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BUILDING DIVISION PRRMIT
CONTRA04i
LDNQ ADDRESS:
GREENFIELD PLUMBING
PERMIT Nrb4070090
118PBRMITfSSUe
F
NAME:
DATENER'S
TA -MING WU & LI-CHYAN
3513 MADRID DR
NE:
IF
SANITARY N0. CONTROL NO.
(408)921-8980
ARCHITELT/ENGINEER:
BUILDING PERM91NFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
p
I homey affirm dust 1 am licensed under provisions of Chapter 9 (mmmcncing
with Section 7") of Division Softhe Busineasatb fessiaa Code. and my license is
in (till fafx and cffa �
COPPER REPIPE
License Class Lk. M
Dam Convector - '—
ARCNIIECTS DEC A
7�
Ia1Qe rad my plans elWl ec usetl urn hYe menrd
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Q(
Lh4 dPofcuianal
OWNER- BUILDER DECLARATION
1 herthy affirm Net 11. exempt from do License law for the
7
Cad:
IInl.; Business and r..I.. Code: y
rtaeoa. lermit
clomu
U.Umy
are pair any nmctum
t improve. Pat,
which roquims a pennon re
which L alter, import, dwo
uirea d werii t fikasigned smemem
lensed the Novisio antsof forthe
Sq. Ft. Floor Area
Valuation
p,avum to Contractor's
Nat me ceemcdpSoet nuoNcprovisionsofthe eBusin0sandPaselaw(Chape,l9
fund ho,
(commencing Saefthroon n0of ivisiofr theeged.aand PrafMyvi Cad) of
(cat
use the of
Neto u exempt Nertfrom and the Ensu for the alleged exempdan. Any
he
'bet0 0
Occupancy Type
it Penalty
Section any applicator for • aumh subjects the apphcmt la a civil pcndty of
d.il
nm ¢ort Nenfiw hundrtd dollen (530)).
a tban five
'
I] 1, as owner of the pmpeny, a my employees with wage, u their sok compensation,
Required Inspections
will do the work, and the structure is notktended"Offend f..ale(Sec. IDs, Business
and Profe1VON Cade: The COmmetaf'e License Law dM] Wt apply m an Owner of
9 p
property who build or improves Nemon, andwho doesauch work himself orthrough his
own employees, pmvided that such improvements aro not Intended moRered forsale. If.
however. the building Or impmverom la sold within one year of omeple imt, the owncry
' builder will Nve Ne burden of proving that he did not build or Improve for purpose of
sale.).
❑ 1, a owner of the property, em exclusively contracting wish licensed contraors 10
consumer the project (Sec. 700, Business and Poduslom CadO Tie, Contractor's Li.
ecce Law does not apply o an Owner of property who builds or improves do m e. and
who contracts for such prejects with a comnctar(a) licensed pursuant ode, Comment's
,
kcnse Law.
4mn exempt under sec. ,B&PC for this msson
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby aRlan under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent m self -insure for WorkersCompen-
Cation, a provided for by Section 3700 of the labor Code, for the performance of the
work for which this permit is issued.
71 1 have and will maintain Workor's Compensation Insurance, a required by Schon
'
3700 of the Labor Code, for the performance of the work for which this permit issued.
My Woraces Compensation lnavmna carrier and Policy number are:
No.:
Cartier: Policy NO.:
CERTIFICATE OF PTION WOR S'
COMPENSATION INSURAN
(fEieacdmneednotMcompke,difi ep.itisfnc achundmddmlus(SIW)
or tors.)
1 unify that in the peolmi rSae of use work for which Nis Permit is issued, l shall not
r many manner sossmb comcsubjecuo Jxworkeri COmpenudan
Ms
Laws of (' h is Date
AP..
NOTI APP f making this Ccniflcam of Exemption, you should
born a subjat o e Wo ors Co.,emadmi P.W.O. of Ne Lahr Code. you mud
faMwdthcomply W such pmvisiom or Nu permit sMll M deemed mwked.
LENDING
CONSTRUCTIONre
.
lending Cgency (err dm perfumnana of
isaConstruction ng agency
1 herby a0irm that then it a
Wood (Sme. 3
the work for which Nu permit u iilued (Sac. 7091, Co, CJ
Name
Under' s Address
I sonify Nn I haw rad this application and aur Nn Ne above infaumuian u
I agent o comply with all city and county ordinances and sum laws muting to
building construction, and hereby aushmimrepresentatives Of this city to enter upon tha
a1mve-nontianed Property far Inspection purpmes.
/ /
(We) agree o save, indemnify and keep harmless 0m City Of Cupertino against
c
J
liabilities, judgments, cots no expenses which may in any my acme against said City
in conuence of the
APPLICANT UNDERSTAND(aANhisD WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE RE UTA ONS. /'
42
Re -roofs
Type of Roof
gnaorepplm HAZARDOUS MATERIALS DISCLOSURE nae,
Will Na applicant or fumro building cam" rem m handle harudaus mamnd
as dined by the Cuper inn Municipal Code. Chapor 9.13. and the Health and Safety
Cade. Seeders 25533(.)3
❑Yee
All roofs shall be inspected prior to any roofing material being installed.
INu
future
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or building Occupant use, equipment or devices which
it havardaus air canuminanu as defined by the Bay Area Air Quality Management
all new materials for Inspection.
strict?
❑Yea kNo
1 have mad the ha nodous mamrlals requirements under Chapter 6.95 of the Califor-
nia Heath A Safety Cad, Sections 25305,5533 and 35534.1 undmund that if Ne Wilding
does not currently how a tenser. Nat It y msponsihilhy o noufy the occupant of the
'a
requi meauwhich mus, beMid (aCenificemaf c9.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owaerar oma:' ages Dam
r
7ITY Of
BUILDL
1 of .1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Elk: Lot:
APN ........: 36208007.00
DATE ISSUED.......: 07/16/2004
RECEIPT #.........: 26328
REFERENCE ID # ...: 04070090
SITE ADDRESS .....: 1118 YORKSHIRE DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: TA -MING WU & LI-CHYAN
ADDRESS ..........:
CITY/STATE/ZIP .... ,
RECEIVED FROM ....:
GREEN FIELD PLUMB
CONTRACTOR .......:
TRAN, TOM LIC # 20711
COMPANY ..........:
GREENFIELD PLUMBING
ADDRESS ..........:
3513 MADRID DR
CITY/STATE/ZIP ...:
SAN JOSE, CA 95132
TELEPHONE ........:
(408)921-8980
OPERATOR: quem
COPY # : 1
GE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW RAL
BPERMFEE
VALUATION
2,000.00
83.16
0.00
83.16
0.00
BPREPIPE
NO OF FIXTURE
6.00
54.00
0.00
54.00
0.00
PPERMITFEE
FLAT RATE
1.00
38.37
0.00
38.37
0.00
BUSLIC
FLAT RATE
1.00
----------
100.00
0.00
100.00
0.00
TOTAL PERMIT
275.53
----------
0.00
----------
275.53
----------
0.00
METHOD OF PAYMENT AMOUNT
----------------- ------------
CHECK 275.53
TOTAL RECEIPT 275.53
VOICE ID DESCRIPTION
301 ROUGH PLUMBING
507 FINAL PLUMBING
L�
NUMBER
------------------
1564
VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY
E
9
C
r
CUPEkTINO
CITY OF CUPERTINO c
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN #
Da .
PREPIPE
Re i e of Fixtures
PLUMBING
Building Address:
Bldg. Permit Fees
BUILDING
1w,7
QRL)k 457(41` 7
PLUMBING
Owner's Name:
/ % �n //7 r�
Phone #:
Contractor:Phone(yQ
Sewers
License #:
--A
L qc oZ
Contact:
Phone:
Cupertino Business License #:
f o
Building Permit Info:
Bldg ❑
Elect ❑ Plumb l&
Job Description:
Residential
Cor&ndrcial ❑
Cost of Project
I
Qty. if
Xp ica le Fee ID
Fee Descrintion
Fee Gmun
PERMTTFEE
Plumbing Permit Issuance
PLUMBING
PREPIPE
Re i e of Fixtures
PLUMBING
BPERMFEE
Bldg. Permit Fees
BUILDING
BPFDXTURE
Pb] . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
_ BPSEWAGE
Sewa a Dis osal
PLUMBING
BUSLIC
Business License
BUILDING
CITY Of
JPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: je
r N
PERMIT # o
OWNER'S NAME: W
PHQNE #
GENERAL CONTRACTOR —
FAX #
6 .i 4
I am not using any subcontractors:
Signature Date
Please check avolicable subcontractors and complete the WInwino;nfnrmaiinn-
/Contractor Signature Date
01
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
/Contractor Signature Date
01