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11020061 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10186 CAROL LEE DR CONTRACTOR:FAST WATER HEATER PERMIT NO: 11020061 OWNER'S NAME: FUNG DAVID K AND OLIVIA C 12601 132 AVE NE DATE ISSUED:02/16/2011 OWNER'S PHONE: 4082533441 KIRKLAND,WA 98034 PHONE NO:(800)454-8955 G LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r1l ELECT rE PLUMB rE License Class Lic.# MECH r!]RESIDENTIAL COMMERCIAL rE Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE/REPLACE GAS WATER HEATER (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'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:0 Valuation:$850 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. APN Number:31623062.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date: 9.18. Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent: Compensation laws of California. If,after making this certificate of exemption,I Date: 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, C and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION L Ig of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. witti all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10720 CASTINE AVE CONTRACTOR:ABLE SEPTIC PERMIT NO: 11020009 OWNER'S NAME: STERN JOSEPH AND CAROL C P O BOX 24819 DATE ISSUED:02/02/2011 " vNER'S PHONE: 4087320860 SAN JOSE, CA 95154 PHONE NO:(408)377-9990 f�J LIC NOSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT[_ PLUMB r— License Class lam- Lic.# MECH f— RESIDENTIAL r COMMERCIAL Contractor Date JOB DESCRIPTION:INSTALL BUILDING CLEANOUT,BACK WATER VALVE AND I hereby affirm that I am licensed under the provisions of Chapter 9 REPLACE EXISTING PROPERTY LINE CLEANOUT (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'sr 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: Valdoton:$3900 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:32643034.00 Occupancy Type, permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIREAF WORK IS T TED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT S NC 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 DAYS FROM LAST CA SP TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: til e. C granting of this permit. Additionally,the applicant understands and will comply with all non-point sour regulations per the Cupertino Municipal ode,Section '° N 9.18. Signatur Date All roofs shall be inspected ,tariy)oofrng material being installed.If a roof is installed without first otaini aiy,ttitlon,1 agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION ' � ' � Date: I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: 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(See.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 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 9.1 an I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti n 33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen Date: 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 CONSTRUCTION LENDING AGENCY 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 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 harmless the City of Cupertino against liabilities,judgments, .,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ,ting 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 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32643034 . 00 DATE ISSUED. . . . . . . : 02/02/2011 RECEIPT #. . . . . . . . . : BS000012633 REFERENCE ID # . . . : 11020009 SITE ADDRESS . . . . . : 10720 CASTINE AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : STERN JOSEPH AND CAROL C ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1313 RECEIVED FROM . . . . : ABLE SEPTIC CONTRACTOR . . . . . . . : GILBERT, GLEN LIC # 21407 COMPANY . . . . . . . . . . : ABLE SEPTIC ADDRESS . . . . . . . . . . : P 0 BOX 24819 CITY/STATE/ZIP . . . : SAN JOSE, CA 95154 TELEPHONE . . . . . . . . : (408) 377-9990 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 900 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 3 , 900 . 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 ----------------- --------------- -------------------- CHECK 106 .50 16320 --------------- 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: 10720 castine ave. I DATE: 02/02/2011 REVIEWED BY: bobs. APN: BP#: ` D�p *VALUATION: $3,900 I*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION 1 RPSS USE: SFD or Duplex PERMIT TYPE: WORK 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: IPPERMIT Other Plumb Insp. 0.0 hrs $42.00 01,"Il, NOTE. These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 09-051 EL.. 7�1i10) FEE QTY/FEE MISC ITEMS Plan Chcc°k Fcc. SrrI1ly/. J'("I"ec. PME Plan Check: $0.00 Pcv-init Fcc: Sir/pL Irr'�/) .k> PME Unit Fee: $21.00 PME Permit Fee: $42.00 Work Without Permit? 0 Yes E) No $0.00 Travel Documentation Fee: ITRA VDOC $42.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $106.50 $0.001TOTAL FEE: $106.50 Revised: 01/15/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 1 am I Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: )p ZO PERMIT# 2 U iJU OWNER'S NAME: L _7, PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: toza CITY/ZIPCODE: (� "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU CONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 6wner o tractor Signature Date CITY OF CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE C U P E RTI N O PERMIT APPLICATION FORM APN# D 32� -4.3 Date- Building ate Building Address:1 20 Owner'se: Phone#: Contractor: Phone #4:06—S7-7—q cla Fax#: 406- 4Z-- gC)$ Contact: kA � �� Phone #40d �F((- Fax/e-mail: - 1 Contractor License#: Cupertino Business License#: Job Description: l YJUI�Q G►n �U G (,JQ 1�.(� Q�L� Residential Commercial ❑ Valuation:2$� 1 Q — 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