06070040 CITY OF CUPERTINO %'•rn>f rd '' y �;„�'s` '
i3cILDtNG.DivISI0N PERMIT CON TRACTCIR�INFURMATION
BUILDING ADDRESS: ALL VALLEY PLUMBING PERMITNO.06070040
20365 VIA VOLANTE
OWNER'S NAME: PERMIT ISSUE DATE
Mk FRANK CHA 3345 SELDON CT 07/10/2006
NE:
SANITARY NO. CONTROL NO.
(510) 376-4816
BUILDING PERMIT INFO
ARCHITECT'/ENGINEER: 'BLDG ELECT PLUMB MECH
0 0 0 0
±Op LICENSED CONTRACTOR'S DECLARATION IObDe$Cil I3Dn
?�C 1 hereby affirm Nal T am licensed under previsions of Chapin 9(commencing P
b with Section 1")of Division Sof the Business and Professions Cade,aM my license is
imm�to=anderr gyr WATER HEATER REPLACEMENT
;yA? Licensc Class
'Fn
Dam Contras
Aashali usu DE I
f e I undersand my plans shall M uuJ u pub m records
>y
C H LiuenseJ Profcssianal
`y� OWNER-BUILDER DECLARATION
Contractor's
INA
1 hereby affirm that 1 I exempt from the Csshina ods License taw for the �ttljvtJJry [[[���
p o fallowing mason.(Satire 7(n stn Business and Profession Cat:Any Eby or county c(� $300 0 0
<m w which I.E.roa permit re cores des, alter.improm,demolish.nr e a sig any swctum �II \\
°i6 poor to its ianuawc,also requires the theapplie O for such permit m OlcasUW(Chapter
ExG that he is licensed pursuanuolM provision Of dim Camramr's license law(Chap¢r9 Sq.Ft.Floor Area tip., _,,.,Valuation
i~$ (commencing with Section 70DO)o(Divusion 3 of Ute Busiw+<and Profession Codc)or
R That be is exempt therefrom and de,hands for the alleged asempum.Any violation of n
Section 7031.5 by any applicant for a permit subjecte the applicant to a civil penalty of ���fff DWI
"U0 Occupancy Type
W ...Nm five hundred dollars(SSW). i) /I�ff �
❑I.uowwr oftM propeny,or my emPloycu with wagnazlMir solacomperexdon, �J /fJ] 4
will do the work and the swclure isnot intended araRered forsale(Sec.70W.Busimen r lar; ase,r
and PNfeailon Cade:The Cmannelnrs License Law doe oat apply b an awns of
Required'In e�V +•$
property who builds or improves thereon,and who duessuch work herselforthrough has
Own employees,provided thin such imprommmts ase not intended oro(fered forsole U,
however.Ne building ar keprommret is sold within one year ofcomplction,the owva-
builder will have the burden of proving that M did not Mild or aff, me for puryose of
nic.I
0 1,as mine of the property.am exclusively contracting with licensed contractors to
consmct the famines(Sec.7(]44,Business and Profrsume,Cade:)The ConwimOres U.
cone taw does coot apply in an owner of propeny who Milds or improve thereon,and.
who contracts for such projocst with a comactoKs)licensed pursuant in the Contractor's
License law.
0 1 am ucmpt under Sec .B&P C for this
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury an of the folbwing duclarauatss:
1 ham and will maintain a Certificate of Consent In self-imme for Worker'sCompen-
union,az provided for by Section 37W of the Labe Code.for the performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Inurarsce,an required by Section
E
of the Labor Cade,for the pammorans.of the wart for which this permit is issued.
My Worker' CompensationI surence wartier and Poliryn bb are:
Gsrior. Polis Na.:1. Z� /
CRTIFICATE OF EKEMPIION FROM WORKERS'
COMPENSATION INSURANCE
(TTu section wed not becompleted If the permit is Ensure hundred dollars($I00)
or leu.)
I certify that in the performance of the work for which this permit is issued,l shall WE
employ any poison in my mmner so az la become subject to the Workars'Compensman
Law'of California.Date
Applicant
NOTICE TO APPLICANT.If,after making this Oce ileum of Exemption,yin ahaub
MYOoe subject m the WOO Er'S Compensation provisions of Ne Lahr Code.into must
.JO foMwi(b comply with such prevision a this permit shall M domed muted.
z"
CONSTRUCTION LENDING AGENCY
I hereby alfrm that there is a construction lending agency for thc mromance of
Oe. the work for which thus permit is issued(Sec.3097,Civ.C.)
QUs&,'.Name
= z Lender's Aedm<.
V 0 1 unify Jot I base ted this application and sum that the mom information is
U, F coffee(.l agree to amply with all city and county ordinances and state laws relating to
0 Ubuilding construction.and hereby authorize mprcsenedins of this city to enter upon the
V) aMecce.judncd pmpc st far inspection tir,owhich a
N Iiabiliti(We)agree
ree to a.indcxpcnund lummpmay ncany the
City
c f CVpAEstuig Against
(„) z (n consequence CANTUNDEof the g ANDS AN.Bur WILLWILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOUR EREGU S.
Re-roofs
g of uUContrac(ar Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant a future building occupantstore ehartdle hazardous material
As dEOwd by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Code.Section 25532(a7 All roofs shall be inspected nor to an roofing material being%h.,.2,d..�
t4+� P P Y g g installed.
If a roof is installed without first obtaining an inspection,I agree to remove
e applkmt or furore Milling attvpam use equipment or levies Mich g
ue air contaminants u defined by Ute Bay Arca Air Quality Management all.new materials for inspection.
t��mad the harudtu;materials mquiromenu underChmoO6.95 of the Califor-
afcsy Codc,Sectio 15505,15533mdM534.lun&rstWthuiftM Wilding
July ban ate that it u my reapanibdity b nmjfy the Occupant of the
hicnm (priormissu of CEnificateofOcavpanry. Signature of Applicant Date
hed. cot Dam All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31601033 . 00
DATE ISSUED. . . . . . . : 07/10/2006
RECEIPT # . . . . . . . . . : 35168
REFERENCE ID # . . . : 06070040
SITE ADDRESS . . . . . : 20365 VIA VOLANTE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FRANK CHA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ALL VALLEY PLUMBING
CONTRACTOR . . . . . . . : MARY SANDBRINK LIC # 23015
COMPANY . . . . . . . . . . : ALL VALLEY PLUMBING
ADDRESS . . . . . . . . . . : 3345 SELDON CT
CITY/STATE/ZIP . . . : FREMONT, CA 94539
TELEPHONE . . . . . . . . : (510) 376-4816
OFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- ------- ------------- -- - ------- ------ ---- --------- - ---------- ------ ----
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- - --------- ----------
TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
aa
Community Development
10300 Torte Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
OPPEkTINO
Building De artment
JOB ADDRESS: aQ /a PERMIT #
OWNER'S NAME: re[-� PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractor .
Signature Date
Please check applicable subcontra rs 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
er/Contractor Signature Date
00 CITY OF CUPERTINO C�,01
WATER HEATER
• CUPERTINO PERMIT APPLICATION FORM
APN #
Building Address: n il�il t i q
Owner's Name: fYa Yl� CGA V /C Phone #: 4
Contractor: l License #: lCl
G 3E 9 90
Contact: Pho e #:
i�.�r xl S/O ow
Applicant/Contractor:
S
Building Permit Info:
Bld Elect um Mech
Job Description:
esidential: Commercial:
Sq. t. loor Area: $/Sq.Ft.:
Architect/Engineer: Valuation: #260 oo
SolType of Construction: Occupancy Group:
Qty. if
A licable Fee ID Fee Description Fee Grou
BPWHEATERWater Heater/ Vent BUILDING
PPERMITFEE Plumbin Permit Issuance PLUMBING
BPERMFEE Bld Permit Fees BUILIDNG
BMITIGAT Housing Mitigation Fee BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG