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14080252L3 CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10840 ALDERBROOK LN I CONTRACTOR: ALLSTAR PLUMBING PERMIT NO: 14080252 OWNER'S NAME: YOO HYUNG MO & JEONG SOO OWNER'S PHONE: 4084469560 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lie. # 7 i Contractor _ I'0MbOJ Date �� y I hereby affirm that I am lice sed under nder 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: 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. 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. 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 4` �� '� Date ❑ OWNER- BUILDER DECLARATION 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). I hereby affirm under penalty of perjury one of the following three declarations: 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. 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. 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. 326 PHELAN AVE DATE ISSUED: 08/26/2014 SAN JOSE, CA 95122 PHONE NO: (408) 230 -5569 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL C P_ Rey LAcG *A I (\J w p-r-� u/JJ c Sq. Ft Floor Area: I Valuation: $3000 APN Number: 36920037 00 1 Occupancy Type: PERMI IF WORK IS NOT STARTED WIT 180 DAYS �PERMIT ISSUANCE OR 180 DA S FROM LAST CALLED INSP CTION/. Issued by: Date: RE- ROOFS: All roofs shall be inspected pnor to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Date: ALL ROOF COVERINGS TO BE CLASS "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: �J�� `mss t 1Gc 11)ate: +�—�Q CONSTRUCTION LENDING AGENCY 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 I Signature Date I I x eUe' TINO GENERAL PERMIT APPLICATION ImAl E P COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPER T INO, CA 95014 -3255 (4 ) 777 -3228 • FAX (403) 777 -3333 - building5guDei �ino.ora \� Mk A=ry I ).r<r e 1 �_— - n i asCbLLAl; OUS PROS CP ADDP ASS / j ��/i t\ (L�U"�'V ✓f n „ ' %D 7Cfl((J Ov' 'RliA1J� P ` Ll f C15 -o . II STS- ? ADDPMS ® Y ! / CTi I, "TATS I r CON TkCT NAi,r ; ( PHONE, ST'P ADI MESS CITY,STA17B, Zip I FAX ❑ OgN�t ❑ ORtv3LTLnZ 0�:'iN AC�.T ❑ coh– m4Ci'OR ❑CONTRkCTORkGNT ❑ ARCMECT ❑ ENM—p. ❑ D1MA ?EiL ❑_:�. 2 T f�❑ L 'Sr�ly :b� � I LICL: y TYPE I BUS. LIC COIJL°ANY NAIL' � ' • i \ - v1�\ ~ �J a.II. ( FAX S��a.D�RE58 •- I '�;��?" 1 �J s� � ', I - Ti h_�� G� � 4 rc- f�RCIrTTB��G ..LRN.�;1J.= I LICENSE I-. BUS. LIC C0WANYNAIJ•e E -NAIL I FAX STRs.a-'T AmpmS I CITY, STATE, ZIP I FHONE, USE OF ❑ SFD or DupLzx ❑ man-EmzLY I PROI -tCI N WMDLAND ❑ YES I PROTECT IN ❑ YES B[SII�AG ❑COYUERCIAL URBAN IN I=- ACE AREA ❑ NO FLOODZONL ❑ NO I IS = BLDG AN ❑ YES BIC°.Lr-RHola? ❑ NO DESCRIPTION OF WORK Decal- TOTfIWIUATION: By my sigria«re below, I ce, �i� to each oftna following. I zm u'�e prope.-ry ocaer or auto ized z�ent to act on the prop_, v ner's behalf. I h >e read this application and the info—nation I have provided is correct I hav' read the Description of Work and verify it is accurate. I agree to local ordinances and state laws relating to building construction. I aut r iw° representatives of Cupe; ino to eater the abo 'e- idenntiaed proper—>, for inspecron puTpeses. 5igaa se of.- .pplicaaU'.�.geat: �i 24 Date: SUPPLEMENTAL LTrORM kTION RE U-1R tD Y- 15M IvfEPAj'isc,�pp_J.doc revised 06121111 CITY OF CUPERTINO IW4 FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10840 alderbrook In FEE DATE: REVIEWED BY: APN: BP #: EVALUATION: 1$3,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION 1 RPR PERMIT TYPE: WORK co er re i e SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES Re -Pipe Interior 1PRREPIPE 1 # $14 TOTALS: $14.00 Plumb. Plan Check 0.0 hrs $0.00 1.3ec1.. Peron it Fee: Plumb. Permit Fee: IPPERMIT Fka Perm/; 7 <<< 01--ce ;ticch, l av, Other Plumb Insp. 0.0 hrs $48.00 oilier t ie'c: Insn 1,h "./r. liz -AP. 1` Ic I',2ar,�b, hl"'p. Tee: i'fec. 13 sn Fee. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt otr ) Thoco foot aro haeod nn tho nroliminan infnrmntinn nvnilnhlo and aro nn/v nn octimato (?nntart tho nont fnr nddn'I in fn_ FEE ITEMS (Fee Resolution 11 -053 Ef . 7f j1 3Z FEE QTY/FEE MISC ITEMS Plan, Chc ck FeVic: PME Plan Check: $0.00 PME Unit Fee: $14.00 PME Permit Fee: $48.00 __F_T n;ash`a.u. Zir�rt Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 : t<- Iti°�a)tc`e'd Planning I *cue's: A Travel Documentation Fee: ITRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 y�4 $156.50 $0.00 TOTAL FEE: $156.50 Revised: 07/10/2014