06070041 CITY OF CUPERTINO •
BU11tDING DIVfS10N PERAHT
a Tom.;t�W,}u. ,rov Y�•aA.,
BUILOINO ADDRESS: ALL VALLEY PLUMBING P..,.N0.06070041
11567 FALLCREE
OWNER'S NAME: FBRMITISSUEDATO
LEELING WANG 3345 SELDON CT 07 /10/20OF;
NE: SANITARY NO. CONTROL NO.
(510) 376-4816
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Sop LICENSED CONTRACTOR'S DECLARATION Job Description I hereby.(Elim Thu 1 sm licensed under provisionsof Chapter 9(commencing
with Smuon 70)(t).t DiHsEft BosiandProf iuuCode.mdmylimemisInraRforceAndenWtlQ WATER HEATER REPLACEMENT
j�4 LicenseClassLk.Dam ConcrS N
¢ I understand my plms.hall M uuJ ur Be records
JyU
e Licensed professional
tN OWNER-BUILDERexempt
DECe Cantr10N
I gesso ,scc ons 11. exempt from the Camaro ra License City
o for tic
p o fallowing moon.(Section 703 construct.
Business and improve.
dem ns Calc:Any city ar county
59 which rtqulres issuance,permit reconstruct alter.improve,h Permiit t a spur Any Natem - 3 8 O
zy priorw itsendpursumgothe thnvisms of for rochpermit wNeasigntstaemcm
that(comm bBceut pas dm7otheproNsi ion3of Canusinm dProfLaw lC odc)ur Sq.Ft.Floor Area Valuation
6 (commcnc orep, S arnom and I Div as for ahem egad exem t on.Any vi ladon of
Nat lo b exempt therefrom and oe bub far due alleged exemption.Any violation of
Seton7031.5 Many rdidantforapermitsubjectsthnapplicanttoacivilperoltYof Occupancy Type
dust
not mom oro Rw hundred dollar($50)).
I,as,owner of on property,a my uoplayens with sego As beef,role eompeneaeon,
will do the welt and theanucom,b not Intended or offered for ase(Sec.7014.Business Required Inspections
and profes.iom Cade:The Contractors Limnse Law does rot apply to in owner of q P
property who buildsorimproves thermn,andwhodotssuat work himselfathough his
own employee.,provided thatmch improvements sse not hammed meed aaffered for sale.if.
however,the building a Improvement braid wltMnone you of comph3ke.the Ownum-
bullder will have bee burden of proving that he did not build a Improve for purpose of
sok.).
❑L.3 owner or the Property.am exclusively contracting with licensed mnsramon to /
enutroct the project(Sm.7044,Business and Profession Cade:)The Contractors Li-
cove Law does not apply to an Inner of property who builds or improves thereon,and O
who contracts for such projects with Aconuawr(s)Ilcenned pursuant to bee Conuacwrs /
License law. b
❑l.messmptmde See ,BdPCfathis.
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby AR.under penalty of perjury am of bee following daladdome
I have bend will reainuin aCeniOme ofConsem to self-imurt fa Waters Campen-
mim,as provitrA for by Section 3100 of the Labor Coal for the performance of de
work for which this permit is issued.
1 have and will mainum Workers Compeuatice Insurance,as maid ed by Section
of the Labs Code,for the perfomsance of use wk far which thin permit Is Ismael.
My Worker Compeasa' n Wurame catricr and Polity n�/yry�bm
Cartier. Policy No.:t:d
CE FlC
COMPENSATION
INSURANCE WORKE
COMPENSATION INSURANCE
(Thusectfon need m1mcmnpked if the permit Is forone hunthod dollars(5100)
or Ica.)
I cerdfy that in the performance of the work fa which this permit is issued,i shall am
employ any person In my matter an as to became subject at the Worked Conpew0m
Lam of California.Dae
Applicant
NOTICE TO APPLICANT:If.after making Ihb Cedifle a of Essmption,you should
become subject to d"Workers Compewuon provisions of the labs Code you most
.J O forthwith comply with such provisions or his permit Nall be deemed revoked.
„Z,i► CONSTRUCTION LENDING AGENCY
[-s I hereby affirm dual then is a con=cdnn lending agency for the Performance of
the work for which beb permit Is issued(Sec.3097.Civ.Q -
WM Q Lenders Name
a Z Lenders Address
U Q 1 mnify that I have rad Otis application and we dust the above Information is
G, F cortect.1 agree to comply with all city and county ordinances and auk laws relating to
0 building ennsuunw,and hereby authoriss repreaenutivu of this city to enter upon the
r t11 .hove-mentioned prepcny for inamcuan p.,poks.
Py (We)agree to save,indemnify And temp humless bee City of Cupertino against
lin limlildas,jodgrecou,casts Ando n.-,which may in my toy accrue.,.Inst saleCity
UZ in consequence of the granting is permit.
APPLICANT UNDERST 5 AND WILL COMPLY WIN ALL NON-POINT Issued by: Date
90URG REGULATIO G
Re-roofs
fiakmawmaHAZARDOUS MATERIALS DISCLOSURE ore Type of Roof
JI the applicant or future building ocoupantstore ahandle hasardou material
As and by bee Cupertino Municipal Cade.Chapter 9.11.and the Health and Safety
Code,Section 15531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Wel the applimm or future building occupant Ise equipment or deviw which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air tontsminanu u dc0 d by bee Bay Area Air Q®lity Management all.new materials for inspection.
District
❑Yo u
I have mad the meard"materials Mquiremcros under Chapter6.95 of the Califon
MA He.]"SalctyCade,Sommts 15505,15533 And 15534.1 understand thuifee W116Ag
does nerdy ha "nam,thin It b my rtspyuthllity to no tify the occupant or the
yvirtmen whkh melpdrw of Occupancy. Signature of Applicant Date
rte m .ed agent mm I All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
acor
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
IOUPEI,TINO
Building De artment
JOB ADDRES - PERMIT #
OWNER' NAME: PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractor .
Signature Date
Please check applicable subcontra rs and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
AM 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36651017 . 00
DATE ISSUED. . . . . . . : 07/10/2006
RECEIPT # . . . . . . . . . : 35168
REFERENCE ID # . . . : 06070041
SITE ADDRESS . . . . . : 11567 FALLCREEK SPRIN CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LEELING WANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ALL VALLEY PLUMBING
CONTRACTOR . . . . . . . : MARY SANDBRINK LIC # 23015
COMPANY . . . . . . . . . . : ALL VALLEY PLUMBING
ADDRESS . . . . . . . . . . : 3345 SELDON CT
CITY/STATE/ZIP . . . : FREMONT, CA 94539
TELEPHONE . . . . . . . . : (510) 376-4816
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 168 . 04 7316
TOTAL RECEIPT 168 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
0c000O41
CITY OF CUPERTINO
• WATER HEATER
CUPEkTINO PERMIT APPLICATION FORM y
APN# 3 ,S—/ 0/ ,7 Date: /
Building Address: II S61 f� Crc ek T?P Com
tel%h �N Phone #(¢09�1r� '�13�1v
Owner's Name:
Contractor: License #:
G 6 9 90
Contact: Pho a #:
-
Applicant/Contractor:
Building Permit Info:
Bldg Elect <35 Tum Mech
Job Description:
esidenti : Commercial:
Sq. t. loor Area: q.Ft,:
Architect/Engineer: Valuation:
• Type of Construction: Occupancy Group:v
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/ Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPERMFEE Bldg Permit Fees BUILIDNG
BMITIGAT Housing Mitigation Fee BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
•