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13070017 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18770 PEN DERGAST AVE CONTRACTOR:MARTI'S PLUMBING PERMIT NO: 13070017 OWNER'S NAME: DAVY PANG 171 BRANHAM LN STE 10-418 DATE ISSUED:07/03/2013 OWNER'S PHONE: 4087191172 SAN JOSE,CA 95136 PHONE NO:(408)375-3190 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALE] REPLACE(E)PROPERTY LINE CLEANOUT(SUNYVALE License Class `Ce Lic.# < SANITARY) Contractor C� i� /��t42Date 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'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:$1800 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:37527029.00 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 WITIIIN 180 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 D STC LED 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 Iss Date: 3 granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulation the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signa a Date_;773 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) 1,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 25505,25533,and 25534. 7 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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, 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 I N GENERAL PERMIT APPLICATION 6EP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION l! 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 0� (408)777-3228•FAX(408)777-3333•buildingCa)-cupertino.org �7 m i S c � I PLUMBING ❑MECHANICAL []ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# l: 3 - 2�- - X2-9 7-17-7 OWNER NAME r PHO EMAIL .- v ftAJ&7 STREET ADDRESS I / CITY, STATEFAX CONTACT NAME ! .tits PHONE 3 I E-MAIL i i :'•I i lil lr✓ STREET ADDRESS CITY,STATE,ZIP is !::I fir/ Fr"- . ❑OWNER ❑ OWNER-BUILDER: ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME i. CENSE NUMBER 7cr SE ^ BUS.LIC# TS T-(; - -MAIL NAME r EMAIL /)� FAX STREET ADDRESS C y CITY,STATE,ZIP: ! Tim ARCHITECT/ENGAIEERNAME "v✓LICENSE NUMBER BUS.LIC# COMPANY NAME , E_MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE , USE OF ❑SFD of DUPLEX:.I:©�MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING. ❑COM[vTERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF 1yORK,' I _ ,. TOT( YIALUA 4 l i� 1 �:, $Ivy FM , By my slgnatue(below,I certify toieach of the following: OWN I am the property owner or authorized gent to act on the property owner's behalf. I have read this apphcatloti and the informatlon;I have poSided is correc I have read the Description of Work and verify it is accurate. I agree to comply'with alLapplicable local' ordinances and state laws�elattng to building cons I I authorize repres pertino to enter the abov✓ ntified property for inection purposes. Signature ofApphcant/Agent Date: ' I ' ,' I''!; j;SUPPLEMENTAL INFORMATION REQUIRED a L i j MEPMiscApp 2011.doc revised 06/21/11 j lilt jWit Ii, I, CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 18770 PEDERGAST AVE DATE: 07/03/2013 REVIEWED BY: MELISSA APN: 375 27 029 BP#: 'VALUATION: 1$1,800 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY SFD or Du lex PENTAMATION 1 RPSS USE: P PERMIT TYPE: WORK REPLACE E PROPERTY LINE CLEANOUT SUNYVALE SANITARY SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $24 �----izI TOTALS: $24 00 iir. iw - ;Leech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 Flee.Plan{:heck keech.Permit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Per:: LW,",'h. Alecrh.Insh, Other Plumb Insp. 0.0 hrs $47.00 (}tl7er face.Inst.Insp.Fee: Plumb. hash.Fee: 1,-,1ec.Insp, Fee: NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: SuFpl. PE:T ee PME Plan Check: $0.00 Permit Fee: Supp 1. Insr)Fee PME Unit Fee: $24.00 PME Permit Fee: $47.00 Conorfiction .Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? ®Yes 0 No* $0.00 Advanced 1Plianning Fees: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Feer 1BCBSC 1 $1.00 n $159.50 $0.00 ," $159.50 Revised: 07/01/2013 X63.