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14080193
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10201 S FOOTHILL BLVD CONTRACTOR:MS CONSTRUCTION PERMIT NO: 14080193 OWNER'S NAME: CHAN CHUN 80 DARRYL DR DATE ISSUED:08/26/2014 OWNER'S PHONE: 4083292526 CAMPBELL,CA 95008 PHONE NO:(408)230-5080 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL REPAIR MAIN WATER PIPE License ClassLic.# (^ G P Contractor /Y) <j (yn'Y�SfiYinl ��Date 0 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:$1500 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:34214075 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 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 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, w, /J costs,and expenses which may accrue against said City in consequence of the Issued b / r` �' granting of this permit. Additionally,the applicant understands and will comply Y• I Date:�6 ' with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. S ` RE-ROOFS: Signature Date G 17 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 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 25505425533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this © Q �j p permit is issued. Owner or authorized agentc�. Date: 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 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 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 CsEC IEE -AL PERMIT RPPLICA T ICT _... MTY DEVELOPMENT D�PAR I Idi�h�T• BUILDING DMSIG{: COMMU 10300 T ORRE AVENUE• CUPERTNO, CA 95014-3255 rR� (408) 777-3223• i=AX(4,03)777-3333 buIIdlnO,-CLos6m0.Or0 v1 m G �U?E��Cht4 O PT-uMSn G El I's C.47- ❑�£CiRiC.ai ❑I'as kN OUs PRGJADD'rESS a VZ-0 c 0o • 1( s)vzt C,-' PDP. SS (O Z0 S 0 I c=, s:A==,z-L. � =t er-t W� C CON--ACP K.11T= P Ona I ]✓_t1 ST?r=3 ADDR _:S CBT-,ST.S i, ZIP Ow?v�. 17 Oi�'?..3:-3L._DrZ ❑ Ovft.�_.h�w1.i cm7.ucrm 13COIF �CiDP.4G?.? ❑ . C-T_CT 1:3�C+�—'sem ❑ D:VFLOP-I ❑ --w Z, CON 71141 032?Ai` ,l� � I I C S^ I uc- T a: I BUS.UC� 7 1 ave o ST2C ETf =.ESB cm -A:3:'`D' e 6 V\ o f�Ciu3E�r G3T?ERNF1 I LLCz,\-SB)4m zR. I BUS.:lc COJ�AT�Y 1 iJ�= I B-JJ3AII, ( FAX S7?,. ADDR SS I CITY,STATF,M I KRONE USEB 07 r or Dum-rxx ❑ MAX-I-PAmLy TSWEL7 W WILDLANID ❑ YES PROTnCt P. ❑Y'-s TS a_BLDG.AR ❑1 S BT-J TMG CONSE?CLkL I tT3t?.37�rAGAPA 0 I ZOOD?OJ NO mc-m-- -10,.-m J 0 DRSCP.IPTiON OF FORK _h _ TOTxr VeLUAiION: OWN mlllm�� By roy sim atl-e below,I c. 'ifs to each of ne loll owing: I alp`,he propt—ty ot;-ei or aunhonzed 2geat to act on the proper iy ownef s hCi 211. I ha-vC re-ad this uDI1C2tI0I1 and i'ne I have provided is Coi mct. I have-.ad ulie Desci ipt ion of\9 Orl:and Fen icy it 15 acv rFt9. !a srtt t0 Com pIy v,ith all aDDIicabIa local O:CL°l8aCe5 and i.._:B i.Ns ieLtli,e i0 I7Llldla COPSS.]CTIOi1 I aL' Or:=e ieaieSOrita i\'CS of L'i!i7w ia0 to..at.r�']^ahoy e-1d.Ilt1-.d rr07e: +f0i 1?SD.`-Ct:o;.7�L'ipoS.S. S:r=5,r.of:gaiic ,'�.e^t: Date ST J- P Mr'A twit OR'kLk 01�R U=D T F � T T TT rQ i �.��_-o�C✓�.. fv • <=amu= N%-_--- -- �_ - 3 q gum m 1r'131w�c�pp_2011.doc revised 06/21/71 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10201 s foothill blvd I DATE: 08/19/2014 REVIEWED BY: Mendez APN: BP#: "VALUATION: $1,500 xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY FEIN IIAMATION 1 RPRP USE: SFD or Duplex PERMIT TYPE: WORK re air main water pipe SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $14 TOTALS: $14.00 a Plumb.Plan Check 0.0 hrs $0.00 Plumb.Permit Fee: IPPERMIT Other Plumb Insp. ETrs—[ $48.00 01he,,1/,,r ireSj: