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08010125 (2)allILDiNc Di VISION PERNIIT *CONTRA4°�TOR TIVTORI�'I'A.T • °&r..P<r. 'bal+^.Ck AvAt $ .Ahc e Bmlgit�c�y,�1�a'k CLELLAN RD TBD — TO BE DETERMINED ga PU8010125 OWNER'S NAME: PERMIT ISSUE DATE WILLIAM LIM 01/18/2008 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BB eO MECH O O LICENSED CONTRACTORS DECLARATION Job Description 1 booby am. Nn 1 am licensed under provisions of Chapter 9 (Commencing witbS«alon71010)atD441on3ofthcBualnessanaproMi coag d�Msu4 INSTL PROPERTY LINE CLEANOUT. IBEEPLUMBING PD BSL in full farce And CII License Clasa �—Lw. a 1/18/7 $110 . Dam Contraewr ARCHI'fECI-S DELLA AT N 1 understand my plans shall W used As public records Licensed Pnrfeuianal OWNER-BUILDER DECLARATION I Wrathy alrim Nn I em exempt from the Contnnors License Law for Ibo fallowing moon. (Student 703 1.5, Business and PafeasiuN Cade: My city or county which requires a pont to consiraL alley, improve, demolish, or repair any structure prim to its issuance, aim acquires; Um applicant for such permit to file a signed mmmeal he is Heated to the of the Conuanufs Uceom Law9 Sq. Ft. Floor Area Valuation Met pusuanl pmvisloN (Chapter $1200 (commencing wins Student 7000) of Division 3 of Um Business and Professions Code) m that he is exempt therefrom and the basis for lbo alleged esempti m Any v1.]Woa of 35705007 � Occupancy Pane Y Type Section 7031.5 by any applicant for a permit subjects the applicant a a civil penally ofNumber not mart Nan Bw hundred dol4n(S300). 0 1. As owner of On property, a my employers With ilea As their wit Compensation, Required Inspections "I m din work and the A=.4 act wtenaedar offered fatale (Sec. R)a/, BuWpes and PafeWans Cade: The contractors Lee.. law does not Apply w N siva of proper who Wildaar improves mereen,and whodamowch wok hwuelfur through his , own employees. provided that such improvements art not handled oraRere l fvsam. if. however. Ne building ar Improvement 4 sola wi1Mn ons year of eumplrtion, the owner. Wilder MB low the Wbee of paving Nat Ac did oat build or improve for purpam of sa4d. I] 1, An miner of the property am mclualvelY contracting with licensed contractors w constweMycal(Sec.7�.BnsinessandPalesalaNGam:)T�Gant�sU � cove law doss not apply in in owner of proper who Wilds or improv thenwn, and 1A who contacts for such projects with a commeaer(s) IwenMed punamnt to the Contractors G Lkense Law. ;'1 �- ❑IAmexempt ander See, ,B B P C for this mason Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby Ll ice under penalty of perjury arc of the following duclattions: have and will maintain a CaN.esuof Consent w self-asum for Wahers Comma. M, ve pans far Se Non 7100 of tie Inbar Code, for we pnwtmma of tic work for which Nis permit is Intend. will SAN7ARY nt ❑ 1 Nw sued will maintain Workers requiem by Smed. Insuruwhi anceofLaUan of the Labor Code. for the perfoman. ofthewart for which Nis permit 4lmued. L h My Wooers Compenuti.A lNu eraM Policy number Ye: my Cam;er r��i 2 Ant Policy No.: Foa7/ 76� CERTIFICATE OF EKEMP ION FROM WORKERS' COMPENSATION INSURANCE Cfbb calm Led not bo compteted line permit 4 foone hundtltldosua ($100) a less.) I Canty Met in the pertome.. of the work for which NIA Pemlt 4 bound. I shall nm employ any Known in My mNMr An AS w WCOI110 Subject to dC Markets! COMpeIUMM Laws of c lifiarul.. Data AppliCnt NOTICE TO APPLICANT: It. Arthur making Nis Ccnifiuw of Exe Sammi, you should become subjem w Ne Wmkcr's Compensation pavlsiuns of UY labor Codc, you roup forthwith comply wins man provisions or this pemlt sha l bo deemW revoked. CONSTRUCTION LENDING AGENCY 1 haMY Asim that Nem Is a consoonlnn coding agency for the perfomance of Uw work for which this pemit Is Issued (Sex. 3097, Civ. C.) Leviers Name , Lendas Adduces I CMdfy that I haw reed this appliemW mod Main that Ute Above information 4 ronim l grce a comply with all city and county ordlnarwes and mm laws misting to Wilding construction, and hereby aoNadm reprvenuuvN of this city to enter upon roc above-mentianCd Property for IMINC M parpaGL (We) ague to UAW IndCmni(Y pw p hYmleY dC city Of Cupertino against Ilabi11tr4,judgmentAcNY expo may w anyway aCLmle against Laid City q 'APPSOUIC APPLIGNT UI Egu IRT oSN ILL C MPLY WITH ALL IONPO Issued by: Date( ode " R U Re-roofs Type of Roof Siinuu of pplicLaUConuaLtnr Oln / HAZARDOUSMATERIAIS Droure a II tie Applicatam(utum WI Cost. ChAnlpore or handle hHealtOnsmuorial .Sect by Ne Cupertino Munni 1 Cavi. ChapYt 9.13, orb me Health and Safety C Can. Scones 25533(x)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yes o If a roof is installed without first obtaining an inspection, I agree to remove well Ne Applicant or ratnre (ding—pani Law equipment a devise which haNns snerr cnnaminame As erned hr M Bay Arta Air Quality Managcmem all new materials for inspection. ct Dy. a I have mW Um hvaN vmatni iamenu under Chapter 6.95 of Ne Califon min HGlthdf SafClyCCdC,. N73S SNd ZSS3J. I MdCRLNd Out if NC building �� NC deers am LYRLnd haw 1 L N 1 Y reapnNlhllily m nOd Nen C gal namincon. e t ,Maane• .Cemex. � 1 Signature of Applicant Date / /1 All roof coverings to be Class "B" or better Dam' ownem ar mmiMxa.genl • i Okoj-O[Z5 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE PERMIT APPLICATION FORM "# 3 � -7 0 D 0-7, cs-0 Date: Building Address: ermit Type ss�9 /fie Group Owner's Name: Phone #: 4)i//1iam P 1CPSS Contractor: Phone #: Fax #: Contact: Commercial re -pipe per fixture Phone #: R3/-- T9�-3e.P c� _ v �7L 1PGASCOM Commercial Gas Piping System P Fax #: Contractor License #: VIFV 79d 1-4 Outlets Cupertino Business License #: Job Description: Seismic Commercial P 1BSEISMICR Seismic Residential P Residential Commercial ❑ Valuation: Green Building Check list must be completed and attached to this application. Green Building Points: P 1RPSS Quantity Fee ID Fee Description Fee ermit 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 f 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type _J 1PRREPIPE Residential re -pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P IBPWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System 1-4 Outlets P 1BPGAS Gas Piping System 5+ Outlets P / 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P l 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B • • 0 • 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec; Twp: Rng: Sub: Blk: Lot: APN ........: 35705007.00 DATE ISSUED.......: 01/18/2008 RECEIPT #.........: BS000003744 REFERENCE ID # ...: 08010125 SITE ADDRESS .....: 22549 MC CLELLAN RD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: WILLIAM LIM ADDRESS ..........: 22549 MCCLELLAN RD CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2769 RECEIVED FROM ....: BRC DRAIN CLEANING 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 ---------- 1,200.00 ---------- 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 ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 102.48 --------------- 102.48 VOICE ID DESCRIPTION ' -------- ---------------------------- 106 ------------------------ 106 SEWER & WATER 301 ROUGH PLUMBING REFERENCE NUMBER -------------------- #1271 VOICE ID DESCRIPTION ----- --------------------------- 202 UNDERFLOOR PLUMBING 507 FINAL PLUMBING RECEIVED BY: PATRICIAG ® TODAY'S DATE: 01/18/08 TIME: 14:09 1 BUSINESS LICENSE TAX • • CITY OF CUPERTINO RECEIPT NUMBER: BS000003745 PAYOR: IBEEPLUMBING & DRAI REGISTER DATE: 01/18/08 IBEEPLUMBING TOTAL DUE: CHECK $110.00 REF NUM: #1270 TENDERED $110.00 $110.00 ---------------- $110.00 CHANGE $.00 0 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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