05100190 (2) CITY OF CUPERTINO ��a��aa,,�� r /Y73�racwwz� ��7I� ��a,� �ir
BUILDING DIVISION PEytyyyyT kVOk\nl,AA TORANF0�YIWOl :
BUILDING ADDRESS: DRAIN DOCTOR PERMIT NG.05100190
NER'S NAME: PERMIT ISSUE DATE
MING 177S WINCHESTER RIAM 0�94 /99()";
NE: SANITARY NO. CONTROL NO.
(408) 370-3082
ARCHIIECTIENGINEEK: BUILDING PERMIT INFO
ELDGELECT
= PO O
�OZp LICENSED CONTRACTOR'S DECLARATION Job Descri tion
i0 1 hereby affirm that 1 me licenacd under provisions of Chapter 9(commencing p
with Sutton 70W)af DIA.km 3 of the Business and Profession&Code.md my license is
kern fotcean rcen. `4T_ 5� EXTEND (E) C/O TO GROUND LEVEL X 3 FT
r< Llecnm Close ` —' MC 3/ •
t Dem Canuactw N OV
ARCHITECTS DEC RATION
� 1 understand my plans&lull W used u public record
Is
5 tad Licensed Prefculnnal
g OWNER-BUILDERIm NMe
DECLARATION /
i9 I hereby (Orrn Net 1 attempttfroe Contractors license Lew for
E
O o fallowing matter.matter..(Sutton 7031.1.5,Business and Improve.
dem li Cade:My city as county
$ which requ(rtaa(mm0h to requires do alcor,W for su deermitsolish,orrtpalrany Ontcwro
a 1,°
prior to s l Inness),atom to the the inions o Me Con permit w rile.a Law(alalemcm
as that he(."Wuliccnsitpuuuem 70the of Division
oftheCBusinesndProrlaw(Chepmr9 SQ.Ft. FIOOf Area O IUBhOn
z (comets exewith Section 70th)of Dutsfraftbeeged exemption.
Any
Code)or /�
$ Net W u exempt timrefrom and the Emu fm the alleged exemption.Any vloution of �a
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of I%L 605 Occupancy Type
not mom Wan five hundred dollars(15007.
❑1,uownmofthepmp)ny,mmyemployeswithmgmulhirmlemmpemadon.
will do the work and theatmctum u not mwex l w offered for sale(Sec.70N,But=
and nywh ons Code:The C s daemon,and
who law doss not apply lf an owner is ReQU Spa 1, �St/
own enywyees,pdmr Mpmvu thereagandeW dussuchwmlh roffoorthrough If. e!O!f ^�
own employees,Meer,,p Ing or i Nat veer Improvements arc net lnmMW moBered install If,
however,Nc wildingorImprovement is hatd within oat year of completion,Mc oween
Wilder
will haw tins WNco of proving that he did rot build or improve for purpose of
sale.).
❑I.as owner of We property,am exclusively contracting with licensed contractors to
consumer the project(Sec.70/,1,Business and Professions Code:)The Compactor's LL
come law does not apply to an owner of property who Wild or improves thereon,and
who contracts for such projects with a eonusctor(s)Human peeress,to the Contractors
Lkeme Law.
❑Iamuennuouer Sec .BBPCfm Mismam
tar
Data
WORKERS COMPENSATION DECLARATION
I hereby affrne order penalty of perjury are of the following declarations:
❑1 haw and will maintain•Cm7fcem of Conant w ulfdmurt fes Woe ces Camper,
Wine,as provided for by Section 3700 of the Labor Cade,for dm performance of the
worir for which this Permit is issued.
❑1 ban and will maintain Worker'&Compensation Insurance,as required by Section
37W of the Labor Code,for the performance or the work for which this Permit Is loved.
My Workers Compeuadon Insurance carrier and Polity number art:
Cartier:Ca�30 YPlgt V IC IQN+t/IfPYI Poliry No.: t4414 t Z;L209
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CNls=lion need net W complemd if tbe Penult lsforone hundreddrllan($IgB
or Ws.)
1 certify that in the prfomance of the work for which this pemit is issued.I shall not
employ any Never in my mannerm u to bmtome subject to Me Worlues Compensation
Laws of Uitmes.Data
Applicant
NOTICE TO APPLICANT.It.after meting this CeulOcate or Exemption,you Amid
become subject to We Worker's Computation provisions of Me labor Cade,you must -
.J Q foMwith comply with such provisions w be
this permit shall doomed raveled.
?^ TR
CONSUCTION LENDING AGENCY
(-0 1 Wroby a1Rnn Mat dart I....do.lending agency forthe perfomance of
Oi
the work for which this Permit Is issued(Sec.3097,Civ.C.)
W Q I.endeh Name
az Lenders Address '
U Q 1 unify that 1 haw read this and mm Mat the above Infomutiun is
W conem,l agree to comply with all city and county ordinances,and sum laws mla0ng w
O Wilding concoction,and hereby authorize mprsntadna of this city to comm upon We
W above-mendonsd property for Inspection purposes.
ti (we)agree re love,indemnify and keep harmleas the City of Cupertino against
f/7 liabilities,judgments.coats and expenses which may In my way am=against said City
fJ 7 In consequence of the granting of this permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date _ �y -
SOURC IE�GULATIOfJ.f. B
—��Sin of Appl( Re-roofs f .ilr
can Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle harudou&material
as defined by the Cupertino Muni)pal Code.Chapter 9.12.and the Health and Safety
nue,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
pens
Will the applicant or fuwm Wilding occupant um equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
..It hazardous air conmminanu as defined by IN Bay Area Air Quality Management all new materials for inspection.
Disuict7
❑Yes u
IIIevc rad Mehw nusmaledsh rtquiremcnts underCMpmrh.95of1M Glifw
riaHcalth&Safety Code.Swd=25305.25533an12553A.lundemwtl Mmif Me building
does not eutremly haw a mmn Met h u my tupsms .,lily tonatiry the occupant of We
petit men wIt h at Mrteluumuccoragessficatcofoccupancy. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owns authorized asap Dam
Community Development
10300 Torre Avenue
Cupertino CA 95014'
Telephone(408) 777-3228
isa
�1PE(�TINO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT#
0300 pktv wP I d:�- lD4' / 4®
OWNER'S NAME: ' ,� PHONE #yOTS c,S— UCao
GENERAL CONTRACTOR 1 va I FAX #
I am not using any subcontractors: m — /o 'Z Y-O S
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
lo
Owner/Contractor Si tature Date
CITY OF CUPERTINO
Is 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 32639029.00
DATE ISSUED. . . . . . . : 10/24/2005
RECEIPT #. . . . . . . . . : 31712
REFERENCE ID # . . . : 05100190
SITE ADDRESS . . . . . : 10300 PHAR LAP DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MING
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1116
RECEIVED FROM . . . . : DRAIN DOCTOR
CONTRACTOR . . . . . . . : JOHN H. LIM LIC # 24784
COMPANY . . . . . . . . . . : DRAIN DOCTOR
ADDRESS . . . . . . . . . . : 1775 WINCHESTER BLVD
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408)370-3082
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
__________ _____________ __________ __________ __________ __________ __________
BPSEWER SEWER SYSTEM 1.00 21.58 0.00 21.58 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
__________ ---------- __________ _________-
TOTAL PERMIT 59.95 0.00 59.95 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ _-----____________
CHECK 59.95 8574
TOTAL RECEIPT 59.95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF CUPERTINO
REPIPE/SEWERS/MAI.N SERVICE
EkT
•CUPINO PERMIT APPLICATION FORM Dv lGt�/l��j
APN #�a / (3 /� 02 n Date:
(p V % O - Z. -O
Building Address:
IV 300 La
Owner's Name: Phone#:
igov
Contracto : Phone: License#:
rAJ e 1 Yoo 21 1151 (0K 3`4 S%
Contact: Phone: Cupertino Business License#:
w ov. gw;r, tx.t od' 31 4 S '--N
nfo:
Building Permit I
Bldg ❑ Elect ❑ Plumb
Job Description:
k.", txis
Residential Commercial ❑
Cost of Project:
e�
60
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Pi in System 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
•