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14040015L11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19900 PRICE AVE CONTRACTOR: TITAN GENERAL PERMIT NO: 14040015 CONSTRUCTION OWNER'S NAME: KWOK RESIDENCE 46509 MISSION BLVD STE 118 DATE ISSUED: 04/02/2014 OWNER'S PHONE: 4085045905 FREMONT, CA 94539 PHONE NO: (408) 883-8668 ❑ LICENSED CONTRACTOR'S DECLARATION I9��- JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] REMODEL (E) DOWNSTAIRS MASTER BATH (48 S.F.), License Class_ Lic. # CHANGING TUB TO SHOWER, REPLACE VANITY & r �/ TOILET Contractor /� (�tt�t�Yn /��Ar4T�kate r _ �'" 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: $5000 ve and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36904029 00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 WIT 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 0 DAYS F M-LA-C—AH-ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of Issued by: Date: ?/ granting of this permit. Additionally, the applicant understands and wil y with all non -point sourc lations per the Cupertino Municipal Code, Section RE -ROOFS: installed. If is 918. 2 49 Signature Date •^ All roofs shall be inspected prior to any roofing material being a roof 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 1, 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) 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 Cuper ' um al Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255 , 25533, and 5534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date:J— ;7--� 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 V GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION \ " 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinga-cugertino.org �TRTrAT nMTSCELLANEOUS C MEPMiscApp_MLdoc J-evised 06/21/11 PROJECT ADDRESS Q A syn r (Z �/� . APN # ^? J G` O L( — OWNERNAME PHONE MAIL l STREET ADDRESS N , l CITY, STATE, ZIP FAX CONTACT NAME (��/ PHONE off c �� E MAS STREET ADDRESS CITY, STATE, ZIPFAX t ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE E LICENSE TYPE BUS. LIC # COMPANY NAME p / E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHO 58 ` ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT INWIIALAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ YES ❑ BUII.DING: ❑ COMMERCIAL - URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? NO N DESCRIPTION OF WORK S TOTAL VALUATION: 5;Z5d _ -�- rz`;�. � �• 111 B' ` `(_ „y £" By my signature below, I certify to each of the fol g:111heoperty owner orize ent to act on o r . I have read this application and the information I have provided is orrect. the Description ofWork and verify it is accurate. I agree to comply with a cable local ordinances and state laws relating to building cons tion.e representatives of Cupertino to enter the above -identified prop rty for inspection pure es. Signature of Applicant/Agent: Date: SUPPLEtMNTAL INFORMATION REQUIRED�4 OEM � - K mpg- OVER � COUNTER, .WEENO -THE 01 O �a MEPMiscApp_MLdoc J-evised 06/21/11 ,tom71711 CITY OF CUPERTINO 7w,c7mTTir A rind-%" 1137TTT "IXTI- 'n1V11Q11nN A, LL 1J" l Xxv- i v ADDRESS: 19900 PRICE AVE DATE: 04/02/2014 REVIEWED BY: MELISSA APN: 369 04 029 BP#: *VALUATION: $5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex 0.0 17�ENTAMATION 1 R3SFDREM PERMIT TYPE: WORK REMODEL E DOWNSTAIRS MASTER BATH 48 S.F. CHANGING TUB TO SHOWER REPLACE SCOPE VANITY & TOILET ,61ec,''��. Pc>rrttitTce: 111,wrb. I'Icm Check Pirl"i" Peri; it T "e. Other Plumb Inv, � Ur xn� I (e{ . Ins"), Phinib. Insp. C-"... n;: frirt .Qrhnn/ NOTE: This estimate does not mcluae fees aue to orner uepurtmeras v.v. 1.u,, ...5, = w���� •. �• - -• _., _ _.. _- _ District,etc.). %hese fees are nasea on me reummur FEE ITEMS (Tee Resolution 11-053 Eff.• 7/1/132 try ur-tut— uvucuooc FEE ..••» »• QTY/FEE �•-------------- - - MISC ITEMS Plan Check Fee: $0.00 48 s.f. Remodel, Bath (<=300 sf) $626.00 1REMRESBAT Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOX., 0 E) Work Without Permit? 0 Yes No $0.00 Advanced Plannin 7Fee: $0.00 Select a Non-Residential Building or Structure 0 A p$ g 13't/1'f `G L)E3 i,'t tii2L'I LL%t/7t>71 Fees Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg* Stds Commission Fee: 1BCBSC $1.00 u, h� �_, �SU�T�OTA�S $1.50 $626.00 TOTAL FEE: $627.50 RCVISCu. U-ww itw 1- rrvv% to . IkF—lv� Kvo K 'Ex, S� -J, , UFFICE Co. 9-,,M, TY P, NIENT BUil-DING UJPE"R1T11\j0 TNII set of p!qains and spe-,';ficalinnc MUST be kept at the I jjoyI, ,,;onstroc:tion. It is unlay.,ful to im,-,lK ny r U'>s or 140rn�! 0, L ,ons an scwne, or to duviu: e th^rcfronn, without approval frorn the Building Official. Tho stamping, of this plan and specifications &IALL NOT be held to pe"11, 1:1,11,1; 1:!etM-Ed11rr1mdP=PrU ' the violation - a;�Zancmr State Law. BY DATE PERMIT NO. N*W REVIEWED FOR CODE COMPLIANCE Reviewed By: