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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
Z?CONTRACTOR INFORMATION
BUILDING ADDRESS:
DRAIN DOCTOR
PERMITNO.0508 O 143
10243 BEARDON DR (4 UNITS
OW NER'S NAME:
PERhBT ISSUE DATE
GOODWIN CHIN
1775 WINCHESTER BLVD
08/17/2005
)NE:
SANITARY NO. CONTROL NO.
(408)370-3082
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB him
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
p
with Section 70W) of Division 3 of the Business and ProfessionaCodegd my license is
in fall mreaandeffeet( 3G �F3'!S
REPIPE FROM METER TO BUILDING &
Do nae clear seas
Dam - Comraerar
WHOLE. BUILDING
ARCHITECTS DEPURATION
I undcrsmnJ my plans shell he used as Public owrds
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby alarm that I am exempt from the Contortions License law for the
following mason. (Section 703 L5, Business and Pmfeaduns Cade: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior in its issuance, also rcquira the applicant for such Permit to file a signed smmment
that he is became! pursuonuo Ne provisiros of the Cmnncmr's License Law (Chapter 9
Sq. Ft. Floor Area
Valu 16000
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt tM¢from and the buds for the alleged a xonfor m. Any violation M
pPN Number
OccupancyType
yp
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penally of
not mom than rive hundred dollars (M).
32632025.00
❑ 1, as owner of the property, or my employees with wages as their rode compensation,
e
Required Inspections
will do Ne work. and the swctue is not intended or offered for safe (Sec. 7014, Business
and Professions Code: The Conuacmr's License Law does not apply to an owner of
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property who builds or improves thereon, and who doessuch work himself or through his
own employees, provided that Such improvements are at intended CroRered fmaale. It.
however, are building or improvement is sold within mm year of completion, the owner
/
builder will have the burden of Moving that he did our build or improve for purpose of
sale.).
�/-
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
consumer the project (Sec. 7014. Business and Profusions Cade) The Convector's Li -
come law does not apply to an owner of progeny who builds or impmvn thereon, and
who contracts for such projects with a conuactor(s) licensed puremm to the Contnemrs
-
License Law.
❑ l am exempt under Sec. .B&P C for this ream
..:.. .. _. _
Owner ... Date
- -'
WORKER'S COMPENSATION DECLARATION--'"
1 hereby affirm under penally, o('do, oa of the following dxlaratiom:
I have and will maintain a Certificate of Consent to self -insure for WorkeriCompen-
on, as provided for by Section 3700 of the labor Code, for the performance of the
rk for which our permit is issued.
1 have and will maintain Worker's Compensation Insurance, as required by Secure
IC173"(ffl!
of the labor Code. for the performance of one work for which this permit is issued.
Workers Compensation Insumne carrier and Policy number amrier.A/r7lo£•iJ%L1t1
Polity No.: 61114/27 •s
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
( h1hrectimt teed not te completed if the permit is formic hundred dollars ($100)
or less.
I CCo fy Nat in throe performance of she work for which this permit is issued. I shall not
employ any person in any manor an as be become subject o the Workeras Compensauan
Laws of Califordt. Dae
Applicant
NOTICE TO APPLICANT: If, after making Nu Certificate of Exemption, you should
become subject to the Worker's Compensation previsions of Ne lahm Code, you must
forthwith comply with such provisions or this permit shall be deemed reverted.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agctey for Nc Perfurmanee of
the work far width this permit is issued (See. 3097, Civ. C.
Lender's Name
Un&,'a Address
'
I certify that 1 have read this application and state that the shove informatiun is
Cower. I agra a comply wish all city and county oMinance, and sate laws relating m
building construction, and hereby authodre rcpresemmi es of this city 10 enter upon she
above-mentioned pmperty for inuf ction Purposes.
(We) agree to save, indemnify and kap homeless the City of Cupertino against
liabilities, judgmers¢, cods and expenses which may in any way same against said City
in conscquenee of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date 9—(, -7-0,r-
SOUR EREGULATIO
Re -roofs • t l
Type of Roof
`
gnazu of o°'_HAZARDOUS MATERIALS DISCLOSURE at,Wm
Will de applicant or future building Occupant some or handle haeafdous material
as dcfned by the Cupertino Municipal Code. Chapmr 9.12, and the Health and Safety
otic. Section 25532(x)?All
Dyer `b&-
roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment Or devices which
.It havardous air contaminants as turned by the Bay Arca Air Quality Management
all new materials for inspection.
svier?
❑Yes 4.,
1 have real the hvaminu tudie cels mquiomcmta under, Chapter fi.95Mdoe Czlifor-
niaHexlth&Safety Code.Sectiatts255(15.25533md 25534.1undemand thatifthe Wilding
doenot currently haa tennt aslam it h my responsibility to ready she Occupant of the
w
moi Er which mus be met prior to issuance ofd certificate of Occupant.
Signature of Applicant Date
All roof coverings to be Class "B" Or better
weer ter sutharvad ageat Date
c®
A.
CITY OF
UPEkTINO
JOB ADDRESS:
OWNER'S NAME: Gcboc
GENERAL CONTRACTOR
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
PERMIT #
Of -(
PHONE #/-foo
9�nI nnl.rn/2 FAX#
I am not using any subcontractors: 6�. z4 -
Signature
Please check applicable subcontractors and complete the following information
ZO/ Y
9117105
Date
5:�- r.�,
Owner/ Contractor Signature
F// 7/0 _s
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
5:�- r.�,
Owner/ Contractor Signature
F// 7/0 _s
Date
CITY OF
CUPERTINO
CITY OF CUPERTINO
REPIPE/SEVERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN #
Bldg. Permit Fees
BUILDING
Date:
Gas Piping System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
Building Address:
V
Re i eofFixtures
/oa y3 -
Pz 5X
Pbl . Fixture
Owner's Name:
BPWSVCS
Main Water Service
Phone #:
CN ^
Sewers
PLUMBING
BPSEWAGE
Contractor:
Phone:
BENERGY
License #:
40../ Doc
I-Foo-qzt -//
Business License
6
Contact:
Phone:
Cupertino Business License #:
C — r00^1
Building Permit Info:
Bldg ❑ Elect ❑
Plumb
Job Description:
&Ale.r X1-r;,,-1F'c� %
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u1 FT
Residential ❑ Commercial ❑
Costo Pro.ect
Cp O00
11
Qty. if
Applicable Fee ID
Fee Description
Fee Group
BPERMFEE
Bldg. Permit Fees
BUILDING
BPGAS
Gas Piping System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i eofFixtures
PLUMBING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING
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