08010032 (2) CITY OF CUPERTINQ
BUILDING DIVISION PERMIT •Cd)k�ITRe�.C>a"I'aIt INFOIiMATIOIV
BUILDI�I�y�gss�REENLEAF
DRPERMIT NO.
TBD — TO BE DETERMINED 08010032
OWNER'S NAME: PERMIT ISSUE DATE
FRANK TSHU 01/07/2008
VE: - SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
!Op
LICENSEDOatI..ONTRACTOR'SDECVsRATION Job Description
i SSC 1 on70(d)GI Nm1amlived underact Piulemofs Cox 9 my Ike=4 p
tJ iNSemion]OMI)ofDivinian3afNCBusiness andPmfcasiomCade,andmylkemcis PROPERTY LINE CLEAN OUT
is full lose an ffecd. Z
s$z License 1 IM.g
Fes Dam a CSDEC
2 ARCHRECI•S DEC R 'ION
W< 1 undersand my plana shall W used ss public rernrds
se V
u.
Licensed Pmfessionel
y 3 atIam OWNER-BUILDER DECLARATION
<E I hemhy.(Seco that 11, pumps from to Cesiond is License Lew for dbo
Q O following massa.(Section 703 1,5,Business and Improve,
&d Call Code:Any city or mond
S$ which its Issuance.
a dermis to ennswet alcor.improv,M Permit i ri wash any suunum
•iy
poor to iaiensedpalw squire Ncidthlapplicant forsuch due Comoducle wfilca Law(saemevd
S
Out Wislicensedpuntion7IWofDiviopofNcConuinesssL3masclaw(Codd)9 Sq.Ft. Floor Area $ Valuation
`F$ (come I.camng wiNSectirn]BW)of Division3 O theBusiness
and Anyvila&m of 2rJQ0
—
that he r campy daemfrom and far
aper for be cut live
exemption Any l peation of
Section 7031.5 five
any red Bolla s(o permit subjecu Ne applicmn w a civil petulsy of
not more Nan Ties haMred dollars(SSW). 3260901DAM Number Occupancy Type
do
ownerk the pmpeny,ar my 1mouce mr.weep ( canpenm.
will M Nc want end e,The num r my mmndns ora w do formic a(pec.7016,ausinnm
and property
who
Code:The Communnor'smthemant Lim"•taw uch not apply b on awdsv of Required Inspections
own eny Che W iprovildismd d Oat loch improvements
who am not ch warthimselfor forage his
awn employee,provided Nat,uch improwmenta in not ear ofc orraffacd for ala d.
hfle.). the building orimprowmemrmld within one year of mmpkdon.the owner-
builder will here the burden of am
Nu W did ac Wild it improve for purposed of
cmade ....MMMM'�AAnn 1I
❑Las owner of ct Pee.704 .B sinus ad pomading Codd Hceosed mans m's i.
connmcs the project(Sea 7009,Busies,and Profwiae Code:)lite Conuecmr,Li- '
come taw does nay applyad en owner of property who Wilds or impmvp Centra,and.
who contracts for such pmjam with aconuswr(o)licensed pursuant to the Contractors
Licensense pe Law.
❑Ismexempimulm Set ,B&PCfm Nrrusoa
Owner Dade -
WORKERS COMPENSATWNDECtdRATION _.
I hereby afford under penalty of perjury are of the following declvWorde
1 haw and will maintain a Cenifean df Comen,m oco self-1farworkeo-
Ys Compe
ion,as provided for by Section 37M of de Labor Code,for the perfarmlaux of the
work for which this permit is issued.
❑ 1 have and will maintain Wml,cel Compensation Immrance,as required by Section
37W fNe Labor CodC,fm Ne perfmounce of Ne work for which Of.permit is '
My Workers Compensation Inmrama Cartier and Policy number arc:
Canoe'l�A 1 "icy'41A2 cOSPTON FROM �C l
WORKERS'
COMPENSATION INSURANCE
(ITr section need not W camplewd if the permit r fmane hundoMdoOan(SIOD)
Ica.)
1 cenify that in the perf dennce of the work for which this Permit is issued.I shell not
craployenyperwn in any manncrw as wlau me.wbject on the Worken'Campewtion
Laws of Califumia.Dam
Applicant
NOTICE TO APPLICANT:IL alter making this Cenifmae of Exemption,you abound
become subject to the Workers Cmdrama dun provisions of the tahm Code,you muss
.J,Z fothwith comply win such provisions a this permit shall W deemed rooked,
OCONSTRUCTION LENDING AGENCY
F I hemhy affirm that,Nem is a cmauunion lending agency tor Ne perfmmame of
L✓7 Ne were for which this permit is issued(Sec.3097.Civ.C.) -
CQ Lenders Name
z Lender's Addreas
O 0 I ceniry Nal I have mad this application and spm Nm the above infamadun is
f^ Correct.1 agrcc to comply with all city and county oolimmees and some laws rearing in
J building construction,and hereby amhonm moesenusiwa or Nis city to enmr upon the
0. mop c rnemiuned pmperty Ire inspcnion purposes.
(We)agree to save,indemnify and ycep bmmless the City of Cupertino against
rn liabilities,judgments,costs and expemo which may in any way accrue spinet said City /
U in Consequence of dive grarling of permit
'—' APPLICANT UNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date
.I Re-roofs
si6pwm a
HAZARDOUS MATERIALS DISCLOSURE Dem Type of Roof
Will the applicant or fuwm Wilding occupant store or handle hmW ow mammal '
as defined by dm Cupertino Municipal Code,Captor 9,IR.and 0m Health land Safety
Cale,Section 2553](a)]
EYP '--d No All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an ins ection,I
Will the applicant or future building occupant use equipment or devices which g P _ agree to remove
it h tdomos air contamimmus ss Mined by Ne Bay Area Air Quality Management all new materials for inspection.
n7
❑Yee No
I have mad the harame-,rda,lho aquindr eau underchmat,6.95 ofd.Califm-
rut Health&SzfetyCoIc,SecMm 25505.25533 and 25534.I undersand Na if Ne Wilding
does not cturaMy ha mane Nat is r my responsibility w notify the o¢upam of dm
loh ma m)pdarmi..once ofa C..kate rQeup ey. Signature of Applicant Date
I o
own)ar,trNa ,c ,gem Dam All roof coverings to be Class "B"or better
t d �Dl OC� �Z
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEftTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
O CT
Owner's Name: Phone#::
Contractor: Phone#:L40.9 - 4a. goo
G CcS Vw- i Setter c Fax #: 24 O�
Contact: Phone#: Lj o$, - 4 0 m 2 8 Oct
^o Fax #: Lfo9 419 p
Contractor License'#: Z /�
Cupertino Business License#:
Job Description:
Ah
Residential Commercial ❑
Valuation:
AS0a
Green Building Check list must be completed and attached to this application.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
1BSEISMICR Seismic Residential P
/ 1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description ftFePermit Type
1PRREPIPE Residential re-pipe per fixture1RPRP
1BPWSVCS Water Service 1CPWS or
IRPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
IBPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
113PGAS Gas Piping System 5+ Outlets P
/ 1PPERMITFEE Plumbing Permit Fee Issuance P
1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
/ 1TRAVDOC Travel &Documentation Fee B
1BUSLIC Business License B
e
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32609010. 00
DATE ISSUED. . . . . . . : 01/07/2008
RECEIPT #. . . . . . . . . : BS000003630
REFERENCE ID # . . . : 08010032
SITE ADDRESS . . . . . : 20889 GREENLEAF DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER FRANK TSHU
ADDRESS 20889 GREENLEAF DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JOSEPH BECHWATI
CONTRACTOR . . . . . . . TBD - TO BE DETERMINED LIC # 00096
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
® FEE ID UNIT QUANTITY AMOUNT PD-TO-DT , THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 2, 500. 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
1TRAVDOC 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
----------------- --------------- --------------------
CASH 102 .48
---------------
TOTAL RECEIPT 102 .48
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER , 202 UNDERFLOOR• PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
m Community Development
_ 10300 Torre Avenue
i Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
at IF % q Grc Lacs !7 CJgo( 0 0 3 2
OWNER'S NAME: T SHV PHONE # o$ 6 J4 o aR o o
GENERAL CONTRACTOR: < FAX # o8 V14i 9
I am not using any subcontractors7— I -;zO
gnatureDI ate
Please check applicable subcontractors and complete the following information:
69 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 bate
FROM :CUPERTINOSANITARYDISTRICT FAX NO. :4082535173 Jan. 25 2008 Oe:34AM PS
`�O SpNlrq poloBOARD OF DIRECTORS
DISTRICT MANAGER-EN INEER �'� %0F
'(Pp
MARK THOMAS&COMP NY,INC. A STEPHEN C.ANDREWS
DAVID E.RD99 � '
WILLIAM A.SOSWORTH
YEAJOHN M.GATTO
DISTRICT COUNSEL SB �m CURTIS B.HARRISON
ATKINSON•PARASYN. LP. �rAB(tg„EO ti9 WENDELLH.KERR,JR.
HAROLD S.TOPPEL
20333 STEVENS CREEK BOULEVARD.SUITE 104
CUPERTINO,CALIFORNIA 580142154
(408)283.7071 PHONE • (408)2635173 FAX
www,cupeWoos enitarydlstrict.com
File: CuSD –MOP
Building Dept. –Cupertino
City of Cupertino
Attn.: Building Deportment /
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: Install Pro erty Line Clean Out
Name: Tshu Residence
Address: 20889 Cre-nleaf Drive
APN: 326-09-010
Permit No. 0801003
■ Videotape n id Property Line Cleanout inspected.
No additi nal conditions/requirements by the District.
Inspector: George Santos/Roger Santos........................ ............
Date:-01- 5-2008................... Sanitary Sewer Location:
6' Lt PIL
cc: Property Owner
35' Long 4' Deep
SUPPLYING SANITARY SENE AGE SERVICES FOR:CITY OF CUPERTINO,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS AND
SURROUNDING UNINCORPORATED AREAS