11010038 ' CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 874 MILLER AVE CONTRACTOR:GENMOR PLUMBING PERMIT NO: 11010038
OWNER'S NAME: LOUIE QUON C AND JENNIE C 2552 SEABOARD AVE DATE ISSUED:01/06/2011
0- NER'S PHONE: 4082487890 SAN JOSE,CA 95131 PHONE NO:(408)855-8348
Li C_ENSED CONTRACTOR'S DECLARATIONr
C` l/yam � BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contract ate � 4
I hereby affirm that I am licensed under the provisions o Chapter 9 JOB DESCRIPTION:COPPER REPIPE OF DUPLEX UNITS&REPLACEMENT OF
(commencing with Section 7000)of Division 3 of the Business&Professions WATER SERVICE APPROX 30171'&REPLACEMENT OF SHOWER
VALVE
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.
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 Sq.Ft Floor Area: Valuation:$3000
permit is issued.
APPLICANT CERTIFICATION APN Number:37541015.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section /-
9.18. � (i"V I --
Issued by: i(/�' �--� Date:
Signature Date �Y
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
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
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Own E�edt-
forthwith comply with such provisions or this permit shall be deemed revoked. Date:-41 '
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a constriction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
ling of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
7 ITEMS OF 13 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37541015 .00
DATE ISSUED. . . . . . . : 01/06/2011
RECEIPT #. . . . . . . . . : BS000012414
REFERENCE ID # . . . : 11010038
SITE ADDRESS . . . . . : 874 MILLER AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : LOUIE QUON C AND JENNIE C
ADDRESS . . . . . . . . . . : 876 MILLER AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : GENMOR PLUMBING, INC
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
---------- ------------- --- ------ ---------- ---------- ---------- ----------
1BCBSC VALUATION 3, 000 . 00 1 . 00 0 . 00 1. 00 0 .00
1BPFIXTURE NO OF FIXTURE 1.00 8 . 00 0 . 00 8 . 00 0 . 00
1BSEISMICR VALUATION 3, 000 . 00 0 .50 0 .00 0 .50 0 .00
1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00
1PREPPIPE FLAT RATE 1. 00 42 . 00 0.00 42 . 00 0 .00
1PRREPIPE NO OF FIXTURE 1.00 11 .00 0.00 11. 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0.00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 146 .50 0.00 146.50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 251. 00 #7640
---------------
TOTAL RECEIPT 251 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING 512 FINAL HANDI-CAP
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# v
OWNER'S NAME: p •e PHONE# '$
GENERAL CONTRACTOR: -;Ae "k V M BUSINESS LICENSE#
ADDRESS: 19aA►r VI CITY/ZIPCODE:C
*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 CONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. "
I am not using any subcontractors:
Signature bate
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
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 874 miller ave. DATE: 01/06/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$3,000
q*PERMITTYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPFIX
USE: p PERMIT TYPE:
WORK replace 30ft water main underfloor re-pipe, shower valve
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixture or Trap 1BPFIXTURE 1 # $8
Re-Pipe Interior 1PRREPIPE 1 # $11
Piping, Area 1PREPPIPE $42
TOTALS: $61.00
VIc,h. Pharr C hc(k Plumb.Plan Check 0.0 hrs $0.00 I't 11/zn t"l cO(
1,t"c{t. Pc>rrrt t 7'11": Plumb.Permit Fee: IPPERMIT t>Itc .r'E'r111t7 f �:
F
Li
t7rtrc--, 1'Iccyt. 7Y<<t> Other Plumb Insp. 0.0 hrs $42.00 0/ i�klo" 117y,
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the Dept-for addn'l info.
FEE ITEMS (Fee Resohrtion 09-05I Eff T"b`10Y FEE QTY/FEE MISC ITEMS
Plan C hcck[(` e:
slippl. P(''1"ce
PME Plan Check: $0.00
Perrnit Fee:
suppl. Irrsp P'ee
PME Unit Fee: $61.00
PME Permit Fee: $42.00
C`on_4truction Tax
Ic:ousticral Review 1'Ce:
Work Without Permit? 0 Yes (E) No $0.00
Manning t"c es:
Travel Documentation Fee: ITRAVDOC $42.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $146.50 $0.00 TOTAL FEE: $146.50
Revised: 12/07/2010
CITY OF
CITY OF CUPERTINO
91 REPIPE/SEWER/MAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
APN Date:
Building Address: ( 14 ( ; - A ,�L rel & �
Owner's Name: 1v1 ty Phone#:
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Contractor: W I �NA bl / ��C Fax
# #.
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Contact: Phone#:
Fax/e-mail:
Contractor License #: $33 0/
Cupertino Business License#: / 1
db,&eriptire.-pip� of W V1-,zV�( Gi✓l 0� r iGt� fi o f
5erv�CQ Gt�c 3of� G�Ytol rP,�lq Of SVS w�'' e
Residential Commercial ❑
Valuation:
Project Size: Counter xpress ❑ Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set & the sheet index.
Green Building Points:
Quantity . Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1 BPREPIPE Commercial re-pipe per fixture P 1 CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BCBSC Cal Bldg Standards Commission B ALL PERAHT
Fee TYPES
1BSEISMICOM Seismic Commercial P
Revised 12/06/10