B-2017-1416CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1416
18730 TILSON AVE CUPERTINO, CA 95014-3858 (375 17 044) 24HR DRAINPRO
PLUMBING
SANTA CLARA, CA
95051
OWNER'S NAME: YEH SHOU LIANG AND CHIANG YOU WEN
OWNER'S PHONE: 408-406-0620
LICENSED CONTRACTOR'S DECLARATION
License Class C-36 Lic: #938180
Contractor 24HR DRAINPRO PLUMBING Date 09/30/2019
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:
m. 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
Adpif, of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
ection 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 Cupertjno Municipal Code, Section 9.18.
Date 8/23/2017
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
m. 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)
z. 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:
m. 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 Date 8/23/2017
DATE ISSUED: 08/23/2017
NO: (408) 621-0067
BUILDING PERMIT INFO:
X BLDG —ELECT X PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REPLACE WATER MAIN SERVICE
Sq. Ft Floor Area: I Valuation: $1800.00
"N Number: Occupancy Type:
375 17 044
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Abby Avende
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fust obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date: 8/23/2017
"A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
r or authorized agent: —�
ate: 8 3 20
CONSTRUCTION L ING GE CY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014_-3255 `
(408) 777-3228 • building@cupertino.org PEMIT #B = •�L 1
CUPERTINO REV# DEF#
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SINGLE-FAMILY/DUPLEX ❑ MULTI -FAMILY ❑ INDUSTRIAL ❑ COMMERCIAL
USE
TYPE
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SQ.FT.
VALUATION ($)
EXISTING USE
EXISTING IF
NEW FLOOR IF
I PORCH
IF DECK IF
I DEMO
IF STORIES #
TOTAL NET IF
REMODEL
BATHROOM IF
REMODEL KITCHEN
IF
REMODELOTHR
IF
GARAGE ❑ ATTACHED
IF ❑ DETACHED
F ISPRINKLERS SING 11YES! ,
❑ NO'
EICHLER ❑ YES
❑ NO
SECOND STORY ADDITION El YES
❑ NO
DWELLING I SECOND DWELLING! ❑ YES ❑ ATTACHED ❑ DETACHED OTHER
UNITS # UNITADDI'TON: , ❑ NO IF
POOLS ❑ FIBERGLASS ❑ VINYL -LINED ❑ GUNITE ❑ PREFABRICATED
POOL - SF SPA -'SF SPA ATTACHED ❑ YES ®NO TOTAL - IF
Commercial or Multi-Famih 8/ uildines with Public Swimming Pools requires Department of Environmental Heath approval
RECEIVED BY:
TTA VALUATION:
RE -ROOF
EXISTING ROOF 7" ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑
WOOD SHINGLES EITILE OiHER (SPECIFY)
REMOVE /REPLACE ❑ NO
yE
IF NO '
I ti:OFLAYERS
PLYWOOD ❑ 'h" E13/8- PLYWOOD
THICKNESS ❑ 5/8" OTHER
TYPE:
❑OSB ❑ CDX OTHER
PITCH:
12
ROOF CLASS
A
PROPOSED ROOF TYPE: ❑BUILT- UPiROOF ❑ASPHALT SHINGLES ElWOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
*Provide a signed copy,of;;the1Cupertino's Tear -Off Policy IF #of SQUARES
By my signature below I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 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 building construction. I authorize representatives of Cupertino to
enter the above -identified property for inspection urposes owledge and authorize all information cont ' ed on this application form
to be made available, for public record. _� ( /
Signature of Applicant/Agent; I Date: U
SUPPLEMENTAL IIVPORMATION REQUIRED
*New SFD/Second Dwr'elling Uiiits/Multifamily Dwellings: A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: • Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application.
*HOA -Provide a'. letter;of.approval from the Home Owner's Association
BldgApp 2017.doc revised 08101/17
G a P&A