11050126 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10787 WILLOWBROOK WAY CONTRACTOR:SPEEDY ROOTER PERMIT NO: 11050126
PLUMBING
OWNER'S NAME: WONG WILLIAM 825 CIVIC CENTER APT 1 DATE ISSUED:05/16/2011
C ,R'S PHONE: 4083709757 SANTA CLARA,CA 95051 PHONE NO:(408)234-8134
❑ LICENSED CONTRACTOR'S DECLARATIO
/ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class b ic.# _Zq r
pr MECH RESIDENTIAL COMMERCIALContractor ( I
I herebyaffirm /at I am licen ed under the provisions of Ch ter 9 JOB DESCRIPTION:INSTALL PROPERTY LINE CLEANOUT
(commencing ' h Section 7000)of Division 3 of the Business&Professions **SEE NOTES**
Code and tha y license is in full force and effect. >r.
4 s•
1 reby affirm under penalty of perjury one of the following two declarations:
ve and will maintain a certificate of consent to self-insure for Worker's 14
.4--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 Floor Area: Valutition•$4000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36920 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is n~
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 EX��'RES IF WORK IS NOT STARTED
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 ISSUANCE OR
costs,and e4srce
may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of ditionally,the applicant understands and will comply
with all nongulations p th upertino Municipal Code,Section9.18. Issued bx:' Date:Si natu Date �.
g
L OWNER-BUILDER E LARATION 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.
1,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 HAZARDOUS MATERIALS DISCLOSURE
declarations:
1 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. 1 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 ction 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additio y, 'on Id I use equipment or devices which emit hazardous air
conta ma s as der
by the Bay Area Air Quality Management District I will
permit is issued. mai tain ompliance wit a Cupertino Municipal Code,Chapter 9.12 and the
[certify that in the performance of the work for which this permit is issued,I shall t Safe ode, do 5505,25533,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 i n or horize ent:
become subject to the Worker's Compensation provisions of the Labor Code,I mus Date: (7 I
forthwith comply with such provisions or this permit shall be deemed revoked.
CONST UCTION LENDIN AGEN Y
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work'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
ir'-*►nify 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
g]—Icing of this permit.Additionally,the applicant understands and will comply
with 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 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36922037. 00
DATE ISSUED. . . . . . . : 05/16/2011
RECEIPT #. . . . . . . . . : BS000013458
REFERENCE ID # . . . : 11050126
SITE ADDRESS . . . . . : 10787 WILLOWBROOK WAY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : WONG WILLIAM
ADDRESS . . . . . . . . . . : 13145 MONTROSE ST
CITY/STATE/ZIP . . . : SARATOGA, CA 95070
RECEIVED FROM . . . . : RICHARD ALVAREZ
CONTRACTOR . . . . . . . : SPEEDY ROOTER PLUMBING LIC # 23086
COMPANY . . . . . . . . . . : SPEEDY ROOTER PLUMBING
ADDRESS . . . . . . . . . . : 825 CIVIC CENTER APT 1
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95051
TELEPHONE . . . . . . . . : (408) 234-8134
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 4, 000 .00 1. 00 0. 00 1. 00 0. 00
1BSEISMICR VALUATION 4, 000 .00 0.50 0. 00 0 .50 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 145.50 0. 00 145 .50 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
0- L i Z(Z)
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CUFERtiN<3
(408)777-3228 • FAX(408)777-3333-building cDcupertino.org misc
PLUMBING ❑MECHANICAL ❑ELECTRICAL El MISCELLANEOUS
PROJECT ADDRESS z APN#
l_./ 11 1 e C,__Yl"l
OWNER NAME i1 tT7� �^-7 E-MAIL
STREET ADDRESS l/ ,Y CITY, STATE,ZIP / FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ 0 R-BUILDER ❑ OWNER AGENT �NTRACTOR C3CONTRACTOR AGENT 11 ARCHITECT C3 ENGINEER C3DEVELOPER ❑TENANT
CONTRACTOR NAME t n L JA CENSE NUMBER wto 2 LI CENSE BUS.LIC A
COMPANY NAME E-MAIL
f0607( /r
�A
STREET ADDRESS 3`� V J CITY,STA ZIP�I V/ PHONE 7 Yof-P/9
ARCHITECrIENGINEERNAME LICENSE NUMBER BUS.LIC A
COMPANY NAME E-MAR. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
'SE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
-Tgu gE ❑ Commercial SAN INTERFACE AW ❑ Yes Cl No FLOOD ZONE ❑ Yes ❑ No
DESCRIPTION OF WORK c� (e-t
a>�
TOTAL VALUATION: (JC/ U kD " �
r - "
By my signature below,I certify toe of a following: I Fam ,zr')A-'
pown authorized agent to act on the property owner's behalf. I have read this
application and the informa' I ha r ide correct I ads of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws a ng Ilding nstruction. Ieent 'ves of Cupertino to enter the above-identified roperty for inspection purposes.
Signature of ApplicandAge Date: / I
PLEMENTAL INFO ON REQ7D
MEPMiscApp Z011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10787 willowbrook way. DATE: 05/16/2011 REVIEWED BY: bob s.
APN: BP#: "VALUATION: $4,000
PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION 1 RPSS
USE: p PERMIT TYPE:
woRK install property line clean out.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1PRSEWER 1 # $21
TOTALS: $21.00
Plumb.Plan Check 0.0 hrs $0.00
Plumb.Permit Fee: 1PPERMIT
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 addh 7 info.
FEE ITEMS (F'ee Resolution 09-051 fff' 1"'I.,"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
Strong Motion Fee: 1BSEISMICR $0.50 0.5 hrs Admin./Clerical Fee
131da Stds Commission Fee: IBCBSC $1.00 $39.00 1ADMIN
SUBTOTALS: $106.50 $39.00 TOTAL FEE: $145.50
Revised: 04/29/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: � 7 g ( po w PERMIT# 'E-)OWNER'S NAME: k),F,4 PHONE#
GENERAL CONTRACTOR: o BUSINESS LICENSE#
ADDRESS: t1 4-vk 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:
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 If
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Si ature Date