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11010079 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10356 PRUNE TREE LN CONTRACTOR:PLUMB-A-WAY PERMIT NO: 11010079 OWNER'S NAME: TAK LEE 2135A TULLY RD STE 158 DATE ISSUED:01/13/2011 OWNER'S PHONE: 4082536638 SAN JOSE,CA 95122 PHONE NO:(408)391-0930 LICENSED CONTRACTOR'S DECLARATIONr— I— ``__ ��0 30 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class l� Lic.# MECH r RESIDENTIAL I— COMMERCIAL r Contracto Date 1/13/1/ I hereby affirm t t I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE SEWER LATERAL IN FRONT YARD FROM (commencing with Section 7000)of Division 3 of the Business&Professions HOUSE TO Code and that my license is in full force and effect. PROPERTY LINE,CLEANOUT AT HOUSE AND PROPERTY LINE CLEANOUT 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 permit is issued. Sq.Ft Floor Area: aluation:$3000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:3 30. Occupancy Type: 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 ?!t�- upon the above mentioned property for inspection purposes. (We)agree to save *40 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signator Date f��3 f Issued b Dat%r � OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Own autho ed a n APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, -ts,and expenses which may accrue against said City in consequence of the Lender's Address ing of this permit.Additionally,the applicant understands and will comply w..n all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31633030 . 00 DATE ISSUED. . . . . . . : 01/13/2011 RECEIPT #. . . . . . . . . : BS000012479 REFERENCE ID # . . . : 11010079 SITE ADDRESS . . . . . : 10356 PRUNE TREE LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . TAK LEE ADDRESS . . . . . . . . . . : 10356 PRUNE TREE LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : PLUMB-A-WAY CONTRACTOR . . . . . . . : CUONG NGUYEN LIC # 25129 COMPANY . . . . . . . . . . : PLUMB-A-WAY ADDRESS . . . . . . . . . . : 2135A TULLY RD STE 158 CITY/STATE/ZIP . . . : SAN JOSE, CA 95122 TELEPHONE . . . . . . . . : (408) 391-0930 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 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 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 106 .50 0 . 00 106 .50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 106 .50 VISA --------------- TOTAL RECEIPT 106 .50 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: 10356 prune tree In. DATE: 01/13/2011 REVIEWED BY: bobs. APN: BP#: `VALUATION: $0 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION 1 RPSS USE: SFD or Duplex PERMIT TYPE: WORK replace sewer lateral and property line clean out SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $21 TOTALS: $21.00 tifcc h Ph";n Ch,i 1 Plumb.Plan Check 0.0 hrs $U "h.xk Af� 'f l'c>r=„ r F�>��: Plumb.Permit Fee: IPPEt>It�c Pz�r-L- ofhi"'rlf�,r,fi f �.f, Other Plumb Insp. 0.0 hrs $4rispf��7r`f??r�l. fi%.tj}, f"'�': t�'�': NOTE: These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept for addn'l info. FFEEITEMIS (Fee Resolution 09-051 E f. 7/1;'1Oj FEE QTY/FEE MISC ITEMSFey, PME Plan Check: $0.00 I'ennif Fee: Scapl71. Irrsp Fee PME Unit Fee: $21.00 PME Permit Fee: $42.00 C onstr uc~tion KIX <lcousfi(.' al Review I'c'e: Work Without Permit? 0 Yes No $0.00 Plcrrrlrin,�r l�'eje:g: Travel Documentation Fee: 1TRA VDOC $42.00 Strong Motion Fee: $0.00 Select an Administrative Item 131dy,Stds Commission Fee. $0.00 SUBTOTALS: $105.001 $0.00 TOTAL FEE: $105.00 Revised: 01/03/2011 Building Department City Of Cupertino LM 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: t 4 3S(o p 12,v/vr-- PERMIT# OWNER'S NAME: ?'fi K. L 6PHONE# Y61 - 'I5 3 6 GENERAL CONTRACTOR: Pt-vm15.4aAX BUSINESS LICENSE# ADDRESS: aISS A Tu U.y f-D A*IS�f- CITY/ZIPCODE: 454� SSE *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCO CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. / I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ��l 311 O er/Contractor Signature Date c CITY OF CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM APN# � � Z`,-� Date: 1/' 3 �►/ Building Address: �J 10356 PitvnvE -r�ZE, LN Owner's Name: Phone#: T�FIc L�r qO�-�2 Sr 3 - 6 6 38— Contractor: Phone #: P C-UP-1 -hl ` `1`/ Fax#: �/d�- 7,1 �'G 9 3 b Contact: Phone#: C ckbA-:> AJ &V YF N Fax/e-mail: Contractor License #: ?R-9,R-0 -3 Cupertino Business License #: Job Description: C e- ,$ 1.0 C-2 L6 7 F- 7. v Frw�7- y-41Z,—b reom NauSE- 7o P" 5 2� Cz�E c��.aK A-r�us;Le C, . Residential Commercial ❑ Valuation: -3,coo Project Size: Counter Express ❑ 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 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 12/06/10