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08080183 (2) CI'gY OF CUPERTINO . BUILDING DIVISION PERMIT x(.',C�1iTlirS. " QRINT`ORMA' IE� IDI npo ES PERMIT NO. BUI .�c:yj NED I?IR CT CAL—COAST REPIPING, INC. 08080183 NEWS NAME: PERMIT ISSUE DATE HJ ! FMI DERICK K AND MARY T 1371 TITAN WAY 08/25/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO RE—PIPE 8 FIXTURES NEW WATER BLDG ELECT PLUMB MECH 0 0 0 0 Sop LICENSED CONIRACIDWS DECLARATION Job Description F I Mmby a(frm that I am licensed under provisions of chapar 9(commencing ZZ!Kari with Section 7")of Division 3 of the Business and Profession Code.and my license is no. in full forte and Wf. ' NA Lken lass Vt) ttt9... DamCamrsethr 3 W ARCHITECTS DECLARATION <] 1 understand my plans shall be used as public record U g C Licensed Professional OWNER-BUILDER DECLARATION 1 hereby.Tort the I em exempt from the C rsiow C s License Law far the OO following reason.permit 703 L5.Business and Pmfdemoli Code:Any city or county which its issu a permit re coneauL alter,impmsu demolish,ri repair any s uctum _z6 Prior mitsiensedpalso uantto ma the ovido ;of for sechpctor's Licensrile a e Law(tammtm ppm¢t that halnlicensedPSccdnttothe ofDivisioofthe heBusineso dNaInsio(Chodter9 Sq.Ft. Floor Area Valuation Y v'� thammendngwiNSec0ore,and the basison]ofgBuunexa and Professions Cod)of that ha u exempt therefrom and the basis for the alleged eumption.Any violation of Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of APN Number Occupancy Type act mom Nan five hundred Miss,(5300). ❑I,ss awns of 0e property,army employees with soirees their sok compensation, wiRdo Newrk.udthesmaumisnatinWndnd"afremdfonale(s".7 ,BuiMan ns Required Inspections and Pmfaalon Cade-The ConuacmYs License Law does net apply an own.of q P propertywho build,orimproms;thomm,andwhodoessuch work timelier through his own amplay=,provided that such improvements not not immnded ar Wfered forsale.if. however.the building or improvement Issaid within arc year of completion,the owner. build.will haw the burden of proving that he did out Wild or Improve for purpose of "Is.). ❑1,an owner of the property am exclusively contracting with licensed nnnoctam m construct Ne prole.(Sec.7W4.Business and Profusion Cade:)The ContncmYs U. cause Law does out apply to an own.of property who builds or improves thereon,and who contracts for such projects with a mnusc on(s)licensed pmavent to Ne Conuamors License Law. WIsmeaemprunder See ,B&I'Crordrumaum as, Date WORKER'S COMPENSATION DECLARATION I hereby Wilms under penalty of perjury one of the following decl.aimu: ❑l have and will maintain a Certificates of Conant to self-ksure far Warkds Compcn- nation,as provided for by Section 3700 of the Inbar,Code,for the performance of the y wah for which this permit is iss u d. le have and will maintain Worker's Compensation Insurance,u required by Section 700 of the labor Cod,for the performance of the work for which this permit is bound. ' My Workers Cam-pe7nedanl0.`weaceenrte,.and Polleynumberam:-v�+I` - Cartier.Tl\s'R'�r\LvJ0.',CYI J+lafsf/Policy No.: (-JC-UILIIStl'TUl CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu notion Med notbeconnumad Btie Permit Is Image hundred dollen($100) or less.) 1 CMJIY that In the perfamuee of the work for which this permit is Issued.I shall not employ any Noon in my answer so as in become abject in Ne Workers'Compouradon Lawn of California.Data Applicant NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should become subject th the Workces Compensation provisions of Ne labor Cade,you muss .J O forthwith comply with each provisions or Nrod is permit shall be deemed oke ti CONSTRUCTION LENDING AGENCY 14[••i I hereby affirm the Nem is a construction lending agency for the Performance of LYi> the work for which this permit is issued(Sec.3097,CN.C.) QLenders Name 7 z Lender,Address V Q I certify Na I have read this application end sea that the&bow information is correct.1 agme to comply with all city and county ordinancex and aorta taws relating ut .� building construction,and hereby uthada representatives of this city to enter upon the W ,Wow-mendond property far Inspection purposes. G (We)agree to ave,indemnify and keep harmless Ore City of Cupertino against N liabilities,judgments.costs and expenses which may in any way agme ag&WL said City („)7 in consequence of the grating of this Permit. a� APPLICANT UNDER ANDS AID WILL COMPLY WITH ALL NON-POINT Issued by: Date sow cE�Rec�un s.Yk j0� Re-roofs Sig Kum of Applicam/Cantructor Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tam applicant or future building occupant store or Imndle h.sreous materia dfinad by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety ode.Sued.25532()? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Na Will due applicant at future building occupant use equipment or dean,whichIf 8 roof Is installed without first obtaining an inspection,I agree t0 remove emit ha'rsrdnM air contaminants as red by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes u I have read the ha numweriau requirements under Chapter g.95orNeCalifor- niaHMlthdkSactyCod. don 8505.75533 and 25574.1 understand thatlithe,building data Mt cunentlY h w a taut.Nu' u my m_+poniM1iliry m godly Ne a.upant of Ne req mch to pct m ora n ertifineo(Occupancy. Signature of Applicant Date Q" 2S OSS All roof coverings to be Class'{"or better Owner m authadecd agcnl Date I CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPE"RTINO PERMIT APPLICATION FORM 020�61H APN# Date: 5S% o l ops,ao Zs 05 Building Address: 1c)S,5q. 9,F0 Owner's Name: Phone#: � yo8-22� �©ys6 Contractor: Phone#: CrA CoPS� Fax #: Contact: Phone#: ' `J:CTt9sLiA �(V�oA2'•��a Fax #: Contractor License#: Cupertino Business License#: Job Description: Q�p<pc- Ask IMF Residential Commercial ❑ Valuation: II006, °0 Project Size: (Express El StandardZ LargeEJ Major 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. Green Building Points: 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 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BSEISMICOM Seismic Commercial P Ak IMF 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 00 CITY OF CUPERTINO V . REPIPE/SEWER/MAIN SERVICE CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1PRREPIPE Residential re-pipe per fixture P 1RPRP IBPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P IBPWATER Install/alter Water Pipe P 1BPFDCTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P J 1TRAVDOC Travel &Documentation Fee B 1BUSLIC Business License B Revised 6-16-08 • CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35905005 . 00 DATE ISSUED. . . . . . . : 08/25/2008 RECEIPT # . . . . . . . . . : BS000005879 REFERENCE ID # . . . : 08080183 SITE ADDRESS . . . . . : 10554 RED FIR CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : HUI FREDERICK K AND MARY T ADDRESS . . . . . . . . . . : 10554 RED FIR CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CAL COAST CONTRACTOR . . . . . . . : CHARLES L VERSHAW LIC # 23227 COMPANY . . . . . . . . . . : CAL-COAST REPIPING, INC . ADDRESS . . . . . . . . . . : 1371 TITAN WAY - CITY/STATE/ZIP BREA, CA 92821 TELEPHONE . (714) 578-5090 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 4, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1.BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00 IPPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 IPRREPIPE NO OF FIXTURE 8 . 00 81 . 60 0 . 00 81 . 60 0 . 00 1TRAVDOC FLAT RATE 1. 00 40 .79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL; PERMIT 273 . 68 0 . 00 273 . 68 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------ ------------- CHECK 273 . 68 5607 --------------- TOTAL RECEIPT 273 . 68 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ----------------- --- -------- ---------------------- ------ 301 ROUGH PLUMBING 507 FINAL PLUMBING •