08050130 (2) CITY OF CUPERTINOBUILDING DIVISION PERMIT . C,ONTRt1CTQI2INk',QRMATIgN
t.URC"
PERMIT NO.
PALM AVE PRO ROOTER 08050130
NER'S NAME: PERMIT SUE DATE
VILLAREAL J C AND MATILDA G 2306 AMERICA AVE STE 7 05/15/2008
NE: SANITARY NO. CONTROL NO.
(510) 670-1115
HITEC(ENGINEER: BURRING PERMIT INFO
BLDG ELECT PLUMB MECH
po LICENSED CONTRACTOR'S DECLARATION1 hwby arnnn tut 1 w Mooed under provisions of Christ,9(wnmen Ing Job Description
Section 7000)ofDivision 3 of the Business and Professions Cods,tons my license is TRNCHLS SWR RPLCMNT OF ABOUT 10OFT OF 4INCCH PIPE
nn full forte and eit
5qOzhn ueenm cl — Lie 6 FRM HOME TO CLEAN—OUT (PROPRTY)
Dam Car hole, o0
ARCHITECTS DECLAR ON
U I uMewnd my plans¢lull be used u public recoNs
�o Lieerised Pmrwionel
OWNER-BUILDER DECLARATION
CO E 1 hereby a(liw on 1 I. exempt from Nt Contractor's o :Any Law for the
COO following mason(Satiate RI31.3,Bushmsa and Rn.demolish.
e oli Code:Any city tcounty
$ which its i sns a pandit neutron;nrdw alter,impwe„d permit ser repair any wuaom
_ma prisebslissuer.rsunttwe wapplicant Currents pewitw Bk asignedsutemcm
€re wmmenccewithSectamtowofDivionsoof the ftBatiosaniu�IaonsCodmr9 Sq.FC Floor Area Valuation
5$ (commencing pt Section and
ser Division 3 of al eg eineae pt on.Professions code)of $5500
�'d� Net he u sumps lanm(rom u0 w bask for w alleged exemption.Any violation of
Section 7011.5 by any applicant for a Permit Objects w appikut o a Civil penalty of �p Number Occupancy Type
Ml mom than five hundred dollam(ss(o). 35704015T7� P Y YP
04uowner ofwpoltary,pmy wploymwW vngeuw'v oak wmpewtm, '
will do wasim..and The
C.O krmtNtendese awdo does
ran apply
owner
and PmreWons Code:The ContruoYs and
law dons rot apply lf an owns of Required Inspections
mummy w ycwt,pds ser enpovea wmon,end Incus am n such work himaelf ser forage his
own wPloyens,patted Mauch int U semenu artne,inttr or CpaRemd fm ow IL
haildur wWildingmhmpavwwksold within arc Yen ta rnmplefor wawrcs-
Widda will have w bmdN of poling Nat bo did w Wit m indiums for purpose of
sale.).
❑1.as owner of the property,am exclusively contracting with licensed contractors m
sense La d esnjea(Sens 7oaa,weer of and Professions Code:)Tie Contractor's soul IN
cent tawdorr Inch apply man reitMpapenyWbosed purfimposth Nortoner's �a�y^p�� r
wbone Law.far wee projects wiNaamuactar(s)Baved pmaB is m the this tots License law. Voir
R"'y
❑1 w exempt undo Sec ,B&P C far this recon
Ox Date
WORKERS COMPENSATION DECLARATION
I bemby sakm ander pctwt,of perjury ane arca fO1kmrig dxWatiau
❑1 have and will maintains Certificate of Consent to self-insum for Worker's Campn-
ration,u provided for by Section 3700 of the Labor Cade,for the pHowuce of the
wplc for which this permit is issued.
❑1 have sand will maintain wok s Compensation Insurance,u required by ScOmer
370Dof we Labor Cade,for w pufowuce of w weekraf which this permit k issued
My Worts(s Compensation Imus.Imus.umayeennylicy number
Cartier. 5Poic,,No.;J 5eta03f � wEOEU-MON FROM OR ERS'
COMPENSATION INSURANCE
trials sconces acted rot bocanpkuA Rw pewit is faoro hum uddoRan(S14)(1)
Orku)
1 certify,Net in the performance of this work for which this Pewit is issued.l call not
employ try person in try manner In as an beeomc subject taw Workw'Compnnown
Laura of CWfemin,Date
Applicant
NOTICE TO APPLICANT:If.after meting this Ccninum of Excerption.you shout
buccae subjm in w Wmkefs Compensation prove ions of the labor Cor,you most
Oforthwith comply with Inch povkions or this Permit shall be dcement rtvaked.
z `� CONSTRUCTION LENDING AGENCY
A
F 1hereby ichum tutcam kat NnsSce. landing agenry forwperlmmuae of
ILa> w wart rat wMCA tda pecan k bound(Sec.1097,ck.c) .
R. A LcndeYs Name
z l.endeh Address
V Q 1 cmtiry Nat 1 have read this applkaunn and sate than the above info ajoh n k
^. CO—11.o comply withill city and county ordiwues and sure laws mixing to .
Wilding cavuucuan.us,hereby wNarirz oes.lausesor on.city to cower.'.ft
above-mmudgm poppy fan iexpctiao which may
Fr+4 (We)agree to save,indemnify and keep handless w City of Cupertino against
n.n Z
liabilities.judgments.Of O,auuud expenses;which may in any myeawcegainst said City
V"h[ In
APPLICANT
Of On UNDERSTANDS
Of thispermit.WILL
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date Sy—I,f 4-7�
SOURCE REGULATIO
YAP^ °j7S/°fRe-roofs
Ainaum qfA tCantrfdor
HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will w applcant ser future building aceupwutme ser Mndle hoodoos mrteriil
defined by w Cupertino Municipal Code.Chapter 9.13,and w Heaths,and Safety
.
Section 25532(.)7 roofs shall be inspected prior to any roofing material being installed.
❑tins Na
Will w e rant a,mtam Wildin Octin ant trate a ul If a roof is installed without first obtaining an inspection,I agree to remove
Pp g p q pmcntotdcvivs which g P
eDm trio? ns ser conuminanu u defined by w Bay Arta Air Quality Management all new materials for inspection.
0 yes 1—MIC—
Ihrve mad unth
somencer mamriak rtquiremenu under Clumer6.95 orw Glirar.
run HI-I"Safety COde.Sceuons25505.25533 and255M.1undemund thnifw Wilding
ns
danat cuwmly have•Iodonban,thb k my noon bilby m hmtify w accnumm of w
mwirt nwhkn bcmet ,oissnateeorrcertire,tearoeea Signature of Applicant Date
o 7� o,�is�6
Ovm.rman risdagcnt —� Ddu All roof coverings to be Class'."or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . . 35704015 . 00
DATE ISSUED. . . . . . . : 05/15/2008
RECEIPT # . . . . . . . . . : BS000004786
REFERENCE ID # . . . : 08050130
SITE ADDRESS . . . . . : 22432 PALM AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VILLAREAL J C AND MATILDA G
ADDRESS 22432 PALM AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2710
RECEIVED FROM . . . . : PRO ROOTER INC
CONTRACTOR . . . . . . . : JIN OH DBA PRO ROOTER INC LIC # 24097
COMPANY . . . . . . . . . . : PRO ROOTER
ADDRESS . . . . . . . . . . : 2306 AMERICA AVE STE 7
CITY/STATE/ZIP . . . : HAYWARD, CA 94541
• TELEPHONE . . . . . . . . : (510) 670-1115
FEE ID 'UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 5, 500 . 00 0 . 60 0 . 00 0 . 60 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
ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 102 . 58 0 . 00 102 . 58 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 102 . 58 #10589
-------------- r
TOTAL RECEIPT 102 . 58' , .
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------ ---------------------------- -------- ----------------------------
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
507 FINAL PLUMBING
•
0so5 0 �3 �
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEf�TINO PERMIT APPLICATION FORM
APN #2✓ 12 `gyp/� O Date: 0S /S
Building Address: �l
t �f3P
Owner's Name: Phone#:
C, �� ,�,,� (s�)
Contractor: n n0 � „ Phone #: 75.0
Fax #: gia 6 71//
Contact: Y Phone#: SCJ 75-0_Daa6
Fax #:
Contractor License#: ]766sa
Cupertino Business License#:
Job Description: 71q&VMe..ss7 /00,Fe(R77-
PLC& /01r/F ffoM hfWf-e 70 CCE-JNC&7-(;PkOvefr77)
Residential p Commercial
Valuation: rcT�jraQ
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set& the sheet index.
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
I PGASCOM Commercial Gas Piping System P
1-4 Outlets
IBSEISMICOM Seismic Commercial P
IBSEISMICR Seismic Residential P
1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
-� CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
OF
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1 PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1 BPGAS 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
•
Community Development
t 10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408)777-3228
qtIDCITY OF
CR,TINO Fax(408)777-3333
V r C 1 ISI Building De artment
JOB ADDRESS: � PALtj AVE. PERMIT #
O�OSo lad
OWNER'S NAME: T - PHONE # S/a SOOO,Z
GENERAL CONTRACTOR PRO Roatq,-LWC. FAX # 5/00 -056,7-
I am not using any subcontractors:
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
f o 05 S O
C�wnerl Signature D to