B-2017-0265CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-20 t7-0265
20585 SUNRISE DR CUPERTINO, CA 95014-2960 (359 10 018)
A R S AMERICAN
RESIDENTIAL
SERVICES OF
CALIFORNIA INC
MEMPHIS, TN 38120
OWNER'S NAME: CHIUN TIEN-SEK AND CHANG SHU-HWA TRUSTEE
DATE ISSUED: 02/1412017
OWNER'S PHONE: 408-966-8606
PHONE NO: (9.01) 271-9700
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B C36 C42 Lic. #7051_55
Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC
—X BLDG _ ELECT X PLUMB
— MIECH X RESIDENTIAL _ COAIMERCILAL
Date 07/31/2018
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
JOB DESCRIPTION:
license is in full force and effect.
REPLACE (E) PROPERTY LINE CLEANOUT
I hereby affirm under penalty of perjury one of the following two declarations:
1. 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.
ave and will maintain Worker's Compensation Insurance, as provided for by
Ip:rrnit
�/A
ction 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area:
Valuation: $5000.00
is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
35910018
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
PERMIT EXPIRES IF WORK IS NOT STARTED
City of Cupertino against liabilities, judgments, costs, and expenses which
YS OF PERMIT ISSUANCE OR
WITHIN 180 DA
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
180 DAYS FRO_,__ AST CALLED TION.
source regulations per the Cupertino Municipal Code, Section 9.18.
l
Issued by: ISA
Signatur6kj Date 02114/2017
Date:
OWNER-BIJILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1. 1, as owner of the property or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
Signature of Applicant.
2. 1, as owner of the property, am exclusively contracting with licensed
Date: 02/14/2017
contractors to construct the project (See.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. 1 have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505,25$33, and 25534. 1 Will
Section 3700 of the Labor Code, for the performance of the work for which thi's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
permit is issued.
material. Additionally, should I use equipment or devices which emit hazardous
3. 1 certify that in the performance of the work for which this permit is issued, I
air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ any person in any manner so as to become subject to the
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
Worker's Compensation laws of California. If, after making this certificate of
the Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner or authorized agentx,
be deemed revoked.
Date- 02/1412017
CONSTRUCTION LENDING AGENCY
APPLICANT�CERTMCATION
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply With all city and county ordinances and state laws
of work's for which this permit is issued (See. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Address
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
ARCHITEC3:'S DEFA,ARATION
consequence of the granting of this permit. Additionally, the applicant understands
I understand my plans shall be used as public records.
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Licensed
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 1 &WIrk C
(408) 777-3228 - FAX (408) 777-3333 buildina2cupertino.org vkb�
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USE OF FISM.,DUPLEX 0 MULTI -FAMILY PROJECT IN 41qLDL,1u\!D El TES PROJECT IN ❑ YES
iIS THE BLDG AN ❑ YES
BUILDING: rl CowIER(-L"L URBAN INTERFACE AKFA D NO FLOOD ZONE NO
EICHLER HOME? ❑ NO
DESCRLPTION OF WORK 0 tags
P.41"
TOTAL VALUATION: 7- 7
By any signature below, I certify to each of the following: I am the property owner or authorized agent to act whe,'sbehalf. I have read this
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application and the 'e provided i correct. I have read the Description of'Work and verify it is accurate. I agree to comply with all applicable local
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-ty for
ons ction. I auth ives of Cupertino to enter the above -i fi d I inspection purposes,
ordinances and state 1=ati.It building oi __I:a�ntat -?"Tti , "I
Signature ofApplica'nt/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
'OFHCE
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AIIE1'A&cApp_,2011. doc revised 06121111
CUPERTINO SANITARY DISTRICT
2Dd03Stevens Creek Blvd #10lCupertino, CAQ5O14
Tel (4UO)253'7U71 -Fox(400)2G3'5173 ~��'�* cwpsnnmO
SANITARY DISTRICT PERMIT L
Cupertino Sanitary District has adopted Resolution No. 1263'
Building
Permit Request
o���x�����v ����uu�������*
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(Over -the -Counter)
SiO8le Family Project [—1 Multi -Family Project F-1 Commercial Project
Project Address: 65 (A �n
Permit Number:
Date: Prepared By:
City Authorized Representative
/,mg property owner orauthorized agent, acknowledge that a// Cupertino Sanitary District requirements
wil/be/netendo0nmouiredheeuvwllbap9id prior to the approval offinal inspection for proposed project
Date: ?_ it Uk I rq Signature:
Owner / Authorized Agent
. CUPERTlNO SANITARY DISTRICT OFFICE USE ONLY
[—1 Pre -inspection Requi d F71 Final Inspection Required
Date Scheduled: M_ )4,J
#ate: Conditional Approval By:
Authorized Representative
Cupertino Sanitary District
District will notify owner ofthe required fee within 5days after Pre -Inspection has been completed and cc
City of Cu no
RT Inspection Fee Paid Date Paid:
Inspection
$25O/unit-Single Family Residential already connected, but new cleanout iarequired
$15O/unit-S' |eFanni|vResidentiadalreadvconnentedxvithexistngdeanoutin working order
[�] $350 Minimum —Commercial and Retail Actua|Ammun
$2OD/eaoh—Disconnect and/or abandon lateral service
Connection Permit Fees:
$35O/unit-Single Family Residential connecting toexisting lateral
[_] $85O/Wnit—Single Family Residential connecting with new- lateral
[-1 $100/unit— K8u|b' Hote|, Living Units, oto. Actual Amount:
$5OO/oonnention-Commercial and Retail Actual Amount:
Connection Use Fees (See Attached Calculation 8heet:
Area and Frontage Fees Amount
[-�
Residential Excess Fees over 3.5unit/acre Amount
[_]
Commercial and Retail Connection Fees Amount
Commercial and Retail Change inUse Fees Amount
Date: Final Approval By: /
rt„,
REscug
ARS, RooTeR.
This letter is for Inspector Paul S for city of Cupertino in regard to Address 20585 Sunrise Dr,
Cupertino, CA. We performed video inspection of the building clean out and property line clean
out, and sewer line. All connections are good and system working properly This letter is so we
can have the permit finaled due to mistakes on are side. Thank you.
Regards,
Andrew Young
Rescue Rooter Plumbing License#765155