05110150 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT v CONTRACT0Rrl 'I�kURMATI( I�
BUILDING ADDRESS: ACE PLUMBING PEIIMIT NO.05110150
1859 HYDE AV
OWNER'S NAME: PERMIT ISSUE DATE
DANIEL C. TSENG 3160 DE LA CRUZ BLVD 111017 11/29/2005
NE: SANITARY NO. CONTROL NO.
(408) 226-2243
ARCH=IENCINEER: BUILDING PERMIT INFO
BLDG EIELT PLUMB MECH
j O Z LICENSED CONTRACTOR'S DECLARATION Job Des L
1 hereby affirm Bon 1 m licences under provisions,of Chapter 9(commencing p
O
with Section 70110)ofDividan 7 of the Buainwand Pmfctmeo Code,and my license s
I
us full REPLACE SEWER LINE (20 ' ) ��
NAL
iii— License Cl _ u ,
t•q Dam Commons
ARCHITECTS DECIARA N EC 1005
1 7� I understand my plans tlWl W used As Public rtmrda
y6W�
t coo� Luxe and Pmfesvanal y
b OWNER-amorpt fr DECLARATION CMu �G I�y p
1 Wrohy otirm Nm 1 R.Mcmpt from ILL ATamara Uconse Law for the
/`)fu' dly
0 O following moon.(Section 7M 1.5,Business and Pmieuinm Cade:Any city or county
3 a� which requiw a permit to ennaerw ,.Iter,hnpmve,demolish.or mums any structure 3500
-Z i prior b its inuanro,also els ems the applicant for such permit a Ole a signed statement
a
that W s licensed pumeaal to the previshmear the Contractors License Law(chapter 9 Sq.Ft. Floor Area Valuation
I (commencing with Section 7000)o(Division 3 of the Business ond Pm(aaimm Code)M
that he is Memel thatcher,and de Was for IW all Meatpdm Aey violWnn of
AM ma7031.5 K a vara icon fo`rsA PBri it am;<cn me aPPRcanl m A-I ll Penalty Of r Occupancy Type
❑1,as Owner of Ne property.or my employees with miles As deo talc compensation,
will do the work and floe srucmm is out Intended ear Offered for mics 7044,Busircas Required Inspections
and Profesdom Code:The Conualort Liwne law docs net apply man owner of q p
Property who builds or improver thatmn,and who dam etch work hinaelf ear Nmugh his
momployees,provided that such ImProwmenss ter net Intended oroffered forsaln If.
howews,the building or Improvement s sold withinae year of completion.0s,Owar-
bulWa MB have the harden of proving that W did net Wim m hnpmve for purpose of
sate.).
❑1,u Owner of the property.am esduaively,conuacdng with Reamed mnuaclat As
commus the project(Sec.7044,Business and Proresmmts Code:)The Contractors U-
anm Law 4.not apply As in owner a propeny'whn Wilds or improm thenum,and
who concocts for such projects with a canmum(s)licensed pursuant to dm Contractors
Lkeme Law. -
❑lameserepteederSee ,Bal PClurthurtnod
Owner Dam
13CIlWORKERS COMPENSATION DECLARATION
1 hemby aVum under penalty of perjury oro of Lie following aasntioMm
I haw and will maimms a CanlBcemaf Commato self-Wort ltaWmkrs CamPem ,
M
ion,M provided for by Section 7700 of the Labe Code.for Ne performance of the
rk for which this permit is,issued.
1 Ww and will maintain Workers Compensation InsurMm.M required by Section
of the Labor Code,for Ne peRamrm¢of de work for which this Permit s laud.
Warkera ompeswlion War artier and Polleyrder Polity lacy Og0 iZ
C FI TEOF EmpnotiFRobiwoRKEiLT
COMPENSATION INSURANCE
(Thssecdon need rot W completed tithe permits[am hundred dMan(5100)
or Item)
I testify that in the perfomtanco of the work for which this Perera is issued.I shell not
employ anypermon in any mamerm u m becomesubject to tie Work a,Compensation,
Laws of Califamim.Dam
Appllant
NOTICE TO APPLICANT`If,after making Nit CcWnmm of Exemption.you should
berme subject to de Watters Compensation pro unmet of the Luba Code,you most
forthwith comply with such provisions or NU Permit"I be deemed revoked.
T CONSTRUCTION LENDING AGENCY
E•:, Ihereby alrimn Nal Vert Is a construction undink Agency for the performance or _
the wank for which this permit Is Issued(Sec.8197.Cih,C.)
Wn Lenders Name
U G LenderA AdNw
1 tealfy that I haw rtsd Lids Application and mct that the me.iMJOmtadde s
corm.I agree to cmnply with all city Aad county adimaea And sum laws relating to
Wilding conation,and hereby authoriea representations of this city to corer upon de
Tsj above-mentioned propesty,her inspection purpoma.
(We)agme to on,indemnify and kap hormkaa the City of Cupeninm against
Ma V limbilides.judgments.costs and expense,which may in any way Arne agaiml sold City
(r) In coneegneae of the gmn0n8 of this permit.
^j APPLICANT U ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9102� Date rig
SOURCE REgWATIO„NS.
o Re-roofs Q
Signature of AppliasUConraerer I Veto
pry'
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de Appliant Or fume Wilding occupant marc or handle hasatdam material
As defined by the Cuperdw Municipal Code.Chapter 9.12.and the Health and safety
Oue.Section 25512(4)7 All roofs shall be inspected prior to any roofing material being installed.
Yes o
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hmr.Wnus air contaminants as,defined by de Bay Arca Air Quality Management all new materials for inspection.
lmDiwict?
❑Ya u
I hmw mad Wmmts hrdmaterias mWimndmenouerChaparS95ofdeCaliror.
u Heslthik a Code,Smidm 25505.25511and25534.lun&'Mr aifNebuilding
am tot ewer haw A MAM,that It u my respomm Made
ibilily Madly occupat of W
qulmmen hich mut Wm 'Orto issu maf.ccrii'l toaaP"Y, Signature of Applicant Date
6�1t''”` r f'47'16 6•� All roof coverings to be Class MMB"or better
Owner tar AuNarirsO cm Dam
Community Development
10300 Torre Avenue
-4 Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�MkTINO ,
Building De artment
JOB ADDRESS: PERMIT #
�e . l.r (D
OWNER'S NAME: a C , PHONE # 3 Z
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: / 2
Signature Date
Please check applicable subcontractors 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
SCUPER,TINO PERMIT APPLICATION FORM
APN # tt Date:
l a
Building Address: d qv�-
Owner's Name: Phone
C , Ts "
Contractor:,, , one: License#:
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Contact: Phone: Cupertino Business License#:
a a
Building Permit Info: ��P�aC2 S P—y-
Bldg ❑ Elect ❑ Plumb [�
Job Description:
Residential Commercial ❑
Cost of Project:
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg..Permit Fees BUILDING
BPGAS Gas Piping Sys ern Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
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