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0806007200 Z � fit w -i f>.G] az U �_0 0 V Fa �z CITY OF CUPERTINO O y < $ — "Iii§zP'- BUILDING DIVISPSN PERMITPER CONTRAC,�TQ,RI,1VI UR�MATION Bu11MV8'TnNE CT ABLE SEPTIC rr NO. 08060072 OWNER'S NAME: PERMIT ISSUE DATE VCJ & MARCOS UNDERWOOD P 0 BOX 24819 06/10/2008 NE: SANITARY NO. CONTROL NO. (408)377-9990 ARCHITEC i'ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 thereby affmrse n that 1 um licensed under provisions of Chaper 9 (Commencing with Secuon7")ofDivision 3 ofthm Business and Notessiom Code.and my license is INSTL BLDG CLN-OUT FRNT HSE & PROPTY-LINE CLNOUT in full form and effecs 1 -I—) I Lkeve Clue L'c. a Dam j5•I` UI Comrumr dt������itQ ,)ZE•I ARCHITECT'S DECLATATION- I undersand my plans shall to used as public records LKe fired P opust...I OWNER -BUILDER DECLARATION I bemby affirm that 1 am exempt from the Commoner Ucc ae Taw for the following mason. (Section 1031.5. Business and Professions Cade: Any city or Coumy which requires a permit to cmtsumct, alcor, improve, demolish, or repair soy swcture prior to its issueme, almmquims tWappika, for such permit o file. signed saemem mat M is limned to the the Commnura Uceme Law Sq. Ft. Floor Area Valuation pursuant provisma of (Chap=9 4168 (eammeodng with Section 7000)of Division 3 of Ne Business and Pmreasioce Codc) or that he is exempt thencl oar and One basis for the alleged exemption. Any violation of 3 5 71610 6 Number Occas ane -Type P Y YP Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of wt marc than fin hundred dollars (1500). .� I,uawmer of ths, property,mmy employee with wagea asmeir sole eompewthon, Required Inspections will dotheworle and Ne I1044.omor mmtiror'sI anal he Lawdes; at owner of ns Cade The law dao rot apply thrimpmvedwho mesnoueh wort f is enywW Wildamns lam m. ndwho his property Eno aroffe ulthrough awn employees, providedori matwch imPronme�U arc not ins,MW If. mum the owner - mpledo . the tuforcalrner- me building or Improvement la sold within one year of cnimorn Wilderhowever. for builder will Nve me Louden of proving that he did rot build or imProsre [m purpose of Wilder ale.). 0 1, n Owmer of the property, am exclusively conuac0ng sold licensed conwmers w comtrom the protea Site. 7,an Business and Coda) The Comrwmrs TARY Of who a cease Law alma tot apply m w sones of property who WtWa or improves thereon. sod. property and whoascucl, for such Projects with a eo manoodo) licensed pursuant to de, Convectors License Law. ❑Tem exempt unmm See ,B&PC Tor Nis reason Owner Das, WORKER'S COMPENSATION DECLARATION 10 1 bnmby afrum under pnralty of perjury ore of me folmwing trtl om: 0 1 ban and will maintains Cer ifmnmof Cement to self-imum far Wormers Compen. cation, as provided for by Section 3100 of the Labor Cade, for the Performance of the wort for which this permit is issued. ❑ 1 have and will maimun Workers Compmestiom Insurance, as required by Section 37W of the Tabor Code, for me performance of the wort forwhich this permit is issued. My Worker`s`Comp1c uon Incomes an-Triesand Policy nulml.b``eram: Cartier, of t, olicyNo.:t.Vl I('.Dl�ihi CERT] GTE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This secdoe need Mt W completed iflas permit is forma hundrW dollars (1100) or Tess.) I unify that I. the perfomwce of the, worm for which this Permit Is issued. l mall nm i employ any person in any mummer so u m become subject to the Warmest Co npemauon , Laws of California Dam Applicant ' NOTICE TO APPLICANT: If, afer making this Cenifiom of Enmpuon, you should become Subject m the WOrter's CampCM1Vlmn PlOvlalma of me LJtm COdc, you most forthwith comply with such provisions w Our recruit shall W deemed revoked. . CONSTRUCTION LENDING AGENCY I hereby affirm mat mem is a caratrocdnn lending agency for the performame of the work for which this Permit Is sound (Sec. 3097, Civ. C.) lenders Name Lenders Address 1 certify that I have mad this application and sane mu the above information is Comm ) agree m comply with all city and county a dimameu and sum laws mladng m Wilding Conswction. and hereby wthonre hepre muuvu of mu city w Cons upon he ahove-menuo ed property for inspection purposes (We) agree t0 an, Indemnify Nd keep harmless Out City Of L'upenim0 against liabilities, judgmenu. costs and expenses which may in any way wane against said City On consegmme Of me Rooting of butpermit APPLICA ER NDS AND WILL COMPLY WITH ALL NO Issued by: Date �- S GUL S. t Re -roofs Signature of ApPiman mcjacmr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will On applicam or future Wilding occulmntnone or handle huudous material u de0ncd by Its, Cupertino Municipal Cade. Chapter 9.11. and the Health and safety ceM. section 25532(,)1 r] Yea •.[].Np All roofs shall be inspected prior to any roofing material being installed. Will mea IILNt or building occupant me equipment PrP g P a Proem ar devices which If a roof is installed without firs[ obtainingan inspection, I agree to remove P emit harm air conuminwu as defined by the Bay Area Air Quality Management all new materials for inspection. DiauicA Dyes 15 (6 I haw; mad be, Inco mousmsed.l.ho iuimmeou under Chapmr6.95 of the Califor. ria HealthGOM,SCLemo2550.25533 and 75534.1 understand metifthe Wilding moo wt c nthY K a 6 mut It u my responsibility In Molly the arwt e upof the ta which met Priori uwwcc of a cmtire.m or occupancy. Signature Of Applicant Date 1 — (',-r`0–c� All roof coverings to be Class'W' or better Owner orwthariredagent- Dam . 4 ITEMS OF 4 • • CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: 7. APN ........: 35716106.00 DATE ISSUED.......: 06/10/2008 RECEIPT #.........: BS000005054 REFERENCE ID # ...: 08060072 SITE ADDRESS .....: 21850 BYRNE CT SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 102.48 --------------- 102.48 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING REFERENCE NUMBER -------------------- #8150 VOICE ID DESCRIPTION -------- ---------------------------- 202 UNDERFLOOR PLUMBING 400 SEWER/LATERAL OWNER ............: CJ & MARCOS UNDERWOOD ADDRESS ..........: 21850 BYRNE CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: ABLE UNDERGRND CONTRACTOR .......: GILBERT, GLEN LIC # 21407 COMPANY ........I.: ABLE SEPTIC ADDRESS ..........: P 0 BOX 24819 CITY/STATE/ZIP ...: SAN JOSE, CA 95154 TELEPHONE ........: (408)377-9990 FEE ID ---------- UNIT QUANTITY ------------- ---------- AMOUNT PD -TO -DT THIS REC NEW BAL 1BSEISMICR VALUATION 4,168.00 ---------- ---------- 0.50 0.00 ---------- 0.50 ---------- 0.00 1PPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1PRSEWER UNITS 1.00 20.40 0.00 20.40 0.00 ITRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 TOTAL PERMIT ---------- ---------- 102.48 0.00 ---------- 102.48 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 102.48 --------------- 102.48 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING REFERENCE NUMBER -------------------- #8150 VOICE ID DESCRIPTION -------- ---------------------------- 202 UNDERFLOOR PLUMBING 400 SEWER/LATERAL A CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # � 7 to Date: - Building Address: C+ Owner's Name: Phone #: _ Nc�)o� 873-9i-�;`7Gj Contractor: Phone #: j -� _ o� Gy e� 0 Fax #: Contact: Phone #: 1CPRP Fax #: Contractor License #: (Q� —A L4 Cupertino Business License #: (j Job Description: � tis )DC/, e U-,�OaNf' Residentiax Commercial Q Valuation: ! ,\' / � — Seismic Commercial Green Building: Please complete relevant portion of the Green Building Checklist &at ach it to the application or if applicable, include in plan set & the sheet index. Quantity Fee ID Fee Description Fee Group Permit Type 1PCSEWER Commercial building sewer/sanitary sewer P 1CPSS 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System 1-4 Outlets P 1BSEISMICOM Seismic Commercial P / 1BSEISMICR Seismic Residential P IPRSEWER Residential building sewer/sanitary sewer P 1RPSS S,�' CITY OF CUPEkTINO CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1PRREPIPE Residential re -pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 4 1BPWATER Install/alter Water Pipe P K 1BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System 1-4 Outlets P 1 BPGAS Gas Piping System 5+ Outlets P f 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P / 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B • 0 AF0 SEUPEkTINO 0 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # © 00-7,), OWNER'S AME: NM S N 4t Wao j PHONE GENERAL CONTRACTOR: 1 vNc�� n, ,v FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information Owner/ Contractor Signature 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 T' Owner/ Contractor Signature Date