06030162 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT �CONTRA6-TOO RA NEDRMATION:
BUILDING ADDRESS: PERMIT NO.
7448 ROLLINGDELL AVE
R'S NAME: PERMIT ISSUE DATE
DEAN YUAN 1300 DELL AVE, STE C 03/29/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 253-0618
ARCHITEC'ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
±00 LICENSED CONTRACTOR'S DECLARATION JobDescr�r1neyfr
O D O
£3U 1 hcrcby affirm that 1 em licensed under provisions of Chapter Y(rommcncing ■ �. lALE
with Sumo 70f10)of Division 3 of Ne Busineasand Professions Code,mdm fume is F
a inmRrIh anaortefe / C�N9OS WATER MAIN PIPE LINE
License{,lass ! - �U Lic.«
tr' Mt 1 19- cJL Contractor
ARCHITECTS DECLARATIO s��/�
I understand my plans shall W used as public records MAR'+`^ 2�/1 OOV��
Is.od Licensed Professional
3 OWNER-BUILDER DECLARATION
<F I hereby reaso .(firm on I [. cBunpt from the Contractor's License Lew for the
p o following myon.(Section 7117 L5,Business and Rofcasinna Code:Any city of county 0 0
5 m which requires a permit to convect,alcor.improve,demolish,or mpwr any slruch m BUILDING
_iy priarm its issuance.also requires the applicant forsuch Permit to rile a signed statement
< thatheialiemosedpuraanll.Nepro.iaiomnfN.c...W" lUc'uselaw(Chapte t) Sq. Ft. Floor Area Valuation
ii-$ (commencingwith Swlion7p )of Div ion3of Ne Business ftressiansCM)or
u3.- that h is tommpt theRfrom and the hosis for the alleged attenuation.Any violation of
Section 7031.5 by any applicant fon permit subjects the applicant to a civil pemlly of ane ber um
A Occupancy Type
not mom than Bw hundred dollars($500). P Y YP
❑1,as owner of the property,or my employees with wages as their sok competition.
will do the work,and the structure Is not intended or offered for sale(Sea 7014.Business
and Professions Code:The Con meters Lixme Law does not apply to an owner of Required Inspections
property who builds or indis aMerton,andwho dosouch work himseIforthrough his
awn employees,provided that such improvements tie notimended oro@red for ale It,
however,the Wilding or improvement is old within one year of compledon.the owner-
builder will haw she buNen of proving that he did Trot Wild or improv fes purpose of
ale.).
❑1,as Owner of the property.am eaclmiwly contracting with licensed commemrs W
comwcl the project(Sec.7014,Basin.and Professions Code:)The ContracWr's LI-
curse:law dm.not apply W an owner of property who hild,or impmva themon,and,
who eommets for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
I ore'.amp,under S . B k P C for this..an
IV F _ Date —� f—Uel� (
WO 'SC DECLARATION
Thereby aR undmitenalOofpeda,uwofdo fallowingdecamliom:
❑1 haw am will maintain a ConiEaW of Consent W self-insure far WorkefsCompen-
ation,as provided for by Section 3700 of the Labor Cade,for the pe fi nnumto of the
work for which this permit is issued.
❑1 haw and will maintain Workcr's Compensation Imu urea.as required by Section
3700 of the Labor Code,for the performance of the wort for which this permit is issuW.
My Worker's Compensation Insurance anise and Policy number am:
Cartier. FT•`rr-y7 Policy Na.:4-rl�si-�u-z3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This auction wed not becompkmd lithe permit is forone hundred dollars($1x0)
nr less.)
1 certify thm in the fte fnmu.ce of Ne work for which Nis permit is issued,I shall mol
employ any pcnon in MY manner u as W become abject m the WOfkeni Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Esemption,you should
become subject an the Worker's Compensation previsions of the Labor Code,you mus
JO forthwith comply with such pmvivons W this Permit shall W domed revoked.
Z H CONSTRUCTION LENDING AGENCY
F I hereby olTnm that them is a comwnian lending agency lot de performance,of
C the work for which this permit Is issued(Sec.3041,Civ.C.) '
Lr,Q Lender's Name
Lando's Address
V Q I ccnify that I have mad this application and more out,the aWw colonnade.is
U. correct.I agree to comply with all city and county on inaraxs and Mule laws miating to
0V Wilding conumction,and hereby Motorize representatives or Nis city to enter upon the
abovcme judgmoncdents,
propertycosts
for inspection purposeWhich May
H a (We)agree m arc.indemnify and keep harnlcss the City of Cupertino against
h
in
of
gratsatlOf this swhich maY in MY my accme a&ainst aid City
V z A APPLICANT
of UNDERSTANDS
of kis permit. Issued by: Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS. ( - V
Re-roofs
Slgnaurc of ApphaHAZA TDO Dak
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant.,fMuni Wilding e.Chapter
orand t e Health amaterial
fined io Or Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety
.Section 35533(a)7[Dy. 0All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
Will the applicant or future building ocupam use equipment or devices which g agree to remove P
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District
❑Yes Nu
Wilding
I haw rtad the hvartlnusmacnals mquirtmcnts under Chapter GYS ofthe Califar
'aHa]thhSafctyCada Suvons25505.25533wd25531.Imdcrssan ifthc
n of curendy haw a�Gpan(that it u my ms'numbithy at ofy the.,.r of th.
tswh75i — ma Or Wmoc.r.Ceru W.rOoc.pacY. Signature of Applicant Date
Gm e,ormthor.mlagent Dam All roof coverings to be Class "B"or better
CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35931064 . 00
DATE ISSUED. . . . . . . : 03/29/2006
RECEIPT 4 . . . . . . . . . : 33780
REFERENCE ID # . . . : 06030162
SITE ADDRESS . . . . . : 7448 ROLLINGDELL AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER DEAN YUAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2934
RECEIVED FROM FRANK CARDIA
CONTRACTOR CARDIA, FRANK L LIC # 612
COMPANY . . . . . . . . . . : CUPERTINO PLUMBING
ADDRESS : 1300 DELL AVE, STE C
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
• TELEPHONE . . . . . . . . : (408) 253-0618
FEE ID UNIT -- - QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- --------- ______ ______
---------- ---------- ----------
BPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ------ ------
----
----
TOTAL PERMIT 47 . 37 0 . 00 47 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-----------------
---- ------------------
OTHER 47 . 37 VISA
TOTAL RECEIPT 47 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER
507 FINAL PLUMBING 106 SEWER & WATER
• .,,,. Community Development
10300 Torre Avenue
Cupertino CA 95014
r °y Telephone(408)777-3228
CITY
Fax(408) 777-3333
4PU
Building Department
JOB ADDRESS: PERMIT # /�
7` {�I �, � IL'n � Vcoo 301co?/
OWNER'S NAME: PHONE # a
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
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
2 9-O
ner/Contractor Signature Date
CITY OF CUPERTINO
_F01712-
REPIPE/SEWERS/MAIN SERVICE
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address.
-7`1yb
Owner' arae: Phone#:
7c/4
Contractor: Phone: License#:
C,, [ 2 ,53 - 0(.1 S y 905
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb 2 �
Job Description:
��lti'� Ma`s l;YIQ
Residential Commercial ❑
Cost of Project: U U -
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Pi ing System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i eofFixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•