05070104 CITY OF CUPERTINOar'-7ar'; I' ^`� Sr''�
BUILDING DIVISION PERMIT COW kTQR INFORMATIONN
BUILDING ADDRESS: DRAIN DOCTOR PERMRNOO5070104
OWNER'S NAME: PERMIT'ISSUE DATE
JACKSON 1411ANC
1E: SANITARY NO. CONTROL NO.
(408) 370-30R2
ARCHTTECTIENG
-
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
u00 LICENSED CONTRACC)R'SDECLARATION Job
mC I Wreby affirm that 1 am Iiansed under provision of Chapter 9(commencingLED
iW with Sation)0007 of Division Softie Buaitr..eM Prafcssiu na do liccnc is
�„ imm�forceAnde(fm REPLACE SEWER LINE
p jjz License Class I.M.0 L
C"o Dau -Contrsctor /��- t ./7 )�UG%O(�^ /
full
HITECI'S DECLARATI • - f / / 2005
By�� -- 1 undc�tandpy plans shat Rncards {y■pB
JiU // v — aTMm �u��®I•
p�`��
s o Licensed c r nal
3
OWNER-BUILDER DECLARATION
I hereby shoo than I am exempt from Ne Conmemfs Licenx Law for the
no following reason.(Section 7031.5,Business and Profession Cods:Any city or county
which requites a permit to construct,alter.improve.dermimh.or rehab any structure
prior to its issuance.also requms the applicant per such permit to file a signed suemm, onn
< that he is licensed pursuant hs the provisions of the Connector's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
ireFm (commencing with Seamon 7")of Division 3 of the Business and Professions Codc)ter
i $ that he U exempt therefrom and the baso for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the Applicant 0 A civil penalty Of 3 9&NM11n0Qr0 0 Occupancy Type
not more than five hundred dollars($5(10).
D I,as Ownerof0tepmpwy,ormyemploycnwithwagmoftbmlecomp melon,
will do the work,And the swcmre i,not intended ter offered forsalc(Sce.70x4,Business
and Prefessmos Code:The Conuacwrs License U.does nor apply to an owner of Required Inspections
property who Wilde or improves thermn,and who doessuchworkhimself orthrough his
awn employcn,provided that Such improvements are not intended oro0ered fors,le.IL
however,the building or improvement is sold within one year ofcompletion.the owner
builder will have tha W rden of proving that he dial ret Wild or improve for purpose of
Sale.)
.
D 1.as Owner of the property,am exclusively contracting with licensed contractors by
convect Ne project(Sec.7014,Business and Profession Code:)The COnuacrefs Li.
Sense law don not apply in an ownm of property who Wilds or improves themon.and.
who contracts for such pmjecu with A contracmr(s)licensed pursuant to the Contractors
License Law.
D 1 am exempt under Sec. .B&P C for this mann
Owner Dau
737MWORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following decimation:
have and will maintain a Certificate Of Consent self-insure for WorkersCompcn-
n,ss provided for by Section 3700 of Ne labor Code,for the performance of the
for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as rcgvired by Section
ofthe Labor Code,far the performance of the weak for which this permit is issuedWorked Cnmpen6 In�nnj�e YtO�cynumberam: I
ier LANV11sd Ya"H"MC nlicy No.:�L..�=// ✓,S
`- CERTIFICATE OF EXEMPTION FROM WORKERS' -
COMPENSATION INSURANCE
(This section need not W completed tribe permit is foronc hundred dollars(S O(h)
or less.)
I certify the,in the Kolmmencc of the work for which this Permit is issued,l mail nm
employ any person in any manner m as to Wcomc subjauo the Workcn'Compensation
Law,of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you Should
become subject m the Worker's Compensation previsions Of Ne tabor Code,you must
,JZ forthwith comply with such provisions or this perm it shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a mnwetinr lending agency for the performance of
[�
the..,it for which this permit is issued(Sec.3041,Civ.C.)
QLendcfs Name
Z Lenders Address
U C) I Certify than 1 base mad this application and sou that d¢above information IS
IS, Ewren.1 agree to comply with all city and county ordinances and state laws relating to
CrJ' building convection,and hereby mthoric,representatives Of this City to enter upon Nc
hove mentioned property for inspection purposes.
f+C (We)Agra to Save.indemnify and keep hmmless the City of Cupcnim agamst
h liabiliticajidgmcmu,costs and expenses which may in any way...agmml sale City
U in consequence of the;noting of this remit.
APPLICANT UNDERSTANDS AND W LL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
s —�— Re-roofs
Signmur ApplicanbConuamor Dau
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant ter fume Wilding occupant store or handle haa4rduus material
as defined by the Cupenim Munici otic,Chapter 9.12,and dte Hcalth and Safety
Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Dy. /40No
Will the applicam or fume building occupant ase equipment or&vim which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conmminanu as dcfin d by du Bay Area Air Quality Management all new materials for inspection.
District,
❑Yes No
I have read the baaardcus materials requirements under Chapter 6.95of the Califor-
m.Hnith&Safely Code.Scction25505.25533 and 25534.1 urWCsnand dun iflW Wilding
does not currently have:•renank that it is my rcaponibili,,m mufy de occupmt of the
requirements wn' hmnu WmeI fa CeniF, nmc/�. _ mature of Applicant Date
—/
Owner or .,cm Dam
All roof coverings to be Class"B" or better
a Izcd r
Community Development
10300 Torre Avenue
Cupertino CA 95014
" Telephone(408)777-3228
CITY OF Fax(408)777-3333
doUPERTINO
Building De artment
JOB ADDRESS: L f /� PERMIT #
f �- \i° 7 l/�IDOL' l V -rO -7 61d �t
OWNER'S NAME: -j r Itxv o v 01 ti PHONE # Llo g Z 1 -605
GENERAL CONTRACTOR: I' v/� v >^ FAX #
I am not using any subcontractors: ( — 7`- 02 0�
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
Owner/Contractor Signature Date
INVOICE. INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
PERMIT INVOICE OPERATOR: kiersaw
Sec: Twp: Rug: Sub: Blk: Lot:
APN . . . . . . . . : 35931027.00
INVOICE DATE. . . . . . : 07/18/2005
REFERENCE ID # . . . : 05070104
SITE ADDRESS . . . . . : 1152 KENTWOOD AV
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JACKSON HUANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5839
CONTRACTOR . . . . . . . : JOHN H. LIM LIC # 24784
COMPANY . . . . . . . . . . : DRAIN DOCTOR
ADDRESS . . . . . . . . . . : 1775 WINCHESTER BLVD
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 370-3082
FEE DESCRIPTION ACCT NUM CHK TOTAL FEE PD TO DATE BAL DUE
_ ____________________ ____________ ___ __________ __________ ------
---
_
Y 4119 A 39.92 0.00 39.92
PERMIT FEES . 4116 P 83 .16 0.00 83.16
SEWERS 4117 P 21.56 0.00 21.58
PLUMBNG PERMIT ISSUE 4117 P 38.37 0.00 38.37
183.03 0.00 183 .03
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
O
pS0�+o►oe*�,f
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
CUPEIZTINO PERMIT APPLICATION FORM
APN# ate:
5';9-3
�_ G
Building Address:
�:1, rye Ati - taro o GI v
Owner's N Phone#:
�ILso'n 4 Vag 763 Z
Contractor: Q r C//r ",/^ � Phone: �� 0 v 9� License 3 l g
�1 r6' t-'j-
Contact: �0 3'? 3 O 2 �P�one: \ ,N c)C L p, Cupertino Business License #:
V 1J T°
Building Permit Info: P-e(l r,e e S w Q✓ fln— /
Bldg ❑ Elect El Plumb l `Z
Job Description:
Residential Commercial ❑
Cost of Project: CJ C9 0
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Pip ng System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE e a e Disposal PLUMBING
/ BENERGY Energy BUILDING
BUSLIC Business License BUILDING
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