15100247P
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10520 JOHNSON AVE
CONTRACTOR: MIKE COUNSIL
PERMIT NO: 15100247
PLUMBING INC
OWNER'S NAME: JIMMY WOO
1915 O'TOOLE WAY
DATE ISSUED: 10/30/2015
OWNER'S PHONE: 4085617780
SAN JOSE, CA 95131
PHONE NO: (408) 2724900
13 LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
INSTALL (N) PROPERTY LINE CLEANOUT; N BUILDING
License Class ' 3 6 Lic. # g�
CLEANOUT; (N) SEWER LATERAL 90' AND REPLACE
Contractor vwst Date 1� �l � h
�ffie (c �"'�r ( %
WATER
**SUNNYVALE
SERVICE FROM METER TO PROPERTY
I hereby affirm that I am licensed under the provisions of Chapter 9
Revision #1 - Install (N) water heater; Kitchen and Bath Repipe with new DWV in wall
(commencing with Section 7000) of Division 3 of the Business & Professions
- Issued 11/19/2015
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
Sq. Ft Floor Area:
Valuation: $24000
performance of the work for which this permit is issued.
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: 37528039.00
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,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
RE-ROOFS:
9.18.
Signature Date
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.
��( (� ,`�f L(
Signature of Applicant: �-tJ�L I e: / 'S•
❑ OWNER-BUILDER DECLARATION
1 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)
1, 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 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent:/Cis` Date:
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
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
K�j' 4
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO. CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buiIdin0(CbQUDer ino.Oro
KPLUb'MING ❑ MECHANICAL ❑ ELECTRICAL ❑ MISC.ELLA.NTEOUS
PROJeCf ADDRESS / J r I .4PN ; '�' ,,5
! (� �
0
ONVNER NAME PHONE,/'
L•?�L� IL
STREET ADDRESSS ` I CITY, STATE, ZIP
c�
9
FAX
CONTACT N.4N.E
PHONE
E-? LAII
STREET ADDRESS I CITY, STATE, ZIP
FAX
❑ OWR.'rii ❑ O)AT`R-BUIIDER ❑ OWNER t,c. T ❑ co\,rRACTOR ❑ co\-rRACTOR AGEATT ❑ A.RCHE ❑ EvGD1= ❑ D1 -LOPE ❑ T=ZA-17
CON RACTOR NA.k��
LICENISE NUI,MER
2 G
� TY
LICSE PO ^ ) 6
BUS. LIC r
CONOANY NAWLEE ( E-MAIL
I FAX
STRE? ADDRESS I CITY, STATE, ZIP
PHONE —
A ROUTECT EXIGIN TER NAME
I LICENSE XMIBER
I BUS. LIC R
COMPANY M ME
E-MAIL
I FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ S,D o, DUPLEX ❑ MLJ-1-TI-F.A ULY PRO QCT LN w ILDLAND ❑ YES
BUn YG: ❑ CON,Amcle I URBAN R\=.ACE AREA ❑ NO
PROJECT IN
FLOOD ZONE
❑ YES
❑ NO
IS n7-7 BLDG AN ❑ YES
I EICY_LER HONE? ❑ NO
DESCRIPTION OF WORK
k k2
TOTAL VALUATION: L
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the operty 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 to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: It/1'5//'5—
SUPPLEMENTAL II\TFORMATION REQUIRED
MEPA isc4pp_2011.doc remised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
19ADDRESS:
10520 Johnson Ave
DATE: 11/19/2015
REVIEWED BY: PAUL
,1
APN: 375 28 039
BP#: 15100247
*VALUATION: Iso
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
#
PENTAMATION PRWHEATR
PERMIT TYPE:
WORK
Revision #1 - Install N water heater; Kitchen and Bath Re i e with new DWV IN tAdigi j-,
SCOPE
y�r�l�l. Irts� .I�ee
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check 0.0 hrs $0.00
QTY
UNITS
BP FEES
Elec•, Perwit Pee:
Water Heater
1 PRWHEATR
€j,;:rt r h1ec. ire, ir.
1
#
$29
Re -Pipe Interior
1PRREPIPE
y�r�l�l. Irts� .I�ee
1
#
$14
Sewer, Building
1 PRSEWER
PME Permit Fee:
1
#
$25
Administrative Fee: IADMIN
$45.00
7
Work Without Permit? Yes 0 No
$0.00
TOTALS:
i
Travel Documentation Fee: ITRA VDOC
$68.00
Strong Motion Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7,/1/13'
ilech. Ilan t:'I,cck
Plumb. Plan Check 0.0 hrs $0.00
t'c:<;. ','=3;r
F,Zch, Permit Fee:
Plumb. Permit Fee: IPPERMIT
Elec•, Perwit Pee:
) 1 ppl. 13C .1` ee
Other Plumb Insp. 0.0 hrs $48.00
€j,;:rt r h1ec. ire, ir.
PME Plan Check:
$0.00
NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7,/1/13'
FEE
QTY/FEE
MISC ITEMS
3lan (" lec';i: 1 ° ee:
) 1 ppl. 13C .1` ee
PME Plan Check:
$0.00
Itr€t I ee.
y�r�l�l. Irts� .I�ee
PME Unit Fee:
$68.00
PME Permit Fee:
$48.00
Administrative Fee: IADMIN
$45.00
7
Work Without Permit? Yes 0 No
$0.00
133pa3"L'ning FCC"" f'_""
i
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
SUBTOTALS:
$209.00
$0.00 TOTALFEET
$209.00
Revised: 10/01/2015
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10520 JOHNSON AVE
CONTRACTOR: MIKE COUNSIL
PERMIT NO: 15100247
PLUMBING INC
OWNER'S NAME: JIMMY WOO
1915 O'TOOLE WAY
DATE ISSUED: 10/30/2015
OWNER'S PHONE: 4085617780
SAN JOSE, CA 95131
PHONE NO: (408) 272-4900
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
22 J '
Install (1) property line cleanout; (N) building cleanout; (1) sewer lateral 90' and
"Sunnyvale
License Cl ' •J Lic. # G
Replace Water Service from meter to property Sanitary"
015
Contractor Date L'O 3�0 015'
I here affirm hat I am licensed under the provisions of Chapter 9
(comm cing wi Section 7000) of Division 3 of the Business & Professions
Code an that m 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
Sq. Ft Floor Area:
Valuation: $24000
erformance 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
APN Number: 37528039.00
Occupancy Ty pe:
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
indemnify.and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
180 D„A.YS FROM LAST CA LED INSPEC IO .
10 '
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all noIrKmt source regulations per the Cupertino Municipal Code, Section
9.18.
1"k 20
RE -ROOFS:
Signature Date is
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.
❑ O NER-BUILDER DECLARATION
Signature of Applicant: Date:
I here affirm hat I am exempt from the Contractor's License Law for one of
the fol win o reasons:
ALL ROOF COVERINGS TO BE CLASS "A” OR BETTER
I, as o 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 w' he Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Cod , Secti25505, 25533, and 25534.
o
Section 3700 of the Labor Code, for the performance of the work for which this
(�
Owner l ✓
permit is issued.
or authorized agent Date•(&4
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
CON TRUCTI N LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a ns ion 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
indemnify And keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CUPERTINO
ml .
Rh
GENERAL PERMIT APPLICATION 951009IFT
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - build! nO(C)CUDertinO.Org
PLUMBING 0MEC14-kNFIC.AL ❑ELECTRICAL [:1 MISCELLANEOUS
PROI-cCf ADDFESS/ �zO
J -O h r O n All �e I .4PI1 R 0qV Pao.
ON'rTrRNPJS j.tri\ Ytit
W C�
I, PHOS -0 --11 �%
E-IJLdIL
STREET ADDRESS r y
CITY, STATE, ZIP v
O -n p V n /
I FAX
CONTACT NAME`
m
PHONE I E-MAIL
Ct s 4 C -t'
STREET ADDRESS
I
CITY, STATE, ZIP
I FAX
❑ OtiR.---t ❑ OWN -ER -BUILDER
❑ 0Vr,-,- t AGr71T CO\7?-',CTOR ❑ CO\ RACTOR AGM? ❑ ARC:1CT ❑ D4GW -A ❑ D-EVELOPER ❑ 1:.,ST
CONTRACTOR N?AaM .
j e� I LIC>?\'SE NAMIMER ,• n r I
I LICDgSE 17PE n+ ` I BUS. LIC r
COI Y.i✓L E -NAIL
> vY1SL iJ-w\Okn
FAX
STREET ADD SS
o o
CITY TATE, ZIP
l c OLV >Kl �i .S i
PHONE J OD
l
-RCMTECTrNGEN EER NAME
I LICENSE NUMBER
BUS. LIC R
CCIIAPAXYNANE
E-MAII.
I FAX
STREET.A.DDRESS
CITY, STATE, ZIP
PHONE
USE OF Sr'D or DUPLEX
BU`I DLUG: ❑ COMFJ,=- CLLT
❑ MULTI-FAhM-Y I . PROJECT LN R'II-DLANID ❑ YES
URBf?N' INTERFACE ARFA ❑ NO
PROTECT IN ❑ YES
FLOOD ZONB ❑ NO
I IS THE BLDG .4N ❑ Yr_S
EICF.LER HOME7 ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION:
By my signature below, I certify to each of the followine: I am the property owner or authorized anent to act on the property owner's behalf. I have read this
application and the i,-ifonnation I ha-, vided is correct. I hive read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu na construction. I authorize re tatives of Cupertino to enter the above -id tified pr et Ly for ins ection purposes.
Sitz ure of .pp Date:
UPPLEN� Er ATAL I FORvIATION REQUIRED
I
ut r cL use o_<LY.
7
�' OVER u �1 :.M
OWs-�; -
A
❑: I�Z�.I OR
ATEP-kfiSCApp_2011.doc revised 06121/11
CITY OF CUPERTINO 6100AICT5M-,7, FEE ESTIMATOR—BUILDING DIVISION
-
ADDRESS: 10520 Johnson Ave
DATE: 10/30/2015
REVIEWED BY: PAUL
UNITS
APN: 375 28 039
BP#:
*VALUATION: 1$24,000
PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE: SFD or Duplex
#
PENTAMATION
PERMIT TYPE: 1 RPS
WORK
Install N property line cleanout N building cleanout N sewer lateral 90' and Replace Water
SCOPE
Service from meter to property **Sunnyvale Sanitary**
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check 0.0 hrs $0.00
QTY
UNITS
BP FEES
Flec. Permit I ee:
Sewer, Sanitary
1 PRSEWER
Oiher Llee. hasp.
1
#
$25
Sewer, Building
1 PRSEWER
S=lippl. Insp Fec
1
#
$25
Water Service
1 BPWSVCS
PME Permit Fee:
1
#
$25
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
TOTALS:
A
Travel Documentation Fee: ITRA VDOC
$75.00
Strong Motion Fee: IBSEISMICR
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 preliminar information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 EL 71111131
1lech. Placa Check
Plumb. Plan Check 0.0 hrs $0.00
I;lee. Ilan Check
:1 -loch. Pertnil lee:
Plumb. Permit Fee: IPPERMIT
Flec. Permit I ee:
f lther.alech. Imp.
Other Plumb Insp. 0.0 hrs $48.00
Oiher Llee. hasp.
alech. Insp. Hee:
Numb. Insp. Ile"
Elee. 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 preliminar information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 EL 71111131
FEEQTY/FEE
MISC ITEMS
Phan (,,heck Fee:
iS'! ppt PC' Fee
PME Plan Check:
$0.00
Permil Fee:
S=lippl. Insp Fec
PME Unit Fee:
$75.00
PME Permit Fee:
$48.00
C `onstruclion Tax:
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
.4dwineed .Planning Fees:
A
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$3.12
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$220.12
$0.00 TOTAL FEE:
$220.12
Revised: 10/01/2015