALDO AVE DATE ISSUED:06/29/2011
"iER'S PHONE: 4089967411 SANTA CLARA,CA 95054 PHONE NO:(408)370-3082
Ll LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I- ELECT F PLUMB f—
License Class C 33.36 di]L,ic.# lS
MECH' RESIDENTIAL COMMERCIAL
Contractor Dt .}0�Date Cf,IX
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE SEWER LINE FROM BLDG TO SIDEWALK WITH
(commencing with Section 7000)of Division 3 of the Business&Professions PROPERTY CLEANOUT(PIPE BURSTING)
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.
1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Flo r Area: Valuation:$6000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:3751300 . rA,ccupancy 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
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK N.' T AT
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT I NCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
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. Issued Date: +
Signature Date n
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons:
inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
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 I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
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
I 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
Compensation laws of California. If,after making this certificate of exemption,I Or~or authorize agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must _��(��� r te_Date:iO4 I
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of mrk's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the
,ig of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
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 . . . . . . . . : 37513007. 00
DATE ISSUED. . . . . . . : 06/29/2011
RECEIPT #. . . . . . . . . : BS000013916
REFERENCE ID # . . . : 11060220
SITE ADDRESS . . . . . : 18856 ARATA WAY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER KIMOON KIM &CHO MIN KYUNG
ADDRESS 18856 ARATA WAY
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DRAIN DOCTOR, IINC
CONTRACTOR . . . . . . . : JOHN H. LIM LIC # 24784
COMPANY . . . . . . . . . . : DRAIN DOCTOR
ADDRESS . . . . . . . . . . : 480 ALDO AVE
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054
TELEPHONE (408) 370-3082
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 0 .50 39. 00 0. 00 39.00 0 . 00
1BCBSC VALUATION 6, 000. 00 1. 00 0 . 00 1.00 0 . 00
1BSEISMICR VALUATION 6, 000 .00 0.60 0 . 00 0.60 0. 00
1PPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 .00 0. 00
1PRSEWER UNITS 1. 00 21. 00 0. 00 21.00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 145. 60 0. 00 145 .60 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 145 . 60 #3103
---------------
TOTAL RECEIPT 145 .60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 18856 arata way DATE: 06/29/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$6,000
'PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPSS
USE: PERMIT TYPE:
WORK re lace sewer line add property line clean out.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Building 1PRSEWER 1 # $21
TOTALS: $21.00
Plumb.Plan Check 0.0 hrs $0.00
[Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs $42.00
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Pe Resolution 09-051 f;ff. 7-1.-'10) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $21.00
PME Permit Fee: $42.00
Work Without Permit? 0 Yes G No $0.00
Travel Documentation Fee: ITRA VDOC $42.00 A
Strom Motion Fee: 1BSEISMICR $0.60 0.5 hrs Admin./Clerical Fee
Bldg Stds Commission Fee: IBCBSC $1.00 $39.00 IADMIN
SUBTOTALS: $106.601 $39.00 TOTAL FEE: 1 $145.60
Revised: 04/29/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS:jin VvAtN w o"- PERMIT# '
OWNER'S NAME: �j PHONE# - ,6 ^� \
GENERAL CONTRACTOR: ck-cBUSINESS 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 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:
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
1 1 13 02 2- 0
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 MISC
CUPERTINO (408)777-3228• FAX(408)777-3333• building aDcuoertino.org
VUNMING ❑MECHANICAL ❑ELECTRICAL MISCELLANEOUS
PROJECT ADDRESS ' APN# � �. 1
3 00-1
OWNERNAME PHONE %_ QI � • ,E-
1 "�
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME C PHONE E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 4 LICENSE NUMBER L SE TYPE BUS.LIC#
M071AVY
COMPANY NAME E-MAILj /'^ FAX
STREET ADDRESS CITY,STATE,ZIP /VA [� PHONE
AO Igo
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF [3 SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA 2-Na- FLOOD ZONE Q-N(r— EICHLER HOME? -B-IT3
DESCRIPTION OF WORK A" gai221r_ 'r
WIAC4
LN _, Y
TOTAL VALUATION: RECEIVED BY: LA
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 read this
application and the information I have provided is correct.,I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction`I autha re tatives of 5ujwtino to enter the above-identified property for inspection putposes.
Signature of Applicant/Agent: / Date:
SUPPLEMEN TION REQUIRED
OFFICE USE ONLY
W L '�VER TH1 COUNTER
❑ EXPRESS
:t
U
w ❑ STANDARD
U
❑ LARGE
❑ MAJOR
1EPMiscApp_2011.doc revised 06121111