B-2016-1709 I
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1709
10685 STEVENS CANYON RD CUPERTINO,CA 95014-3941(342 16 133) MARTI'S PLUMBING
SERVICE
CUPERTINO,CA 95014
OWNER'S NAME: FENG YOULIN DATE ISSUED:04/06/2016
OWNER'S PHONE;408-209-2858 PHONE NO;(408)375-3190
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#958-Q20
Contractor MARTI'S PLUMBING SERVICE Date 02/28/2017 X BLDG _ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
_MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
INSTALL(N)PROPERTY LINE CLEAN-OUT AND REPLACE SEWER
I hereby affirm under penalty of perjury one of the following two declarations: LINE FROM PROPERTY LINE CLEAN-OUT TO FOUNDATION
t. I have and will maintain a certificate of consent to self-insure for Worker's "CUPERTINO SANITARY"
Compensation,as provided for by Section 3700 of the Labor Code,for the
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
permit is issued. Sq.Ft Floor Area: Valuation:$10000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 342 16 133
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in stands u ce of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands a will comply with all non-point
source reg ations per the pe Ino Mun'c pal Code,Section 9.18. 180 DAYS FROM LAST A, LED IN PECTION.
Signatur Date 4/6/2016 Issued by:Alex Vallelunea
Date:04/06/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property;or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(See.7044,Business&Professions Code)
2. I,as owner ofthe property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:4/6/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
i. 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. HAZARDOUS MATERIALS DISCLOSURE
2. hhave and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code, hapte '9.12 and the
C
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handl hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which+1 hazar ous
air contaminants as defined by the Bay Area Air Q _' anage.eint Dist 'ct I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance avith t upertino Mum ' al C de,Ch `ter 9.1 nd
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety ode Sections 25505, 533,and 255P4.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked, c_Owner or-authorized zge
APPLICANT CERTIFICATION Date:4/6/2016
1 certify that I have read this application and state that the above information is CONS UCTION LENDING AGENCY
correct.i agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's'Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 4/6/2016 Professional
GENERAL PERMIT APPLICATION M E OP"
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255 MMISC
(408)777-3228• FAX(408)777 -3333•_building(o)cupertino.ong
CUPERTINO
PLUMBrNIG ❑1,4ECHAIIICAL ❑ELECTRICAL ❑MISCEL ANEOUS
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PROJECT ADDRESS
OWNER TIME PHONY qV A;_>O `-Lg� E-MAIL
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STREET AD S ^ CITY, STATE,ZIP FAX
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C' .'TAT 'AME PHONE
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STREET ADD S AACITY,STA170 A— JLEI
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❑ OwNER ❑ ONvNER-BuiLDER 4 ON'NERAGENT ❑ CONTRACTOR L?C_5NTRACTORAGENT ❑ ARCHITECT ❑E.GD\EER ❑ DEVELOPER ❑ TENANT
CONTR.ACVT„0 NAMELA �� LICENS SER S�
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COMPANY N. E r E-MAIL F e a -
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STREET ADDRESS CITY;STATE ZIP, I PH S,�
ARCHITECT/ENGLNEERNAME LIC EISE NUMB R BUS.LIC
COMPAN7f NAME / E-MAIL FAX
STREET ADDRESSS CITY,STATE,ZIP
f PHONE
USE OF .SFD.,DUPLEX ❑ MULTI-FAMILY PROJECT IN N+ILDLAND ❑ ITS PROJECT IN ❑YES. IS THE BLDG AN -❑YES
BUILD MI : ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
t
TOTAL VALUATION: RECEIVED B3
By my signature below,I certify t ach of the following: I am the property o ner or authorized agent to act on the pr erty owner's behalf. I have read this
application and the information I ave provided is correct. e read the Des ription of Work and verify it is accurate. I agree comply with all applicable local
ordinances and state laws relatingilding construction. Kori repre tatives of Cupertino to enter the above-i ntifie property for inspection purposes.
Signature of Applicant'AQent: Date: �
SUPPLEME STA L INFORMATION REQUIRED - '
oP�CE usE'oi.L� .,
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h7EPAliscApp_?011.doc ret,ised 06/21/11