B-2017-1930 •
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1930
10245 PARKSIDE LN CUPERTINO,CA 95014-6600(369 04 050) MARTI'S PLUMBING
SERVICE
CUPERTINO,CA 95014
OWNER'S NAME: MAES DAVID AND ZHAI HONGWEI KELLY TRUSTEE DATE ISSUED: 11/08/2017
OWNER'S PHONE:408-497-2785 PHONE NO:(408)375-3190
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lie.#958020
Contractor MARTI'S PLUMBING SERVICE Date 02/28/2019 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 SEWER MAIN
I hereby affirm under penalty of perjury one of the following two declarations:
t. 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.
. 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:$7000.00
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 ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize. 369 04 050
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 un- rstands an will comply with all non-point
source regulations .-r the,°uperti e M ipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
00 gnat — Date 11/8/2017 Issued by:Abby Ayende
•
Date: 11/08/2017
OWNER-BUILDER DECLARATION
I hereby affirm that I ani 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. I,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 de 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,.amexclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:11/8/2017
1 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
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
shall riot employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
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,C.apter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,255 ,an,/5534.
Labor Code,I must forthwith comply with such provisions or this permit shall _�®
be deemed revoked. � ner or authorized agent:
APPLICANT CERTIFICATION Date:11/8/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDIN GENCY
correct.I agree to comply with all city and county.ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
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,mentioned property for inspection purposes. (We)agree Lender's 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
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
' Signature Date 11/8/2017 Professional
\\ / SIGN PERMIT APPLICATION (7-b
to,
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
4137
44,41,,9s,, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(cr�cupertino.orq`
13-2014- pavi
PROJECT ADDRESS 1 n 2 (�Q ��s, L�h 0 APN# ` O/t�y
ow..../2414, I.� yI�`^I I^ ( PHONtLJ oq ) 17. 2 7?c E-MAIL
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STREET ADDRESS/07I/y/,'r f ule'kJ irdid e CITY, STATE,ZIP Cii,efi`�0 64 I �l FAX
FAX
CONTACT NAME man/144v ' /���", PHONE�G'' 7/� zip
6 E-MAIL
STREET ADDRESS ` CITY,STATE,ZIPP (F !/ FAX
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT ❑ CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAMEA, L j ,/'), af- LICENSE NUMBER gSro 7 o LICENSE TYPE( BUS.LIC# .
COMPANY NAME yyJ1 h ,I p/� (J��li �(C� E-MAIL FAX
STREET ADDRESS/j I CITY,STATE,ZIP PHONEDf) 7 7s-s P„0
0 J U (��/
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# ,
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORKJ(tee��� )� JA Oe�t
c `U
I
USE OF ❑ SFD or Duplex ' ❑ Multi-Family ILLUMINATED SIGN TYPE NO.OF SIGN AREA VALUATION
STRUCTURE: ❑ Commercial (Y I N) (CODE) SIGNS (SQ.FT.) ($)
SIGN TYPE CODES:
B - BANNER SIGN M MONUMENT(GROUND)SIGN
BL - BLADE SIGN P PROJECTING SIGN
D - DEVELOPMENT ID SIGN SP - SPECIAL EVENT BANNER
i DI - DIRECTIONAL SIGN T - TEMPORARY
E - ELECTRONIC W '-WALL SIGN
READERBOARD WI ,- WINDOW SIGN
RECEIVED BY: /+� VY1 TOTAVAyU TION:
` A � ) 111�15�
By my signature below,I certify to each of the following: I am the property owner or authorized age t to act n the property owner's behalf. I have read this
application and the information I have provided i corre t. 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 bu'ding.s.. tion �e representatives of Cupertino to enter the above-idei ed roperty for inspection purposes.
Signature of Applicant/Agent: !/ Date: / 7
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
Site Plan PLAN CHECK TYPE ROUTING SLIP
Elevations 0 OVER-THE-COUNTER 0 BUILDING PLAN REVIEW
Sign Details-including UL listing(s)applicable 0 EXPRESS 0 PLANNING PLAN REVIEW
Structural Calculations(if applicable) 0 STANDARD 0 OTHER:
Copy of Planning Approval Letter or Meeting with Planning prior to 0 LARGE
submittal of Building Permit application. 0 MAJOR
SignApp_2011.doc revised 03/31/11 ,
CUPERTINO SANITARY DISTRICT ' p
20863 Stevens Creek Blvd#100, Cupertino, CA 95014 N
Tel (408)253-7071 • Fax(408)253-5173 F�°dPusn¢o�- CUPERTINO
SANITARY DISTRICT PERMIT T E,T ER
Cupertino Sanitary District has adopted Resolution No. 1263.
Building Permit Request
(Over-the-Counter)
2 ingle Family Project ❑ Multi-Family.Project ❑ Commercial Project
Project Address t 0 M Tate tote. (A
Permit Number: Lis L-014- .4-vN 3(00( - Oy- D0
Scope o,f Work: -2 �a_6A � �,Lf—ear— Gt�—P✓iCL .1.-a_1( 71_40
Owner/Applicant Name: C Phone:
Address:
Date: II, �, 1 Prepared By: U9u\ OdutA'vJq
ity Authorized Representative
1, as property owner or authorized agent, acknowledge that.1 Cupertin• -nitary District requirements
will be met and al1'required fees will be paid prior t• r.- app ov- • fi = 'nspection 'r preposed project.
Date: Signature: •-�`
Owier/Authorized Agent
CUPERTINO SANITARY DISTRICT OFFICE USE ONLY
n Pre-inspection Required ❑ 'Final Inspection Required'.
Date Scheduled:
• Date: Conditional Approval By: !
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 Cupertino.
Inspection Fee Paid Date Paid: I ( -' - 7
Inspection 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:
$200/each Disconnect and/or abandon lateral service
Connection Permit Fees:
$350/unit- Single Family Residential connecting to existing lateral
$650/unit-Single Family Residential connecting with new lateral
I:= $100/unit- Multi, Hotel, Living Units, etc. Actual Amount:
$500/connection - Commercial and Retail Actual Amount:
Connection Use Fees (See Attached Calculation Sheet):
0 Area and Frontage Fees Amount:
C7 Residential Excess Fees over 3.5 unit/acre Amount:
CI Commercial and Retail Connection Fees Amount:
Commercial and Retail Change in Use Fees Amount:
Date: Final Approval By:
Au oriz d R presentative
CupertinO‘S-afiltary District