15060116 vim_
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 736 MILLER AVE CONTRACTOR: -TO BE PERMIT NO:15060116
DETERM
OWNER'S NAME: MOO POK LEE _ DATE ISSUED:06/172015
OWNER'S PHONE: 4084728903 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
TO CLEAR CODE ENFORCEMENT CASE-PERMIT
License Class Lic.# #15050171
INSTALL WASHER DRAIN,KITCHEN DRAIN AND
Contractor Date REQUIRED
1 hereby affirm that I am licensed under the provisions of Chapter 9 VENT PER CORRECTION NOTICE 6/1/2015
(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:$300
1 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:37542009.00 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 WI'I'�TIN 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 YS FROM LAST CALLED INSPECTIPN.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, '
costs,and expenses which may accrue against said City in consequence of the �5u
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
6/1-7-/oV5
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date All roofs shall be' cted prior to any roofing material being installed.If a roof is
installed wi t first obtaining an inspection,I agree to remove all new materials for
inspecti
OWNER-BUILDER DECLARATION
Si re of Applicant: Date:
1 hereby affirm that I am exempt from the Contractor's License Law for one of v
14
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 HAZA DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6. of the
California Health&Safety Code,Sections 25505,25533,and 25534. will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9. 2 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle haz rdous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which em' hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Managem nt District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, ter 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.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
J I 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
GENERAL PERMIT APPLICATION
1!50601 « MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 MUSIC
121 (408)777-3228 • FAX(408)777-3333•build inoCcDcupertino.or l
CUPERTINO
LUMBING ❑MECHANICAL ❑ELECTRICALL ❑MISCELLANEOUS
PROJECT ADDRESS .��r _ i" I APN n
O WNER NAME PHONE(ac
STREET ADDRESS �X CITY, STATE,ZIP FAX
CONTACT NAME T� JWP S,v� PHONE E-MAIL
STREET ADDRESS �b CITY,STATE,ZIP FAX
OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGDIFEER ❑ DEQ ELOPER ❑ TT:.NA.NT
CONTRACTOR NANE Q�'4- `A( LIC7SE N MER LICENSE TYPE I BUS.LIC
COMPANY NAME l �L E-MAIL FAX
STREET ADDRESS , 3 CITY,STATE,ZIP PHONTE
ARCMTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC
COMPANY NAME E-MAIL. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD x DUPLEX ❑ MULTI-FANU.Y PROJECT LN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BLMZLNG: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I 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 agree to comply with all applicable local
ordinances and state laws relating t building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Sig-nature of Applicant/Agent: Date:
S PLEMENTAL ENTFORMATION REQU oz>>c$USE ON ,
OBER 3�COLITE
A7EPAIiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 736 Miller AveDATE: 06/17/2015 REVIEWED BY: Paul
APN: 375 42 009 BP#: ISM1011b *VALUATION: $300
xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPFIX
USE: PERMIT TYPE:
WORK To Clear Code Enforcement Case- Permit#15050171 Install washer drain kitchen drain and required
SCOPE vent per correction notice 6/1/2015
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixture or Trap 1 BPFIXTURE 2 # $20
Piping, Vent 1 BPVENT 1 # $48
TOTALS: $68.00
Afech. Plan("heck Plumb.Plan Check 0.0 hrs $0.00 IJec.Plan Check
Feclr. Perm Fre• Plumb.Permit Fee: IPPERMIT klec. P�rmi-
Other Alech. Insp. Other Plumb Insp. 1.0.0 hrs $48.00 Ocher Elec.Insp. Li
Wech. huh_ Fee: Phtnth. hrsh. Fe" Tec. Insp. Fee-
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are only an estimates Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E$. 7/1/131 FEE QTY/FEE MISC ITEMS
Plan
Supl)l. PC Fee
PME Plan Check: $0.00
Permit Fee:
pp/. Insp Fee
PME Unit Fee: $68.00
PME Permit Fee: $48.00
Construction Kr.v.
Administrative Fee: 1ADMIN $45.00
Work Without Permit? (F) Yes O No $116.00
,Advanced Planning Fite,
Travel Documentation Fee: ITRA VDOC $48.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
341, Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $326.50 $0.00 TOTAL FEE: $326.5j
Revised: 05/07/2015