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14080204CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19707 ALDERBROOK WAY CONTRACTOR: ONE DAY COMPLETE PERMIT NO: 14080204 REPIPE OWNER'S NAME: JEANIE CHANG 617 N 12TH ST DATE ISSUED: 08/20/2014 OWNER'S PHONE: 4086030554 SAN JOSE, CA 95112 PHONE NO: (408) 603 -0554 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL F] �� COPPER REPIPE License Class Lic.# Contractor Date G( I he irm am 1' 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. 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. 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 9 18. Signature DatelA� OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 9 18. Signature. Date Sq. Ft Floor Area: I Valuation: $3800 APN Number: 36921046.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN YS OF PERMIT ISSUANCE OR 180 DAY FRAST CALLED INSPECTION. Issued by: Datel70d •% RE- ROOFS: 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. Signature of Appl Date- ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code, Sections 25 25533, a Owner or authorized age Date:�� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C ) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional k. GF-NEC .AL PERMIT RPPLIGA i ION U� MEP CDMMUN17Y DEVELOPMEN T DEPART MEENT • BUILDING DMSION 10300 TORRE AVENUE - CUPERTINO, CA 950143255 (408) 777 -3228 - P ?.X (4,08) 777 -3333 - building. ®cuDe fino.org U ❑ C —T ❑ha5CELLAX--OUS m I S (C _lAp_2 011. r-' r =vi coy' 06/21/11 "CAT IP �0I I B -M j—, ADDP. =5c �iAi- CONTACT NAM -- I I k Q , /I— �p 1 /L J 0 0 S-1 YZ OW ❑ Otl,° r -3L'_J ❑ OvF1 f C= i c ? 4C: ❑COI'? 4rOR A=-\ ❑ .? =CT ❑ EI'M ?. ❑ D= l %�O ?? ❑ ^? �1 i CG2hTr. C'02I x +s I L C ,SB T�U amER C f i ICS SE i ?= J �Q I BUS. UIC. COI✓n}i�71:. =?+� r I __tJt� I rk.: CTi`.L! ADDPrrS• =1 , S1A. z V92 19 fi�c ;�� CT - RI�x1J= I LiC SEl�'L��ER. I BUS.IIC - COM-Df.1dYA'A I �N.4II I FAX SiP caT ADDPFSS I CITY, STAi F, ZIP I P O ,USe OF ❑ sm o. D pmc ❑ vm- n- Fl.J✓,I y PROJECT R W31- DLA-ND ❑ 1 S PP.OTr.CT N, ❑ Y'S I IS TM BLDG AN ❑ Y---s BTj=ING. ❑ COn �CL,,L t,?.B ES IN —IMEr t C= AR BA ❑ NO FLOOD ZAlIZ--- ❑ NO I r,C-- Z 30I+r.?? ❑ ? O DBSCF,?TioI; OF WORK [/✓ TOTAL VALUATIOt By my r.'c^g�, :T„ p?IO��, I c�i�LY t0 each 0. -e- follo Sing: ty 2Lih0i�iZ.��.d a�e�# to ect en i~:e prope-�y' OC „let's bel:al_`. ,`.ace :cad 25 cuDllcation Lad the info: -aeon I LI have Dl ovid`d is co- wt. I hwve -_d Lyle OL �1 orA and ve3 :y Jt i's C.'�•Lc XF� e. 1 a to to comply v+i h all -L7I1 ablt local Description ordinances Lid state laws relatL -IC to bLSlvlilQ C� L�CLiCZ. I :I - -Sen:euves O CLp°. -.no :.7 enter ill above -idni . 1°d Df ��°t.y 101 I ��° :1 17 �vseS. 4 ” S I �a ~tre DI 4 D+•il�vC_IL� ^.�- P.i:L. -.' . �G .°.. � ✓ I\r'I,;, T,=•_I., L?\r0IRMA 0?v RE TJ =I-D _lAp_2 011. r-' r =vi coy' 06/21/11 CITY OF CUPERTINO _"Inl" -1mc1rvirAff ♦ rvd-%" 113'FTFF "IT%TC- nlV-FQFnN APPLIANCE / EQUIP TYPE 1`L' X:j JVdLy A 1iv QTY/FEE QTY UNITS 19707 alderbrook ave DATE: 08/20/2014 REVIEWED BY: mendez WJ 1 *VALUATION: r$3,800 $14 APN: BP# - rPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPRP PERMIT TYPE: A USE: $14.00 PME Permit Fee: $48.00 WORK er repipe �co SCOPE $45.00] APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES A Re-Pipe Interior 1PRREPIPE 1 # $14 PME Unit Fee: $14.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00] Work Without Permit? 0 Yes Q) No $0.00 $0.00 TOTALS: T Travel Documentation Fee: 1 TRA VDOC $14.00 1 $0.00 C; , --k Plumb. Plan Check 0.0 hrs $0'00 rs IPPE h"cb, Pef,i�fif Fee: Plumb. Permit Fee: IPPERMIT Other Plumb Insp. Loj hrs $48.00 ofiwr f Fee: F""c: NOTE: This estimate does not inctuaejees aue to utnerueputurmytta i- < ••s, - --, - -- -, - -- - I I ___ __ :.- th, Pont farnfidn'l in.fa. District, etc.). These tees are Dasea on the preummur FEE ITEMS (Fee Resolution 11-053 Eff. .711113) irsiurritutt 11 FEE QTY/FEE MISC ITEMS Piun Ch :4- A RB PME Plan Check: $0.00 PME Unit Fee: $14.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00] Work Without Permit? 0 Yes Q) No $0.00 $0.00 A," , VtVICOIJ P/Urm,;Tl} Fees: T Travel Documentation Fee: 1 TRA VDOC $48.00 Strong Motion Fee: lBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 _7 77777-7 �M U "_'S IN M tZ $156.50 $0.00 TOTAL FEE: $156.50 VV iacu.