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