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12080308 CITY OF CUPERTINO BUILDING PERMIT BUILDING.\UIIRESS: 10282 TERRY WAY CO\TRACTOR:BENAVENTE PLUMBING PER\IIT N0: 12080308 0\1'NER'S N.\JIE: JUNG N'ING G AND JOE KIT FONG TRUSTE 305 S,\N A\TOMO CP APT 3106 DATE ISSUED:08292012 O\vNER'S PnONE: 4082577888 SAN.IOSE.CA 95116 Puorve no:(ios>n:-7071 ❑ LICIiNSED CON7R,\CI'OK'S UKCLAR,CI'ION r_ r r_� T ^/ � � BUILDING PERh11T INFO: BLDG ELECT - PLUD16 License Class �—�� Lic.t! C G SD (- rr C,� D1ECF1 r RESIDENTIAL(J COdI R1ERC1.\L r� Contractor�MµJP��A�^s-`T.�a^j3arc p��-���2-- 1 hereby nffinn That 1 um licensed under the prvn•isions of Chn plrr 9 JOB DESCRIPTION:SINGLE FAMILY ADD NEW GAS LING FOR NGW STOVE (am,mencing with Section 70110)of Division J of the Business&Prttfesxionx TOP �'(, I Code and that my license is in full force and effect. 1 hereby affirm under penally of perjun�ane of rhe following two declnralions: I have and will mainlnin o certificate ofconsent loself-insure I'or WorAer's Compensation,as provided for by Section 3700 of the Labor Code,(or the perfomtanee of the work(or which this permit is issued. - I have and will mainmin Worker's Compensation Insurance,at provided for by Sq.Ft Floor Area: \'aluarion:$500 Section 3700 o(the Labor Code,for the performance of the work for which this permit is issued. AP\Number:35917014.00 Occupanq•"I)pe: AI'I'LIC,\\F CERTIFICATION I certify that I have read this application and state Thal the above information is coned.I agree to comply with all city and county ordinmtees and slate laws relating to building construction,and htreb}'audtorize rcpresenmtives of ibis cil}'to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to cove indemnify and keep hamdess the City of Cupertino against fiabinties,judgmtmrs, WITHIN 180 DAYS OF PERMIT ISSUANCE-0R costs,and cxpcnsts which nmy acerae against said City in conscquencc of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicmn understands:rad will comply with all non-point source regulmims per the Cupertino Municipal Code,Section �^ 9.18. �^ Issued by Date:��-S--� Signoture � Date /' �� ❑ O\\'NER-RUILDFK DFCLA R.\TIO\ KF:ROOFS: All roofs shall be inspected prior to an}•roofing material beitg installed.If a roof is I hereby nllirm that I am exempt from the Contractor's License Law for one of insmlled withou first obtaining an inspection,I agree to remove all new materials for the following two reasons: � inspection. I,as owner of the propcny,or my employees with wages at their sole compensation, will do the work,and the stmcture isnot intended or ot7ercd far salt(Stc.7044, Signature of Appli©nr: Date: Business.@ Professions Code) I,as owner of the property,am exclusively contracting with licensed commcmrs to construct the project(Sec.7044.Business& Professions Cadc). .U.h ROOF CO\'IiRINGS'f0 1)li CLASS"A"OR BIi PIER hereby nlBrnt under paudl}•of perjury unc of the following Ihrcr Jeclnrnrions: Ih\''/.AKUOI7S bh\'I'ERLUS DISCLOSt1RF. I hm•c and will maintain a CeniOdme of Consent to st1(insure(or\Vorktr's I here rend the hnznrdnus materials requirements under Chapter 6.95 of the Compensation,as provided far by Section 3700 o(the Labor Code,for the California Ilealth S Safety Code Sections 25505.?5533,end 25534. 1 will mainrnin performance o(the work for which this pemtir is issued. compliance wish the Cuprrtino\lunicipal Code.Chapter 9.12 and the Ilealth S I have and will maintain Worker's Compensation Insurance,as provided far by Safety Code.Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance o(Ihe teork for which this '\dJilionally,should 1 use equipmtm or devices which emit hazardous air ermir is issued. contaminams as defined by rhe Ray,\tea.\ir Quality Alanagemenr District I will P maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the I certify that in the performance of the work for which this permit i5 issued,I shall Ilealth S Safely Cnde.Sections 25505,25533,end 25534. not employ any person in any manner so as ro become subject to the Worker's Compensation laws ofCalifomia. If,after making this certificate of exemption,I O _ ut6 tre ng p. ,a, _2 become subject Io lht 1Vorktr's Compensation provisions of the Labor Code,I must Dare: f forthwith comply with such provisions or This pcmtit shall be deemed revoked. co�srlulcrlo� 1.l:NDlnc ncr•.NCY \PPLIC.\1 I'CEK'1'IPIG\'I'I(l� 1 hereby affimt that there is n constmetion lending agency for the perfomtance of work's I ctri(}•that I have read this application mtd slate that the above infonnalion is far which this pencil is issued(Sec.3097,Civ CJ correct.I egret to comply with allbity nttd county ordintmees mtd state Imrs relating Lender's Nnme to building construction,and hereb}'authorize representatives of this city to enter upon rhe above mentioned propcny for inspection purposes.(We)agree Io save Lender's Address indemnify and keep harmless the Cil}•o(Cupenino against liabilities,judgments, costs,and expenses which may accrue against said City inconsequence of the AKCIII"fFCI"S DECLARATION granting o(this permit Additionally,the applicant understands and will comply with all non-point source regulatims per the Cupertino h1unicipal Code,Section 1 understand my plans shall be used as public records. 9.18. Licensed Professional Signature Ume j 3 �� GENERAL PERMIT APPLICATION mEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 I c CUPERTINO (4-08) err-32288 - FAX (-08)ir7-3333 • buildingt8ruD=aino.ora Lt+s Lhfl *G DIECz ANICAL kx-.ous PRo;rADDvs lo4z !•rRll .1/J19 /g 1�. $I I .A?N --7 DwNERNAME ` 20N_ B 2S SFJfI E-MA! S-=�ADOAESS C N. STA--L7 - /NO 9-SDI'L L1IIlf CONTACT NAME NONE _MA� 4 f zs7--7eoFj STR-11 ADDRESS CI.STAT; EP FAx OWN t ❑ OWNEt-aur' ?t ❑ OwN %AC_1 ❑ CON CT,OR ❑CORA=R AGFl.+r ❑ ARC.,—C: ❑EVC]Jl ❑ DEv10Pa ❑ --1�i CONTRACT OR NA,��fc� (�, I LICc?15i`1lJNL9A / Lf113L5.GC- rj ^ �lnAVrn'b-IC i I �}Ja�r��- G.rb�lJr- f CaCCrv� :AX V/ L - ADDRSSSu.+ (�1 ��J(QCO I .lcCi/ LVJ Ce, I ���7f2•�o�J ARChTi T/E OINZz:t+ NAME I IJCLJSE NUMBER13U5.L1C 4 COMPANY NAME' I E-MAM I FAA STREET ADDRESS ���. I Cl~,STATE Z3 PHONE 115E OF v..,-r PROicCi[N wRD[.WO ❑ YFS mcuz TW ❑ YFS6T}Tv 3LDG AN ❑ Y3 3UTL-DNG: ❑COMWUClkL LR3AN lN—iZXFACE AREA ❑ NO I FLOOD ZONE ❑NO I EC--?Ri NOME? Cl NO DESCRIPTION OF WORK \/f TOTAL VA;.UATION: &5-OQ 05 I RECEIVED BY: NBy my signz below,i c^y w each o;the ol!ow±ng: ?x tie p npc-y cwrIm or mthorzed agent to act=the prone y owcc's behalf. I'aave,ad aIis zpplicaion and the in'ormador.I have provided is cor_eL I have:ad the Description o`Work and ve y it is acc=,mte. I zgregw compiy with z1!x, 1;cable local ardinanca znd sate laws mlztirg w buildir. onsmt�im I zathor' - _p. _atives of Copertirs:c^L;Lhe above-iid/enti5e3 pe.-1.or inspection pu:�eses. Sigaan.�e o;ApplimnJAgenc Dare: 6/z/lr' %Z,. SUPPLZ . iNFOR-M-A lON QUIRED OFFICE USE ONLY y ❑ OVER-THE-COUNTER i ❑ EXPRESS u • ❑ STANDARD U ❑ LARGE ❑ MWOR �LLPMsc4,Tp_i011.doc rzvzszd 06/?i/11 ' CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 1:21 ADDRESS: 10282 terry way unit 1 DATE: REVIEWED BY: bobs. APN: BP#: 'VALUATION: $500 *PERMIT TYPE: Plumbing Permit PLAN CIIECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTANIATION 1RPGAS USE: I PERMIT TYPE: Al WORK sfd add new gas line for new stove top. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Piping, Gas <=4 Outlets 1PGASRES 1 # $67 TOTALS: $67.00 dlech.Plon Check Plumb. Plan Check 0.0 hrs $0.00 Flec.Plan Check ,lech. Permit Fee: Plumb. Permit Fee: IPPERMIT rlec. Permit Fre: Other Hech.Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elce.hup. d O.&bull. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This avinutte does not include jeev due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District, etc. . These eev are bused on Ilse prelintinan•information available and are onh,an estintale. Contact the De t or athln7 info. FEE ITEMS (Fee Resolmion 11-053 Efl. 7/1/11) FEEQTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Stppl. /asp Fee PME Unit Fee: $67.00 PME Permit Fee: $45.00 Consp-tiction Tat: Administrative Fee: GtDMIN $42.00 Work Without Permit? Yes Q No $0.00 Advanced Planning Fees: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: IBSEISAtICR $0.50 Select an Administrative Item 131dg Stds Commission Fec: IeCBSC $1.00 SUBTOTALS: $200.501 $0.001 TOTAL FEE: $200.50 Revised: 07/01/2012