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16010011CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20726 GARDEN CREST CT CONTRACTOR: TRENCHFREE INC PERMIT NO: 16010011 OWNER'S NAME: CHEN CHWAN-NAN AND CHAO HENGYU PO BOX U DATE ISSUED: 01/04/2016 OWNER'S PHONE: 4084212316 SAN JOSE, CA 95151 PHONE NO: (408) 726-7926 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ REPLACE WATER SERVICE FROM METER TO PROPERTY License Class Lie. # Contractor !P✓t CG.— �✓�� 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 Sq. Ft Floor Area: Valuation: $2350 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 APN Number: 36230055.00 Occupancy Type: `��-- permit is issued. : M. L V 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 INS PEC ION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the �4He.�{-1/" Date: granting of this permit. Additionally, the applicant understands and will comply Issued by: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: 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. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I 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 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534.� �'' Owner or authorized agent: /_ 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 CONSTRUCTION LENDING AGENCY 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 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 GENERAL PERMIT APPLICAT[ON COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (4-08) 777-3333 - building5cuoerino.org 7�UNi3NG El MECHANICAL F ELECTRICAL ❑A411SC.ELLA NE0US PROTECT!.DDRESS L G y �c Y fCL I hPN OWTiRNA✓EC'il,.r vx/t/ �/1�I / /TW/1<'/jf' Pi?0?\ /,DQ 7I�i I I `�' �' %—�— E-]JL=iLbl f g%L/ a-)— /V 0 .'�� ..2STREET STREETADDRESS CITY, STATE, ZIP CO? -TACT ?\.WJE P ON -B E -!V-A M STREET ADDRESS I CITY, STATE, ZIP I FAX ❑ OF7 t ❑ oW)L-,-BITTuD:-2, ❑ Oti' tAG T ❑ CO).'TR,,CTOR ❑ CONTPLALTORAGaRT ❑ ARC917EECT ❑ E-01IN .R ❑=y=LOPEI'� ❑ i�`�R-r CONTRACTOR SAJ's LICENSE -TYPE BUS. LIC' 2 old COM2.kA"Y 1;p iv!E E-MAIL, FAX STREET ADDRESS / 7 v LGti1 �! U<-� �I Y� T GtiVI 17 1 I C. Y��iTE ZIP C o)'9) -42,�- IG/ ?A� ARCHITECTrnGWEER TAMM LICENSE .YU-MBER BUS. LIC C01d2ArvY :gip NE E-M1,II. I FAY STREET ADDRESS I CITY, STATE, ZIP pgpl\t i:SE OF ❑ SFD.,DT P= ❑ MULTI-FAhM-Y PROicCTIN R' T)LA- D ❑ YES PROTrCTIu ❑ YES LS Tri BLDG AN ❑ YES BuLTDLNIG:❑COhO'�CLAL I. LR3j? Pi'DLFACEApE4 �� )'0 FLOOD ZONE El Iv0 EICFZFSfiO)J.E7 E3 1v0 DESCPIPTION OF Ca'ORiC(` lac'- f 'C k +e� ' lYt� �ev 4-4�_- Ila- A u---�e . Voir �c w)'') / ifyo ie nem rYle-Qr U L'') 00 , se r- 'b "' kvse o it u lt� . Ac5e AD r `Ivyi . c c l On S-�t 4 o--�-� )� lea 1 v -e- �c� a� l ►� � �� ; 1 dTI TOTA.L�P.LU..r_0?�: By my signature below, I certify to each of the following: I ars the property owner or auuorized agent to act on the prope. owner's behalf.M I have read this application and the uiformation I have provided is co*rect. I have read the Description of'Work and veru it is accurate. I agree to comply with all applicable local ordinances and state la„vs relating to bu construction. I authorize representatives of Cupertino to enter the abojve-iddpropertye`ntifed for inspection puroses. p / SiaofA.cplican /Agent: Date: / ' 7 '�.�i SU-PP_EI\r1E1N1lALLi\tORvIATION REQULRED 8.K: y TT yk xv ? riA7i�R Q, x . ?1j'EP11t7sC,4DR_M1.d0C remised 06/21/11 CITY OF CUPERTINO Ww FEE ESTIMATOR — BUILDING DIVISION 20726 Garden Place Ct k-1141 FEE DATE: 01/04/2016 REVIEWED BY: PAUL liADDRESS. APN: 326 58 998 1 BP#: A,,Iech. Ph. - n Check *VALUATION: 1$2,350 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: $0.00 L,,7e,,A;*)i0r.; FP—ENTAMATION 1 RPWS I PERMIT TYPE: WORK Replace water service from meter to property SCOPE DOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). 11tesefees are based on the preliminary information available and are only an estimate. contact the Ueptjoraaantinfo. FEE ITEMS (Fee Resolution .1.1-053.L,-ff.'-71'1113) FEE QTY/FEE MISC ITEMS Pk�n, A,,Iech. Ph. - n Check Plumb. Plan Check 0.0 hrs $0.00 L,,7e,,A;*)i0r.; (.7"'e""J". Permil P. L!(": Plumb. Permit Fee: IPPERAIIIT $25.00 PME Permit Fee: "'r nwh I'Ce: Other Plumb Insp. 0.0 hrs $48.00 $0.00 T:ees" Ll Travel Documentation Fee: I TR,4 VDOC $48.00 Strong Motion Fee: IBSEISMICR Ph. Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 DOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). 11tesefees are based on the preliminary information available and are only an estimate. contact the Ueptjoraaantinfo. FEE ITEMS (Fee Resolution .1.1-053.L,-ff.'-71'1113) FEE QTY/FEE MISC ITEMS Pk�n, PME Plan Check: $0.00 Permil P. L!(": PME Unit Fee: $25.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN $45.00 Work Without Permit? 0 Yes (E) No $0.00 T:ees" Travel Documentation Fee: I TR,4 VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $167.50 $0.00 1, - $167.501 Revised: 10/01/2015