B-2017-0286CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0286
19333 SORENSON AVE CUPERTINO, CA 95014-3433 (375 02 017)
ALL PRO REPIPES INC
SAN JOSE, CA 95112
OWNER'S NAME: WANG JOE JYH-LONG AND CINDY MING -FANG TRUST
DATE ISSUED: 02/21/2017
OWNER'S PHONE: 408-366-6030
PHONE NO: (408) 332-8571
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class CM Lic. #1022644
Contractor ALL PRO REPIPES INC Date 01/31/2019
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:
UNITS 1,2 & 3; COPPER RE -PIPE, ALL 3 UNITS; REPLACE
I hereby affirm under penalty of perjury one of the following two declarations:
BUILDING DRAIN/SEWER, ALL 3 UNITS
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.
JC 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
Sq. Ft Floor Area:
Valuation: $15000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
375 02 017
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 consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations p Cuperti o Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature-' Date 02/21/2017
Issued by: ME A ES
Date: 02/21/2017
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. 1, 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 (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature ofApplicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 02/21/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
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 handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health &Safety Cod c ' ns 505,2 533; and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:.
APPLICANT CERTIFICATION
Date: 02/21/2017
I'M
I certify that I have read this application and state that the above information is
CONST. ND
I hereby affirm that t ere is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
Lenders 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
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 02/21/2017
Professional
GENERAL PERMIT APPLICATION M E
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 M I
CUPERTINO (408) 777-3228 - FAX (408) 777-3333 • buildina(a>cupertino.org
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USE OF CI SFD . DLPLF_X ❑ MULTI-FATT4TLYI PROJECT A WILDI_ANTD ElYES I PROTECT LN ElYES
IS THE BLDG ANT ❑YES
BLTII.DATG: 1.7 COJ1,a ERCLkL I URBAN INTERFACE AREA ❑SNO FLOOD ZONE E3 NO
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TO"EAL VALUATION: \5,000
B- my signature below, I certify to each of the following: I, am perty owner or authorized agent to act on the p e owner' ave read this
application and the information I have provided is correctsI-b v g>ad the Description of Work and erify itis accurate. I agree to comply with all applicable local
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ordinances and state laws relating to building ns ctr thorize representatives of Cupertino to enter the above-identifiedpe for inspection purposes.
Signature Applicant/Agent: Date: oq-` 1.
of
SUPPL TAI INFORMATION REQUIRED
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STA14I3ARD.
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MEPMfscApp_2011.doe revised 06121111
101