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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 "(3- Z-01�--On6 PLUhMrNG , nMFCHANT('AT. 7T:T7/-+TAT(-AT I—IraTcrT:TT AM, c�TTo PROJECT ADDRESS t q _WSQ ��� ®� � 1 APNT OPdNTER NAME 'J JYII it�i I�1; PHONE E-MAIL NA� - lAot (�" 366 -6Q30 STREET ADDRESS (9 7H CITY, STATE, ZIP 0 I FAX CONTACT NAN4E0 �� `Cx C� PHONE U �� E-MAIL t� U J `� l I � CpSQ b4 Q:� o\ l, . c• STREET ADllRESS�. �-� ' � CITY, STATE, ZIP �� 0,�� FA){ ❑ OwhER ❑ OV,! ER-B=ER ❑ OWNTERAGENIT . L_I COh3RACTOR ❑ CONTRACTORAGENT ❑ ARCMECT ❑ ENGIA'EER ❑ DEVELOPER ❑ TENAN7 CONTRACTOR NAME t, LICENSE NTUMBER LICENTSE TYPE BUS. LIC r % r COMPANY NAME E-MAIL us, FAX r� STREET ADD ESS CITY, STATE, ZIP S` PHONE ` ARCHITECT/ENGINEER. NAME LICENSE NUMBERJ BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDIRESS CITY, STATE, "LIP PHONE I 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 i EICHLER HOMEY ❑ NO DESCRIPTION OF WORK ON ��! A �� el 9 0''f tnr P ���S — jzq VQ L(A�' 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 f 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 ,.. ....<_ :,.OFFICE.LISEfl1ti71<"::.::;.'=,.x:;:.,,,_; ;:<;:: �7:. ' ..:, ..=.OI,ER,THERCOis'i`TER.",`:;+r-:: r ;:. STA14I3ARD. hZ4JOR �" MEPMfscApp_2011.doe revised 06121111 101