B-2016-1145CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 1372016-1145
1113 MILKY WAY CUPERTINO, CA 95014-5064 (362 19 013) (A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC)
MEMPHIS, TN 38120
OWNER'S NAME: LAU PETER YUET KWAI AND HO SHUI CHAN ALICE
OWNER'S PHONE:
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #b's i �� U3 G C -t2
Contractor (A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA
IN Date #J, Iii 1 ( 6
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:
1. 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.
VLOP 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 permit is issued.
APPLICANT CERTIFICATION
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, costs, and
expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will
comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signatures Dati �,� I i
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code)
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 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 permit is issued.
3. 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 become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
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, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant
understands and will comply with all non -point source regulations per the
Cupertino Municipal Code, Section 9.18.
DATE ISSUED: 01/11/2016
PHONE NO:
BUILDING PERMIT INFO:
X BLDG —ELECT X PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE (E) FOUNDATION (2 -WAY) CLEAN OUT
,, 14
t
a i ti
Sq. Ft Floor Area: I Valuation: $3250.00
APN Number: Occupancy Type:
362 19 013
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
445
Date:
RE -ROOFS:
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.
Signature of
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:('
Date: 111 11.1 to
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
GENERAL PERMIT APPLICATION
C0MP%4UNITY DEVELOPMiiENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 o FAX (4-08) 777-3333 • buildina(Dcuoertino.org ^ �'
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By my signature below, I certify to each of the following: I am the prope_- ty owner or autboriZed agent
to act or ;;mer's behalf. I have reg
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application and the information I have provided is correct. I have read the Desciption of Work and verify itis accurate. I agree to comply with all applicable local
ordinances and state laws relat, g to buiidmg n. I authorizer,- resentatives of Cupert no to
enter the above -identified property for inspection purposes.
Signature ofAppl
Date:
L EME TAI L�'FORvIATION REQUIRED
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?t/f'P 'TSC 4vp_2011. do remised 06/21/11
CITY OF CUPERTINO
WNW FFF. F.,qTIMATO'R - RIMMING DIVISION
ADDRESS: 1113 MILKY WAY
FEE
DATE: 01111/2016
REVIEWED BY: MELISSA
APN: 36219 013
BP#:
*VALUATION: 1$3,250 1
*PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
PNM Plan Check:
$0.00
ENTAMATION 1 RPSS
FPERMIT
USE:
Suppl, 117�pfi`ee
TYPE:
WORK
REPLACE (E) FOUNDATION (2 -WAY)
CLEAN OUT
PME Unit Fee:
$25.00
PME Permit Fee:
SCOPE
C`Onshwfion 71ry:
Afec-6. Plan L Plumb. Plan Check 10.0 1 hrs $0.00 Plo,-1 Check
llergiiil- " ce: Plumb. Permit Fee: IPPERMIT1.1 ff!H! . I " - tle*:
Other Plumb Insp. 0.0 hrs $48-00 ofier flup.
VOTE. This estimate does not includefees due to other Departments (i.e. Planning, Public Works, tire, Nanuarysewer vistrict, 3cnuui
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept,/or aaan't info.
FEE ITEMS (Fee Resolution 11-053 Ay. 711113'
FEE
QTY/FEE
MISC ITEMS
SuppL P(..`.Fee
PNM Plan Check:
$0.00
Suppl, 117�pfi`ee
PME Unit Fee:
$25.00
PME Permit Fee:
$48.00
C`Onshwfion 71ry:
Administrative Fee: (ADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
Advance4l Phmning Fees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCB SC
$1.001
SUBTOTALS
$16 7.501
$0.00 TOTAL FEE:
$16
Revised: 01/01/2016