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B-2017-1197Susan Winslow From: Karen Wong <michiwong3@yahoo.com> Sent: Wednesday, July 26, 2017 4:37 PM To: Susan Winslow Subject: Cancellation of permit #620171197 Sue, have cancelled the plumbing job at my property: 10154 N.Portal Avenue, Cupertino, CA 95014. Permit #: 620171197. Requesting an 80 percent refund to the plumber, Mr. Song, as soon as possible. The refund will be greatly appreciated. Thank you, ° Karen Wong (408) 307-5337 A CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1197 10154 N PORTALAVE CUPERTINO, CA 95014-2323 (316 28 052) DRAINDOCTOR INC SANTA CLARA, CA 95054 OWNER'S NAME: WONG KINNEY AND b&CHIKO KAREN DATE ISSUED: 07/24/201 OWNER'S PHONE: 408-253-1387 PHONE NO: (408) 970 34 LICENSED CONTRACTOR'S DECLARATION BUILDING PERNHT INFO: License Class SANITATION SYSTEM Lic. #64345$ Contractor DRAIN DOCTOR INC Data 0113112018 X BLDG ELECT X P I hereby affirm that I am licensed under•the provisions of Chapter 9 (commencing MECH X RESIDE _ COMIVIE with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESC ION: REPLACE ING SEWER; PIPE -CRAWL I hereby'affirm under penalty of perjury one of the following two declarations: . SPACE t. I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 ofthe Labor Code, for the perforntauoe of tfie work for which this permit is issued. illfiPPI have and will maintain Worker's Compensation Insurance, as provided for b Section 3700 of the, Labor Code, for the performance of the work for whit s permit is issued Sq. Ft or a:Valuation: $12000:00 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 or 'nances APN Number Ni Occupancy Type: and state•IaWs relating' toibiiiiding construction, and hereby aut rize 31628 052 representafives of this city', to enter upon the above mentione , roperty for inspection purposes. (We) agree to save indemnify and k harmless the' City of Cupertino against liabilities, judgments, costs, an expenses which T EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the gr ting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally; the applicant understands and will corn with all non -point source regulations per th Cupertino Municipal C % Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. are _ Date 7/24/2017 0 Issued by: Abby Avende OWNER JII.DR.R DECLARATION Date: 07!2412017 -B I hereby affirm that I,am exempt fro a Contractor's License Law for one of the following two reasons: RF ROOFS: All roofs shall be inspected prior to any'roofing material being installed. If a roof is i. L as owner of the prop , or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will d the work, and the structure is not intended or offered for inspection. sale (Sec.7044, B ess & Professions Code) z.. j I, as owner of th roperty, am exclusively contracting with licensed Signature of Applicant: .'contractors to tract the project (Sec.7044, Business & Professions Code). Date: MOM I hereby.affirm'und penalty of perjury one of the following three declarations: ALL ROOF COVERIPIGS TO BE CLASS "A" OR BETTER a.. j1 have will maintain a Certificate of Consent to self -insure for Worker's Comp cation, as provided for by Section 3700 of the Labor Code, for the jperf be of the work for which this permit is issued. i. .1., ave and'wili maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 695 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and725534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter. 9.12 and the 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 equi pment or devices which emit hazardous shall notemploy 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 Code, Sections 2!005; 25533, and 25534, Labor Code, I must -forthwith comply with such provisions or this permit shall be deemed revoked, ell'. or authorized agent: APPLICANT CERTIFICATION Dat®. 7/24/2012 certify that I. have read this application and state that the above information is GENCY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending bgency f 'the performance correct. l agree to comply with all city and county ordinances and state laws 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 mentionedproperty for inspection purposes. (We) agree Lender's. Name to save indemnify and keep harmless the -City of Cupertino against liabilities, Lender's Address judgments, dosts; 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 AgCT=CT, I understandmy plans shall be used as, bublic records. Code, Section 9.18: Licensed Signature Date 7/24/2017 Professional eoL awy) Z,� 5 /Ai" e - O y -J r� C�c� �C�-'`� JDA A - C'elyl,o-pa� Yl - P -o 1�fqdv PC, 'MEPGENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA -95014-3255 CEJPERTIF+lO (408) 777-3228 • FAX (408) 777-3333 • buiidingOcuperlino.orct M C - PLUMBING ❑MECI mcAL ❑ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS' / Q/ t I-.14 v Y APN',�. `�1 � ' V– O:sZ OWNER NAME f.yt j /� r i PHONE I(V/ /rill � E-MAIL STREET ADDRESS - . C Ar/ f �• '( A CITY, STATE, ZIP C g FAX V � CONTACT NAME �14Ae p,.S Crnn,� � � L '/ �l W r Ir �Vt�{��1 PHONE' E - STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT D CONTRACTOR❑CONTR/ACTORAGENT ❑ ARCHITECT ❑ENG{NEER , '❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ' /� j % � (/t Cj (' N ICENSE NUMBER ` i/ �./ � % T' V LICENSE TYPE C (/ b , BUS. LIC n COMPANY NAME \�/� .� )9 ©/ Y �(L,. E-MAIL ' FAX STREET ADDRESS /�U 0 /may CITY, STATE, ZIP QVl) Ol � O�� HONE j ARCHITECT/ENGINEERNAME LICENSE NUMBER/ BUS. LTC #f COMPANY NAME E- FAX STREET ADDRESS STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROTECT iN R LAND ❑ YES BUILDING: ❑COMMERCIAL URBANINTE ACE AREA ® NO PROJECT IN ❑ YES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES mckEkHOME? ❑ NO DESCRIPTION OF WORK a Y CQ �0� i �► •� . �-a j r1 r�7' . a n TOTALVALUATION: ' RECEIVEDBYs By my signature below, I certify to each of th following: 'I am the property owner or authorized agent to act on the property 94 er's be alf. I have read this application and the information I have provi dAcorr I have read the Description of Work and verify it is accurate, I agree to comply with all applicable local ordinances and stale laws relating to buildin c�awthorize tatives of Cupertino to enter the, abave identified pr petty for in ection purposes. �/ Signature ofApplicant/Agent; Bate: el� i SU�Plr EMENTAL INFORMATION QUIRE) `-+' w' : v 0# " CE IISEONLY>> -TSE-COUN''TER _ r) �j _ ;TvfA30R A?EPMI=4�p_,201 I.doc revised 06121/11 J—/