B-2017-0409CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2017-0409
7452 DUMAS DR CUPERTINO, CA 95014-4353 (359 26 014)
FIX - IT PLUMBING
SAN JOSE, CA 95132-
3023
OWNER'S NAME: PAN LICHUAN AND CHYI TRUSTEE
DATE ISSUED: 03/13/2017
OWNER'S PHONE: 408-309-7351
PHONE NO: (408) 509-2772
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Q_:& Lic. #90601 5
Contractor FIX - IT PLUMBING Date 11/30/2017
X BLDG _ELECT X PLUMB
—
MECH X RESIDENTIAL _ COMMERCIAL
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.
JOB DESCRIPTION:
REPLACE MAIN SEWER LINE (TRENCHLESS) & INSTALL
I hereby affirm under penalty of perjury one of the following two declarations:
FOUNDATION & PROPERTY LINE CLEANOUTS
1. 1 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. ;7 ' 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: $4900.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number: Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
359 26 014
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
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 per the Cupertino Municipal Code, Section 9.18.
180 DAYS FR SPECTION.
Signature /1'k Date 03/13/2017
Issued by: MELISS
Date: 03/13/2017
OWNER-BUE DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
I, as owner of the or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
1. property,
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 of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 03/13/2017
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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 34. of the
California Health &Safety Code, Sections 25533, and I will
Section 3700 of the Labor Code, for the performance of the work for which this
Municipal ter 9.1
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
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
material.
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 Code; Sections 25505, 25533, 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: 03/13/2017
rnTTSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there 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
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
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 03/13/2017
Professional
•
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingCa1cupertino.org
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT
ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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USE OF ❑ SFD oc DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN W ILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME?❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION: /f
CEIVED BY: -
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prope s ehalf I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
LEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
M
MEPMiscApp_2011.doc revised 06121111
CUPERTINO SANITARY DISTRICT
20863 Stevens Creek Blvd #100, Cupertino, CA 95014
Tel (408) 253-7071 • Fax (408) 253-5173
Q�o�a sa�trA�y®lr
�ST��1rsxEo���� CUPERTINO
SANITARY DISTRICT PERMIT LETTER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over-the-Counte6
Single Family Project ❑ Multi -Family Project ❑ Commercial Project
Project Address: _74�52_ �C, IADL__S `fir'.
Permit Number:
Scope of Work: nyi si l -t l et� ral r' -r a la e --o lIA a I -2c.0 I Ai M IL c�_Jb i -
Owner/Applicant Name: 2L k • I PlumbkA _ Phone:
Address: i X2®1 �►nA--e 6-V>_ � S 13 �
Date:
Prepared By:
City Authorized Representative
1, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements
will be met and all required fees will be paid prior to the approval of final inspection for proposed project.
Date:
Signature:
Owner / Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
❑ Pre -inspection Required
Date Scheduled:
Date: Conditional Approval By:
Final Inspection Required
Authorized Representative
Cupertino Sanitary District
District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc
City of Cup erf o.
Inspection Fee Paid Date Paid:
Inkee tion Fees:
$250/unit - Single Family Residential already connected, but new cleanout is required
$150/unit - Single Family Residential already connected with existing cleanout in working order
$350 Minimum — Commercial and Retail Actual Amount:
0 $200/each — Disconnect and/or abandon lateral service
Connection Permit Fees:
$350/unit - Single Family Residential connecting to existing lateral
Cl $650/unit — Single Family Residential connecting with new lateral
D $100/unit — Multi, Hotel, Living Units, etc. Actual Amount:
$500/connection - Commercial and Retail Actual Amount:
Connection Use Fees (See Attached Calculation Sheet):
C] Area and Frontage Fees Amount:
D Residential Excess Fees over 3.5 unit/acre Amount:
I� Commercial and Retail Connection Fees Amount:
Q Commercial and Retail Change in Use Fees Amount:
Date: Final Approval By: �Zxakl
Authorized Representative
Cupertino Sanitary District