B-2017-0772CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10025 BYRNE AVE CUPERTINO, CA 95014-2805 (357 11 023)
OWNER'S NAME: LIOU SHU-CHUN AND BROWN EDWIN W III
OWNER'S PHONE: 408-883-4588
LICENSED CONTRACTOR'S DECLARATION
License Class C-38 Lic. #2$42_Q
Contractor MARTI'S PLUMBING SERVICE Date 02/28/2019
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.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
r, 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.
Date 5/17/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
t. 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.
Signature
CONTRACTOR: I PERMIT NO: B-2017-0772
MARTI'S PLUMBING
SERVICE
CUPERTINO, CA 95014
DATE ISSUED: 05/17/2017
PHONE NO: (408) 375-3190
BUILDING PERMIT INFO:
X BLDG —ELECT X PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE SEWER MAIN; INSTALL PROPERTY LINE CLEAN OUT
Sq. Ft Floor Area: I Valuation: $11000.00
APN Number: Occupancy Type:
357 11 023
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby &&nde
Date: 05/17/2017
RF -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fust obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 5/17/2017
ALL ROOF
"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: 1
Date: 5/17/2017
CONS7
I hereby affirm that there is a cons fiction 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
Date 5/17/2017 Professional
T)� mq' o'T-t-�
GENERAL PERMIT APPLICATION MEF
A COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO
M IS(;
XPLUMBING ❑MECHANICAL C (ELECTRICAL 7MISCELLANEOUS
(408) 77? -3228 •FAX (408) 777-3333 • buiidino(c�cu�ertino.orQ
PROJECT ADDRESS
APN # %(��'-7 _ I I _ O Z �
n ./J`f V [�
ONVNER NAME J
ONE E-MAIL
O
STREET ADDRESS
/00
CITY, STATE, Z'iP
A- 0 CA
FAX
CONTACT NAME
PHONE E-MAIL
STREET ADDRESS
CITY, STATE,
FAX
❑ ONT'ER ❑ OwNER-BUII.DER
❑ oWNER.AGE?.'T CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
% LICENSE NUMBER LICENSE TYPE
(o
BUS. LIC # 2 1��I
J
COMPANY NAME
Minc
E-MAIL
FAX
STREET.ADDRESS
I
p- r C.
CITY, STATE; ZIP
f-
HONE
D - l C1 Q
.ARCHITECT/ENGINEER NAME
IL
LICE 'SE NUMBER
BUS. LIC
COI`�IPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE; ZIP
PHONE
- USE OF F9FD o, DUPLEX
BUILDING: ❑ COI S'ER.CLAL
❑ ML`LTI-FAMILY PROJECT LN WIIALAND ❑ 1'ES PROJECT IN ❑ YES
URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO
� IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
l
ci C G A e—
roper�y Ifn
..
t •, -�
,
Gil�'I.�S � [ .. c l L 'e—,
TOTAL VALUATION:
RECEIVED BY:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property ow ers behalf. I have read this
application and the information I have provided is correct. I have read the Description ofWork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating ld' onstruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature ofApplicanvAgent: Date:a-
PLEMENTAL INTFORMATION REQUIRED
oFFJCE USE "ONLY
V..
OVER-THE-COUNTER
❑ EXPRESS
STANDARD'
❑. LARGE
?.14JOR
M'fFA47scApp_2011.doc revised 05/21111
CUPERTINO SANITARY DISTRICT
20863 Stevens Creek Blvd #100, Cupertino, CA 95014
Tel (408) 253-7071 • Fax (408) 253-5173
��~`moo snwrrsg�os�
��r0$t�swEo�9� GVPERTINO
SANITARY DISTRICT PERMIT LETIFER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over -the -Counter)
[] Single Family Project ❑ Multi -Family Project ❑ Commercial Project
Project Address: fl 0c
Permit Number:
Scope of Work:
��- Ii - 02_3
Owner/Applicant Name: KkCkA'-, �! t� Phone:
Address:
Date: 5 �1
.w1
Prepared By: Lu) 'A �lati�
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 paidprl,-,�to the approval of final inspection for proposed project.
Date: 05-1 q 't _�- Signature:
Owner / Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
❑ Pre -inspection Required Final Inspection Required
Date Scheduled:
Date: - Conditional Approval By:
Iuthorize Representative
Cupertino anitary District
District will notify owner of the required fee within 5 days after Pre -Inspection has been completed and cc
City of Cupertino.
0 Inspection Fee Paid Date Paid:
Inspection Fees:
$250/unit - Single Family Residential already connected, but new cleanout is required
D $150/unit - Single Family Residential already connected with existing cleanout in working order
O $350 Minimum - Commercial and Retail Actual Amount:
D $200/each - Disconnect and/or abandon lateral service
Connection Permit Fees:
$350/unit - Single Family Residential connecting to existing lateral
D $650/unit - Single Family Residential connecting with new lateral
D $100/unit - Multi, Hotel, Living Units, etc. Actual Amount:
O $500/connection - Commercial and Retail Actual Amount:
Connection Use Fees (See Attached Calculation Sheet):
D Area and Frontage Fees Amount:
Residential Excess Fees over 3.5 unit/acre Amount:
Commercial and Retail Connection Fees Amount:
D Commercial and Retail Change in Use Fees Amount:
Date: �; - �- Final Approval By: I
Auth6rizee-ep-resentative
Cupertino Sanitary District