13040079 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 850 STENDHAL LN CONTRACTOR:ARROYO PLUMBING PERMIT NO:13040079
AND DRAIN,INC
OWNER'S NAME: YEEN VINCENT Y AND JULIA Y 650 LINCOLN AVE STE D DATE ISSUED:04/09/2013
OWNER'S PHONE: 4083799039 SAN JOSE,CA 95126 PHONE NO:(408)278-0170
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class ' 3 Lic.#. , 3 31 INSTALL PROPERTY LINCL AN OUT
Contractor /V L 1.:u J- Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000),of Division 3 of the Business&Professions
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'sAdftN'l
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:$4600
I have and:will maintain Worker's Compensation Insurance,as provided for b-
Section 3700 of.the Labot Code,for the performance of the work for which this APN Number:37541018.00 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 WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 80 DAYS OF PERMIT 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 F OM LAST CALLED IN CTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and.expenses'whi m /3
ay accrue against said City in consequence of the q
granting of this permi Additionally,the applicant understands and will comply Issued by: Date:.
With all non point so rce regulations per the penin icipal Code,Section
9.18 ry
RE-ROOFS:
Signature Date L' I J 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'l,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 isnot 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. I 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/Bay
mentor devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by tea Air Quality Manage�went District I
performance of the work for which this permit is issued. will maintain compliance with tno Muni 'pal Code, bapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti25533, d 25534.Section:3700 of the,Labor Code,for the performance of the work for which this Owner or authorized agent: `." Date (f j
. permit is.issued:
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person ini any mannerso as to become subject to the Worker's
Com&nsation,laws:of Caiifotnia. 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
correctYI agree to comply with all city andcounty;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 harmless 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 c this permit:Additionally„the applicant understands and will comply
with all'non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
918
II ' II i
Signature Date
I
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
.10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildino(a CUDerdno.Org , J o U�
CUPERT'INO & MISC
PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS ? s v S4
e N 1 A L� APS Zq 1 a C
OWNERNAME ` Ge ve le r\ l� PHONE qo�--3�9 tU3`+ E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONUACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑O\xR.TER ❑ OR'NER-BUILDER ❑ OWNER AGENT JDCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TEN-ANT
CONTRACT R NAME f II LICENSE NUMBER LICENSE TYPE BUS.LIC
VI/ a_ a 1vv. AA bj/-4 3`l3SD C• 3 3Z3 ZZ
COMPANY NAME I I, ) � FAX �
J rtl ✓�G �Av✓o D" 1 xltM off^ uIN. t(fl �Z�1 D`1
STREET ADDRESS �,�qq, CITY,STATE,ZIP PHONE
6Sp W w vOUe by D Turn u (t' LA `lY (�
ARCHITECTIENGLNTEER NAME LICENSE NUMBER BUS.LIC
COMPANY NAME' E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMILYPROJECT IN WIIDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING: Q COMMERCIAL TURBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK 1
TOTAL VALUATION: b RECEIVED Y:
By my signature below,I certify to each of;/e following: I am theproperty er or authorized agent to act on t e p pery owner's behalf. I have read this
application and the information I have p Ided is correct. I have d es ption of Work and verify it is acc I agree to comply with all applicable local
ordinances and state laws relating to I in construction. I au repr ntatives of Cupertino to enter the above'dent ed propel ry for inspection pudposes.
Signature ofApplicant/Agent: Date: L f
SUPPLEMENTAL INPORMATION REQUIRED OFFIC° QLY
OVER-THE-COUNTER
❑ EXPRESS
'J
U
❑ STANDARD
V
Z
❑ LARGE
❑ MAJOR
MEPAfiscApp_2011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 850STENDHAL LN DATE: 04/09/2013 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: 1$4,600
r-PErIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1RPSS
USE: p PERMIT TYPE: i
WORK INSTALL PROPERTY LINE CLEAN OUT
SCOPE
a
,ate<ch.flan Check Plumb.Plan Check rFeeIPPER
Elec.Plan(.,heck
ch.Pennit Fee:: Plumb. Elec.Permit Fee:
Other'Mech.Insp. Other Plumb Insp. Other Elee.Insp.
Rlech.Jnsp.Fate: Plumb.Insp.Fee.: Iles.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer.District,School
District 'etc). Thesefees are based on the relimina information available and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS'(Fee Resolution 11-053 E . 7J /1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Plumbing
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $23.00 IPRSEWER Sewer, Sanitary
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp:Fee-0 Reg. Q OT O,Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: 77 $45.00
Consit action Tax.
Administrative Fee: IADMIN $42.00 ® .
Work.Without Permit? ®Yes No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Travel Documentation Fee: ITRAVDOC $45.00
Strong Motion Fee`. IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee; IBCBSC $1.00
m
$133.501 $23.00 $1.56:50
Revised: 04/01/2013 .