05080013 CITY OF CUPERTINO �ws..+ .+3s . f" " ' " "'�`'' °' �
BUILDING DIVISION PERMIT' CONTRACTOR IIVFURMA'CIUN
BUILDING ADDRESS: TOM' S PLUMBING PERMITNG'05080013
10502 PART AV
OWNER'S NAME: PERMIT ISSUE DATE
JOAN OYANG LEE 12246 SARATOGA 2005
ONE: SANITARY NO. CONTROL NO.
(408) 867-6010
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG
O EO PO O
300 LICENSED CONTRACTOR'S DECLARATION JobDescrition
f I hereby of m Nal I sm licensed under pravisious of Chapter 9(mmmcraina - P
IN Section 7000)of Division 3 ofthe Business am Professions Code,and my It==is
a InfallforcemeeIT / REPIPE FROM MAIN TO .KITCHEN/WATER HEATER
LI"n"clez'�'�1a—u`'. WASH MACHINE/HOSEBIB
3
Datay�Conlncmr ��[
U `�SARCHI'IECrS DEC A ISA—'
I undenun l my pims.hall h used u pas tic record
C�a Licensed Professional
^ 5 OWNER—BUILDER De the Co TION
i I I hereby a(frm on I am uusin from me Gonias o License law for Jon
0 o which re moon.Permit
o]1013,Raciness and ova.dm Professions Code:My city Or musty
$Ini which requires a permit m<nnmme4 alter,impmw,demolish,or repair any structure
ZOn, prior in its issuance,also requires the applicant far such permit to file a signed statement
5xp
that he is licensed pursuant In Nc provisions of the Contractor.License law(Chapter9 Sq.Ft.Floor Area Valuat S 2 5 0
3$ (commencing with Section 7000)of Division 3 of the Business and Professions Com)or
a deal M is exempt Nemfmm and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any application for a permit subjects dm applicant to a civil penalty of APN Number Occupancy Type
am mom than Bw hundred dollars($500). 36925009 . 00
❑I,u Owner of the property,or my employees with wages as their mu compensation,
will do be work and she smunure knot Intended aO@sed far.1.(Ste.70x4,Business Required Inspections
and Prefesaieas Code:The Cornerstone,Licease Law does set apply m er an ownof q P
property who builds or Improves Neuron,and w ho does such work himself or through his
own employees,provided that such Improvements ase not Intended aoRee d for We.If. �I
however,the building or improvement is mid within one year of compledon,me owner
builder will have the burden of proving that M did not build or Improve far purpose of
um.). a.
❑1,as Owner of the property ser eaclusively contracting with Ikensed.mammas in
construct the prokn(Sec.7044,Business and Professions Cod:)The Contnemr's U.
cause law does not apply m an owner of property who hill or Improves Nerean,and
who contracts forsueh projects with a conarmmr(s)licensed pursuant m the Conuadars u
License Law.
❑1 am asempl under Sec. .B is P C for this resume
Owner Dau
W ORKERS COMPENSATION DECLARATION
I hereby elDrmunder penally of perjury arc of tie following declarations:
__ IhawaMwillmamuinaCeniOnteaf C...l u,self-iasucfarWorker's Compeer
ution,u provided fm by Section 3700 of du labor Code,for the performance of me
work for which this Permit is issued.
❑1 haw and will maintain Worker's Compensation losurrem.as acquired by Section
3700 of the Labor Code,for Out peRormanm of Ne work for which this Permit is issued.
My wodue.Compeandon Iand Polity number are:
Carrier. Policy Na:
CEI
R ^I CATEOFMISMIFTIONIFIRUMWORfiS,
COMPENSATION INSURANCE
(This section road not h completed If the permit Is furore hundred dollars($100)
or Isar)
1¢nifY that in the performance of the won for which this permit is Issued.I Nall not
employ any pcmon In any manner an as in became subject in the Warken'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,afar making this Certificate of Exemption,you should
became subject in the WOrkera Compensation previsions of the Labor Code,you mum
0z forthwith comply with seen provisions or this Permluhell be deemed revoked.
zO CONSTRUCTION LENDING AGENCY
1 hereby*Mona that Neu is a construction lending agency for the performuce of
C„>,t the work fa which thts permit k named(Sec.3097.Civ.C.)
aQ Lenders N.me
z Lenders Address
U p I certify dot 1 have mad this application and sou Nm the show Information is
correct.I agree to comply with all city and county oNlnarms and sou laws missing m
building construction.and hereby uthadm mpmunmivv of Nis city to enter upon the
W above-mentioned property,for impaction purposes
(We)as=m taw.indemnify and keep harmless the City of Cupertino against
C,) liabilities,judgmens.costa and expenses which may in say way amue sgshum said City
V 7 in cmnce scan of the Swung of this Park.
F7 APPLICANT UNDERSTANDS A 411 ND WILL CO PLY WITH ALL NON-POINT Issued by: Date
SO CE 04EGULKONS.
M
8-30' Re-roofs -T
S' arum of AlapficamiConlaactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appllum Or future building oceupmtmare orWndle huardous material
as dented by the CupeNm Municipal Cod.Chapter 9.17,and the Health and Safety
Ode.Become75532(a)7 All roofs shall be inspected prior to any roofing material being installed.
0Yes CkNo
Will me applicant or future building emupant use,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It havummur alt conuminuu u defined by me Bay Area Air Quality Management all new materials for inspection.
Istel?
❑Yes �fNu
1 haw rural NehasaNms materials requirentenuunder Chapkrb.95 ordu Califor-
nnHealth&Safmy COU.Satiau 25505.75533 and M34.1 undcnuM dist ifthe building
dons set commonly haw s tenant tiW ilk my as Ity m nai(y rite acevput of the recut mcnswhich mumbcmetpermiuu of cdreateo(Oceupamy. Signature of Applicant Date
0 amt mama ant Dam All roof coverings to be Class"B"or better
Community Development
oclo
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
DSOZ 0. 0-o l3
OWNER'S NAME: !6 A,v DY - Cc PHONE # 77-7 - p
GENERAL CONTRACTOR FAX#
I am not using any subcontractors: CJS 3' v
Signature Date
Please check applicable subcontractors and complete the following information:
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
6wner/Contractor Signature Date
'OFCITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE 0
CUPEIITINO PERMIT APPLICATION FORM
APN# 367
6 2-r Date:
Building Address:
�soz A0.4o, ,�
Owner's Name: Phone#:
aa. v lAe - Lem- -777— 09.."7
Contractor: Phone: License#:
Contact: Phone: Cupertino Business License#:
zCt aril q4 7- 6 d/d a
Building Permit Info:
Bldg ❑ Elect ❑ It Plumb
Job Description: iy, c
up
CO404- ur-<c� t}S
Residential Commercial ❑ t-0
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
I PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFDCTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING