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06090116C)Q z r iy CL A oz UO u. u.r �0. U CITY OF CUPERTINO Ci11' 1 IN�aU1tMAArTIUN -. BUILDING DIVISION PERMIT '7CR4CT .�w Bu1LOINGADDRESS: PLUMBERS ON CALL PEum" NG'0609O116 1171 STAFFORD DR OWNER'S NAME: PERMIT ISSUE DATE VERONICA LAW & WEISIN CHON 520 MEGLIAC NE: SANITARY NO. CONTROL NO. (408)879-9416 ARCHr1EC (ENGINEER: BUILDING PERMIT INFO BLDG EO PLO MSCH O LICENSED CONTRACTOR'S DECLARATION Job Description 1 hemby affirm Net 1 am heated under previsions of Chapter 9 (commenting with Section 7000) of Division 3 of Ne Business and Professions Code, and my license is in ten farce end err, 71 Z�%K� REPIPE GALVANIZED TO COPPER License CI Lic. p Dem Cantracwu ARCHITECTS DECLARATION 1 understand my plans,hall Mused as public rxmN Licensed Pm(maionel OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt Item the Connector's License Law for the following roman. (Section 703 1.5, Business and Professiaas Code: Any city nr mainly which requires a permit to comm ct, elle, improve, demolish, or repair any suucwm $6496 prior m its issuance, also requires the applicant for such permit to rile a signed summem that he is licensed punuanito the provisions of the Coramar', License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business ant Professions Code) or dist he u exempt therefrom and the basis for The alleged ex ani don. Any violation of r Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil Penalty ofrkPN not mart dim fw hundred dollars (5500). ❑ I, as owner of the property, or my employees with wages as their sok comp osadon, e Required Inspections will do Newark and the mmctme is hotheaded.,offered forsale(Sm. 7044, Business arm Professions Cade The Conurem's License law saes not apply a an owner of 9 P property who builds orimprov thereon, ant who dos suc h work himself sir through his Own employeas, provided that such improvements rte notinended aro@red fm We. If, however, One building or improvement is said within am: year of completion, the own" - builder will have de, Marden of proving that he did rot build or improve for purpose of sok.). ❑ 1, as owner of the property, an exclusively contracting with Restated rontrecia. e construct Ne project (Sec. 70M. Business and Professions Code:) 77rc Communes Li- cense law does not apply e an owner Of property who Milds or improv dmmem. and. who contracts for such projects with amantracmr(s) licensed pursuant to dm Contractor's License Law. ❑ 1 an exempt under, Sec. B & P C for this mason Owner Dau WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following deselaradmet: I have and will maintain a Certificate of Consent la self -mane far Weher'aC.mpm- on, as provided far by Section 37W of the labor Code, for use performance of the rk far which this permit is issued. 1301.100 I have and will maintain Worke's Compensation Insurance, as required by Section of the Labor Code, far dm perforeame.arim work far which this permit is Issued.y Worker's Compensation Ins c cart err and Policy number m: rtier. �Lr2 `'� 7 policyN..: 12�712G (- CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE - (This sectio need at M completed lithe permit Is foram hundred dollen ($100) or less.) I certify that in the performs ce of the work for which this permit is ivied. I shall not employ any person in any mmnerm as to become abject to the Worke,i Compensadon ' Laws of Califomia. Date Applicant NOTICE TO APPLICANT: IL alter making this Cenircee of Exemption, you should become subject an the Worker's Compensation provisions of the labor, Cade, you mum forthwith comply with such provisions or this permit hall M deemed rooked. CONSTRUCTION LENDING AGENCY I hereby affirm that Nem is a construction lending agency for the performance of ,he .,it fur which N6 permit Is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I mnify that I have road this appliuda and sue that the shove infamous, M correct. I agree 10 comply with all city and county ordinances and sue laws muting to building construnion, and hereby suntan. repreaenulives of Nis ehy to emcr upon the move-mandoned property for inspection purposes. (We) agree to save, indemnify and keep harmlcac de, City of Cupertino against liabilities judgments, costs and expenses which may in any way accrue against said Cityin APPLICANT UNDERSTANDS AtND WILL COMPLY WITH ALL NON -POINT �✓' Issued by: Date SOURCE REGULATIONS. Re -roofs fit/ Type of Roof t �zc� . It 01 Signelum of ApplicandCantrxror Dae HAZARDOUS MATERIALS DISCLOSURE Will the epplicam sir future building occupant mem or handle hrrudoes manna] as darned by Nc Cupertino Municipal Code, Chapter 9.13. and the Health and Safely Cade, Sued. 25532017 All roofs shall be inspected prior to any roofing material being installed. ❑Y.s OK If a roof is installed without first obtaining an inspection, I agree to remove Will dm applicant or future building Occupant use equipment or devices which emir hayardnu, air coumiaunts a dcfned by the Bay Area Air Quality Management all new materials for inspection. DislrictT ❑yes I'J Nu I have read the Weacdaus materials nequircerma under Chapter 6.95 of the Califon. .iaHcalN& Safety Cade, Saeuons 35505,75533a d 25534. I understand NN lfthe Wilding data not currently haw a ensm, that It Is my remansihility in notify the Occupant or the requirements which Most the met poor at asuanm of a ccniicme of Gmmapmmy. Signature of Applicant Date q., -a -a Agnelli IF;/ All roof coverings to be Class "B" or better Owner or authorized agent Dam sm 1 of 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ... ..... : 36206026.00 DATE ISSUED.......: 09/15/2006 RECEIPT #.........: 36057 REFERENCE ID # ... 06090116 SITE ADDRESS ...... SUBDIVISION ....... CITY .............: IMPACT AREA ....... 1171 STAFFORD DR CUPERTINO OPERATOR: amyw COPY # : 2 OWNER ............: VERONICA LAW & WEISIN CHONG ADDRESS ..........: CITY/STATE/ZIP ...: , RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY/STATE/ZIP TELEPHONE .... PLUMBERS ON CALL ROBIE DOBKINS LIC # 27158 PLUMBERS ON CALL 520 MEGLIACY LANE #12 CAMPBELL, CA 95008 (408)879-9416 •FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL --------------------------------------------------------------- ---------- BPERMFEE VALUATION 6,496.00 137.16 0.00 137.16 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 TOTAL PERMIT : 175.53 0.00 175.53 0.00 VOICE ID DESCRIPTION -------- ------------------- -------- ------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING • VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS:-// � 7/ S Gr!�v✓� ( PERMIT # OWNER'S NAME: X,.kr a % PHONE # 7e(-OV'F--3 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: -ea�q Signature Please check applicable subcontractors and complete the following information: Date Owner/ Contractor Signature Date 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 9< Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date 0 UPERTINO CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE PERMIT APPLICATION FORM oun 110 APN# /,nr6(0-02U Bldg. Permit Fees Date: / Building Address: Gas Piping System Fee PLUMBING / PPERMITFEE Plumbing Permit Issuance PLUMBING Owner's Name: Repipe of Fixtures Phone #: IiC YGn I C u u !2 I.✓ / CGran CYC% `ie?;�-26 2c, Contractor: Phone: License #: L Lem // �� Sf7 —G °/�i3 7/ 2 Contact: Phone: ai Cupertino Business License #: y Building Permit Info: Business License BUILDING / BldgEl Elect El Plumb Er Job Description: e - Residential [' Commercial ❑ Cost of Project: 0 Qty. if Annlicahle Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING / PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING