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08010151 CITY OF CUPERTINO �!�€+'p'♦` /�apr �"y� BUILDING DIVISION PERT CQs-��'"gTVAI' O`',��y BUILDING ADDRESS: PERMIT NO. 7559 WATERFORD DR PACIFIC PLUMBING 08010151 NER'S NAME: PERMIT ISSUE DATE SAMUEL LIU 2138 O'TOOLE AVE 01/28/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO INSTL 1 PROPTY LINE CLEAN- BLDG ELECT PLUMB MECH 0 0 0 0 Sop LICENSED CONTRACTOR'S DECLARATION Otfila Job Description e 1 hereby 0)ou' Net 1 am II¢nud under and Professions of CMptm 9(commencing P with Section7000)e)ecDIVIAaa 3 oftiu Badmen and Profcuium Codqe,and my license is n L full force and effort �•�_ , �i_ Linen Lu.R ' Dau Comrw1ur ARCHITECTS DECUARATION eI unaeratsnd my plain Nall W used u Public records 4 Licensed Professional 7 OWNER-BUILDER DECLARATION S A E 1 herehy.111.that I am exempt from the Contractors License Law for the r o Ofollowing reason.(section 7831.5.Business and Pmfedou Cada:Any city or county 3$ , which require a Permit N romuuc4 slur.improve,demolish,in repair any structure Zi, prim he its issuance.also requires theapplicim for such permit to file a signed statement zFF< "eve is licensed pursuant to the pervisdom of the Conmactor's Likinnize Law(Chapter 9 Sq.Ft. Floor Area Valuation 5$ (commencing with Section 7800)of Division 3 of the Business and Profusions Cod.)or 3 that he is attempt therefrom and Ne bub for the alleged eumption.Any violation of Section 7031.5 by airy applicant for•permit subjects the applicxt to a civil Penalty of APN Number Occupancy e nor mare Irn Ove ahundred dollen(11507. P Y TyP ❑1,u owma of Ne Ptrp°tY,a my mPloym wird nigra u the'v sole eompewtion, will Prfuwork,and -The Comennoruundedorowasstorula(Sec.an an .of and Rtywhons Code:The Cwnmcmrs Licenseand law arca not apply lf rt owner is Required Inspections property ertY wyees,provided impmvea thereon,and who me not intended bit croelf or through his t. howemplay chain Ori provemattruch ent lmprowmenuasemtomoRered the forsids. r. however,Ne Wilding mlmpmprovinhut ho within war or mprolefor Ne owner- LJ "-'�LvyI1'1L'I11Ir buildu will have this tarda of proving that k did rot Wild or improve for purpose of ale.)• ❑1.u owner a!this property,.Business sis and conuacdng wW licensed ronousen u cease La the Project(Seco an Owner and property whoProfessins Cada:)The Conmount.and cense taw don not apply a am wither of isun(s who Wilds in improve thereon,and who as LaNfoe such gojecu withaeonuaner(s)Ilanxdpunuentm tine Conv¢uM1 Lk I sum law. ❑lam exempt undo See ,BBPCfor NIS reaxn , 40— Data WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I ban and will maintain a Cer9Bcate of Conemt to self-IuumfaWarkefaCompco- station.as Provided for by Section 3700 of the labor Code.for the Ixrfamunm of the work for which this permit is issued. ❑1 have and will maintain Worker's ComPonsatian Insurance,as inquired by Section 3700 of Ne later Code,for the pedormanceofthe work for which Nis permit is issrcd ' My WorkeYa Compensation Wunmc carrier and Policy number' Confer. V ty �� by liry Na.: TIFICA OFEXEM ONFROM ORKERS' COMPENSATION INSURANCE - (Thb secdm need ret WcomPleud lithe permit Is(ormu hundreddo0an(SIM) . 1 cerdfy that in the perfarmahse of the work for which this permit is issued,I Nall not employ any parson litany commerce u u become subject in the Worked Comperuman lawn of Califomia.Dau A,Hcam NGnCETO APPLICANT.If.after making this Cenifiuu of Exemption,you should become ubjem to the Worker's Compeeeition previsions of the Latour Cade,you muss .J 0 forthwith comply with such prnvfdnu or this Permit mall be deemed revoked. y CONSTRUCTION LENDING AGENCY [-� 1 herehy affirm that Nem Is a construction lending agency for the performame,of a the work for which Nes permit It Wood(Sm.3W7.Civ.C.) 0 Lender's Name ] z Landers Address U O I cmdfy Nat 1 haw rtad this application and sou that the show InromNm is {T. comon.I agree in comply with all city and county ordinance and sou laws relating in .O Wilding construction,and hereby authadu repmunutives of this city to noun upon be [i7 show-mentioned property for inspection purposes G (We)agree to taw,indemnify and keep harmless he City of Cupertino against IA IlabililimItalgmants,cord and expenses which may In any my acmue against said City U Z in consequence,of the granting of Nis perosis APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: NS. ✓SOD Re-roofs Date LR��TIOy" PV4s4'r, Signsmkc or IianVConuecur �iTe4 �— HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the apPIIML or future Wilding occupant sure or renals licentious maurial deRned by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety .Samba 25532(,)7❑Yu ON. All roofs shall be inspected prior to any roofing material being installed. Will de aPpliu/nt m future Wm building opant use equipment or devices which If a roof is installed without first obtaining an inspection,.1 agree to remove ..It huardaus Mr communanu u dcOned by the Bay Asea Air Quality Management all new materials for inspection. District? ❑Ya ON. I have mad the hoardam onerleb requiremrouunder ,Chaperd.95of Ne Califer. rias not Co Safety Cade,Sections 75585. my nortM15534.1 undersand that lithe Wilding /n�N dna not currently how•anent,Net It 4 my rupeuiMlity,b notify,NI rccuput of the "'TTT66fA 4/)e ✓ requftnewhieh muss be me prior iuuuce of a CcetiOau of Occupancy. —� pa Signature fApplicant Date Owner m out "sed agent Daug All roof coverings to be Class"B"or better ' • CITY OF CUPERTINO 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36617027 . 00 DATE ISSUED. . . . . . . : 01/28/2008 RECEIPT #. . . . . . . . . : BS000003781 REFERENCE ID # . . . : 08010151 SITE ADDRESS . . . . . : 7559 WATERFORD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SAMUEL LIU ADDRESS . . . . . . . . . . : 7559 WATERFORD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5233 RECEIVED FROM . . . . : PLACIFIC PLUMBING & CONTRACTOR . . . . . . . : JOSEPH BECHWATI LIC # 22640 COMPANY . . . . . . . . . . : PACIFIC PLUMBING ADDRESS . . . . . . . . . . : 2138 O'TOOLE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 9513.1 ® TELEPHONE . . . . . . . . : (408)452-8633 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 1, 800. 00 0.50 0. 00 0. 50 0. 00 1PPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00 1PRSEWER UNITS 1. 00 20.40 0. 00 20 .40 0. 00 ITRAVDOC FLAT RATE 1 . 00 40.79 0. 00 40 .79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 102 .48 0. 00 102 .48 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 204 . 96 16782 --------------- TOTAL RECEIPT 204 .96 VOICE ID DESCRIPTION ." ' VOICE ID DESCRIPTION ----- -- ----- -- ---------------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING 01/22/2.008 09:50 .FAX 408 777 3333 CITY CUPERTINO0(�_O .D fQ001/002 OYY • CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN# Date: .3 (P ( I oIas �� Building Address: owner's Name: Phone#: MuEL I,L kA Contractor: Phone #: ��( SIC Q�Um�N� SYC 5 �CE�INC . Fax Contact: Phone#: �� I` Ctl W i�TT Fax Contractor License#: —4T� Cu ertino Business License#: • Job Description: To iW)TWW C l��i 0-1,47 Residential ( Commercial ❑ Valuation: /1 Green Building Check list must be completed and attached to this application. Green Buildin Points: Quantity Fee ID Fee Description Fee Permit Type Group IPCSEWER Commercial building . P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP IPGASCOM Commercial Gas Piping System P 1-4 Outlets 1BSEISMICOM Seismic Commercial p / 1BSEISMICR Seismic Residential P / 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 01/22/2008 09:50 FAX 408 777 3333 CITY CUPERTINO 16002/002 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEf�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group IPRREPIPE Residential re-pipe per fixture P 1RPRP IBPWSVCS Water Service P 1CPWSor 1RPWS 1PPRSEWG Private Sewage Disposal System P 5CESS Cesspool p 1BPWATER Install/alter Water Pipe p 1BPFIXTURE Plumbing Fixture p 1PGASRES Residential Gas Piping System P 1-4 Outlets IBPGAS Gas Piping System 5+Outlets p 1PPERMTPFEE Plumbing Permit Fee Issuance P IPLMBLNCK Plumbing Plan Cbeck p IPLMBINSP Other Plumbing/gas Insp, P ITRAVDOC Travel &Documentation Fee B 1BUSLIC Business License B • Community Development 10300 Torre Avenue i 1,,,:/ Cupertino CA 95014 Telephone(408)777-3228 �oCITY C�TIA'O Fax(408)777-3333 rC 1 '�l Building De artment JOB ADDRESS: PERMIT # 4j--s W A r y- F a R iq 'o Q w/o OWNER'S NAME: P4ejr,1CP44A1616 .PG} NE # a X5? , %l2d GENERAL CONTRACTOR: / FAX # I am not using any subcontractors: ��vr f �le/K �Gr�C f Signature Date Please check applicable subcontractors and complete the following information: 60 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 Owner/Contractor Signature Date