06040001 CITY OF CUPERTINOi°^* ��
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ,'.
BUILDING ADDRESS: PERMIT NO.
809 ROSE BLOSSOM DR
NER'5 NAME: PERMIT ISSUE DATE
JEAN SUN 04/03/2006
PHONE: SANITARY NO, CONTROL NO.
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
IcaO j LICENSED CONTRACTOR'S DECLARATION
w 1 rest,iffnm that 1 am licensed under provisions of Chapter 9(Commencing Job Description
:WwiNSection]pM)ofDi on3afthB nssandPolssnnsCod.aMmylicumeu REPLACE THE WATER PIPE FROM THE WATER METER TO
w in full force and effear.
>qz LmcmccClaa Lia.0 THE HOUSE
'go Dam Comracmr
pp'�` ARCHITECTS DECLARATION FINALE
'w /s aw
1 C s 1 understand my plans shall he used as public records 'p,`Y®■Yajl`p[�41ys61
>yU
g C Licensed Professional
g OWNER-BUILDER DECLARATION
y 1 hereby affirm that I am exempt from she Contractors License Law for the APR 11 c
O O following reason.(section 7131.5� ,Business and Profecsium Code:Any city or count' LY�t�
$ which requires a permit to crossbar,after.improve,demolish,or repair any structure 0
prior m its issuance,also requires the applicant for such fereciOo file a signed statement
< Nat heislicencalpursuammBeprovisionsaftheContracmrsLicenselaw(Chapter9 Sq.Ft. Floor Area Valuatio
z (commencing with Section 71100)of Division 3 of the Business and Professions Code)or G'g�
_
that he u exempt thmefrom and the basis for he alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects thc applicant m a civil penalty of 3 �i I�l�er 0 0 arc Type
not mare man five hundred dollars(SSO)). , Y yP
❑I,as owner of the property,or my employers with wages u Weir sole compensation,
will do Ore work and Neswctu e isnot intended or oacred for We(Svc.7044,Business
and Pmlessitum Code:The Contractors License law docs not apply Or an owner of Required Inspections
propcny w ho bui Ids or imprnvm thereon,and who does such wort himul f or through his
own emplayeas,provided that such improvements are notinmMed oroRered for We.If.
however,the building or improvement is sold within one year of completion.the owner
builder will love she burden of proving that he did nor Wild or improve for purpose of
Oak.).
X1,as owner of the property,am exclusively contracting with licensed contractors to
mtmct the pmjeet(see.7014,Business and Pmfessians Cade:)71te Contractor's U.
come taw docs not apply to an owner of pmpem,who Wilds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant in the Convectors
License Law.
1 am aain't under SecB&P/C forthisMasson
wnOr Dam
WORKERS MPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑flown and will maintain a Certifieam of Consent mself-insum(m WerkersCompen-
sation•as Provided for by Section 37M of the labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurams.a required by Section
370D of me labor Code,for the performance of the work for which this permit is issued.
My Work,,',Compensation Insurnme caries,and Policy number are
Cartier: Policy No.; _
CERTIFICATE OF EXEMPTION FROM WORKERS*
COMPENSATION INSURANCE
flus aeesian recd not the complemd ifthe permit is fortune hundred dollars(SIM)
or Imo)
1 certify thm in me performame of the work for which his permit is issued,I shall not
employ any person in any manncrm!I bee ncsubbct m the Wortrrs Compematins
Laws of California.Date —O
Applicant l�
NOTICE TO APPLICAMr.If,after making this Cenificam of Exemption,you should
become subject or the Workeh Compcwtion provisions of the labor Code,you muss
.,,z faMwith comP1Y with such provisions or this Permit shall W deemed rooked.
z O CONSTRUCTION LENDING AGENCY
PI hereby affirm that Nem is a Coruuuctinn lending agency for the Performance of
Di> the work for which this permit is issued(Sec.3097,Civ,C.)
CLanders Name .
z Lender's Address
V C) 1 certify that 1 have mad this application and sum that be above information is
I, F correct.I agree to comply with all city and county onfinances;and sure laws relating in
OU Wilding etunsuuction,and hereby authodre mere mitims of his city to enter upon the
above-mentioned property for inspection purposes.
H 0. (We)agrte m save,indemnify and keep harmless the City of Cupertino against _
fA inconsequece of th,tumuand expenses which may in anyway accrue against mid City
V z APPLICANTeUNDERSTANDSthis
AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
�` � — c6 Re-roofs
Soynuum of ApphmnVCon ter Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ser future building occupant Om a or handle hasNous material
a defined by she Cupertino Municipal Code.Ghipmr 9.12,LOW the Hcaldr and Safety
Cade.Section 25532(,)7
❑Yea r�Nu All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant usv equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hal rdnus air contaminants a okfned by the Bay Arca Air Quality Management all new materials for inspection.
District' ,W
❑Yes yNu
I have read the hvallous mamriilsrequiremcusiouRI WPmr6.95ofdeCalifm-
maHcatth&Safctyeode,Scauau 25505.25533 and2.5534.1 understood this ifde Wilding
dna not CO..,[,have a tenant,that Ir is my responsibility in nodfy the acupant of the
mquimmcnu whicypaa k met pr;ormiaa:maa ton ceneficate ofaapaney. Signature of Applicant Date'
Q nom.--- /t-3-u6
Owner or aulec ndagenl D,m All roof coverings to be Class "B"or better
CITY OF CUPERTINO
&m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35903005 . 00
DATE ISSUED. . . . . . . : 04/03/2006
RECEIPT # . . . . . . . . . : 33811
REFERENCE ID # . . . : 06040001
SITE ADDRESS . . . . . : 809 ROSE BLOSSOM DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JEAN SUN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4213
RECEIVED FROM . . . . : JEAN SUN
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY JEAN SUN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4213
• TELEPHONE . . . . . . . . :
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 DISCOVER
TOTAL RECEIPT 47 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform
• A. Y, All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below,
2. A state licensed contractor will be hired to do:
A. All of the work
B. A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
CiS'v'i LLiGi[
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firuy' Address/City Phone Number Type of work to be
erformed
eo •UJ evel &se lkk-8 73- ` )4 I
Da iv ,,, D �4 M/2 Wx +nn U
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: VZ.4, ., i — Date: !2�--3 -v-el,
Job Address: ep los-e,4 .c, Dr. Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
•
City of Cupertino Building Department
CITY OF 10300 Torre Avenue•
C U P E kT I N O Phone: (408)777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself, you
may protect vourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes,workers compensation insurance,disability insurance costs, and unemployment compensation•
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department, •
City of Cupertino
._ Printed on Recycled Paper
• 5112-
CITY OF CUPERTINO 0(oO40W�
;,
REPIPE/SEWEII.S/MAIN SERVICE
OF
-CUPERTINO PERMIT APPLICATION FORM
APN# �)t , DLJ' ��•✓ Date:
Building Address:
9709 If':s-a- r>osss,,L
Owner's Name: Phone#:
C
�e,ibo 40a 5��,, c47.3 — ,F2-,�/
Contractor: o /� Phone: License#:
Contact: / Phone: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential ®— Commercial ❑
Cost of Project: *600,
tom.
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•