13030131 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10560 SAN LEANDRO AVE CONTRACTOR:JD PLUMBING PERMIT NO:13030131
OWNER'S NAME: KWAI-CHEUN SO 270 UMBARGER RD STE 66 DATE ISSUED:03/25/2013
OWNER'S PHONE: 4087779839 SAN JOSE,CA 95111 PHONE NO:(408)646-3266
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License ClassC-3 21 Lic. INSTALL NEW SEWER LINE FROM(E)PROPERTY LINE.
^Z�r.^�
Date CLEANOUT TO HOUSE AND INSTALL(N)CLEANOUT AT
Contractor iCOI-aCJ� J THE
I hereby affirm that Lam licensed.under the provisions of Chapter 9 HOUSE FIX
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that-my license is in full force and effect.
' SAN inTARY
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:$8000
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 Number:35705030.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF W IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT:IIN 180 D F RMIT 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 DAY OM 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 Z c
granting of this permit. Additionally,the applicant understands and will comply by:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
00, 4E-ROOFS:
Signature Date 3 ? 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)
I,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.'1 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 25505,255339 and 25534. ,D
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Date l �
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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
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 harmle_ss the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting 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
GENERAL PERMIT APPLICATION � MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 416
.10300 TORRE AVENUE•CUPERTINO,CA 950143255
(408)777-3228•FAX(408)777-3333• building CDCUDertino.org O misc
CUPERTINO
` PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS �rf� / _d CC� i /- � APN# '3 O 0
OWNER NAME �f ',Qvv` ` VVI\G/1v P ONE _9-9 -2 E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP F.4X
❑ OWNER ❑ OWNER-BUILDER ❑OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR
"AG�E1TT) E3ARCHITECT ElENGINEER 13DEVELOPER 11T
TENAN
CONTRACTOR NAME . LICENSE NUMB ER LICENSE TYPE,,9,n BUS.LIC#8
p Q( @ �l
COMPANY NAME E-MAIL FAX / I pJ
STREET ADDRESS C]TjY�STATE Q �� a? PHONE cl�4�
ARCHITECT/ENGIN'EER NAME LICENSE NUMBER ( BUS.LIC#
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MUI-TI-FAMMII..Y PROJECT IN WILDIAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONTE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
��- r & dek-tz a Q ta-el
TOTAL VALUATION-0 000 RE BY:
By my signature below,I certify to each of the following: I am the property owner or autho' gent to ac on the prope mer's beh . ave 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 com Ith all applicable Inca]
ordinances and state laws relati92;�
resentatives of Cupertino to enter the above-identifie propef y for inspection purposes.
Signature ofApplicant/Agent: Date: /Z��r
SUPPLEMENTAL INFORMA N REQUIREDOFFICE USE ONLY
OVER-THE-COUNTER
❑ EXPRESS
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❑ LARGE
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❑ TiAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10560 SAN LEANDRO AV DATE: 03/25/2013 REVIEWED BY: MELISSA
APN: 357 05 030 BP#: "VALUATION: 1$8,000
%PERMIT TYPE: Plumbing'Permit PLAN CHECK TYPE: Alteration/Addition/Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 RPS i
WORK INSTALL NEW SEWER LINE FROM E PROPERTY LINE CLEANOUT TO HOUSE AND INSTALL
SCOPE I(N) CLEANOUT AT THE HOUSE FIXTURE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Building 1PRSEWER 1 # $23
TOTALS: $23.00
Elm
,ate A Plan.Check Plumb.Plan Check 0.0 hrs $0.00 Dec.P1an C"heck
:Llech.Permit Fee: Plumb.Permit Fee: IPPERMIT Dec.Permit T se:
Other,11ech.Imp: Other Plumb Insp. 0.0 hrs $45.00 Other Elec,Insp.
14ech.Insp.Fee: Plumb. hisp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseres are based on the relimina information available and are only an estimate Contact the De t or addn'l info,
FEE ITEMS(Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check I ee.:
Suppl. PCTee
PME Plan Check: $0.00
Per snit Fee:
Suppl, .Insp Fee
PME Unit Fee: $23.00
PME Permit Fee: $45.00
Construction Tax: T7
Administrative Fee: IADMIN $42.00
Work Without Permit? 0 Yes (E) No $0.00
Jdvuncei/Planning Fees:
Travel.Documentation Feer ITRAVDOC $45.00
Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item.
Bldy,S.tds Commission Fee: 1BCBSC $1.00
$156.80 $0.00 4 � s $156.80
�` Revised: 01/01/2013