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15030114 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10209 BONNY DR CONTRACTOR:ADVANCED PLUMBING PERMIT NO: 15030114 TECHNIQUES OWNER'S NAME: CHANG WANG-YANG AND CHIANG JANET S 1023 BLAZIN WOOD DR DATE ISSUED:03/18/2015 OWNER'S PHONE: 4083010605 SUNNYVALE,CA 94089 PHONE NO:(408)396-8071 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E] / RE-PIPE COMPLETE INTERIOR OF SFD License Class C 36 // Lic.# 9'9k 75-3' Contractor Ro�Vjl'o G.�jLo✓J26 Date 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 JQ -performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3500 1/ 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:35912032.00 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 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 3 �� f granting of this permit. Additionally,the applicant understands and will comply IS b e: with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. 5 'YJ,✓ RE-ROOFS: Signaturee/� / '� Date 177 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 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 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,Secti�2545;33, 4. Section 3700 of the Labor Code,for the performance of the work for which thisepermit is issued. Owner or authorized agent: Date. at 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 918. Signature Date ........................................... GENERAL PERMIT APPLICATION `� MEP IM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 b (408)777-3228•FAX(408)777-3333•building a(kupertino.org MISC CUPERTINO PLUMBING ❑MECHANICAL [:]ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS APN# 3 ( n ^ O 3 Z_ OWNER NAME PHON�- } / E-MAIL ✓1 e, MCA ` b STREET ADDRESS l Q CITY,STAT ZIP © FAX CONTACT NAM r PHONE ( p,, E-MAIL , rn u r(>(J c a STREET ADDRESS CITY,STATE,ZIP FAX EI'OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME D^ LICENSE NUMBER�n LICENSE TYPE ^�6 BUS.LIC# (moi 1 l`F COMPANY NAME E-MAIL P FAX �� rc a a; � C• NY11a ic1,�. � STREET ADDRESS( le CITY,STATE,Z �� � PHON O �0//^0 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# v COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD or DUPLEX ❑ MULTI-FAMII,Y PROJECT IN WILDLAND [IYES PROJECT IN ❑YES IS THE BLDG AN El YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ElNO DESCRIPTION OF WORK y I u TOTAL VALUATION: IZECEl Y� a f By my signature belo ,I certify to each of the following: I am the property owner or authorized agent to act on the property o s have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I ab to comply with all applicable local ordinances and state laws relating to bbuil5ng co truction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.. Signature of Applicant/Agent: L Date: I f SUPPLEMENTAL INFORMATION REQUIRED ° � 4 OFFICE USE 01\T;, � �, rR OVER THE COt7ITER z � x QEi� EXPRESS1 1" r ;TANDARD ?12AJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10209 BONNY DR DATE: 03/18/2015 REVIEWED BY: melissa APN: 35912 032 BP#: *VALUATION: 1$3,500 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPR WORK RE-PIPE COMPLETE INTERIOR OF SFD SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Re-Pipe Interior 1PRREPIPE 1 # $14 TOTALS: $14.00 20'5 -�kdh. Alan Check Plumb.Plan Check 0.0 hrs $0.00 Elec_flan('heck FT,1r. Aerfnit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit F-e: of/wr Alech.Ins[). Other Plumb Insp. 7f $48.00 other t Zec.Insp. Alec h. lnsp. Fce: Plumb. Insp. Fee: Elec.Insp,Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prelinmdina information available and are only an estimate- Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check 1 ee: .Suppl. .F'C' ee PME Plan Check: $0.00 Perinit Fee: Suppl. Insp F'eye PME Unit Fee: $14.00 PME Permit Fee: $48.00 (.onstr action lax: Administrative Fee: IADMIN $45.00 Work Without Permit? ®Yes 0 No $0.00 rldv°anced Plcirnung�1�'ees: Travel Documentation Fee: ITRAVDOC $48.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg,Stds Commission Fee: IBCBSC $1.00 $156.50 $0.00 TOT L FEE: $156.50 s - Revised: 02/14/2015