08010151 (2) CITY OF CUPERTINO �!�€+'p'♦` /�apr �"y�
BUILDING DIVISION PERT CQs-���'"gTVAI' O`',��y
BUILDING ADDRESS: PERMIT NO.
7559 WATERFORD DR PACIFIC PLUMBING 08010151
NER'S NAME: PERMIT ISSUE DATE
SAMUEL LIU 2138 O'TOOLE AVE 01/28/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
INSTL 1 PROPTY LINE CLEAN- BLDG ELECT PLUMB MECH
0 0 0 0
Sop LICENSED CONTRACTOR'S DECLARATION Otfila
Job Description
e 1 hereby 0)ou' Net 1 am II¢nud under and
Professions
of CMptm 9(commencing P
with Section7000)e)ecDIVIAaa 3 oftiu Badmen and Profcuium Codqe,and my license is
n L full force and effort �•�_ ,
�i_ Linen Lu.R '
Dau Comrw1ur
ARCHITECTS DECUARATION
eI unaeratsnd my plain Nall W used u Public records
4 Licensed Professional
7 OWNER-BUILDER DECLARATION
S A E 1 herehy.111.that I am exempt from the Contractors License Law for the
r o Ofollowing reason.(section 7831.5.Business and Pmfedou Cada:Any city or county
3$ , which require a Permit N romuuc4 slur.improve,demolish,in repair any structure
Zi, prim he its issuance.also requires theapplicim for such permit to file a signed statement
zFF<
"eve is licensed pursuant to the pervisdom of the Conmactor's Likinnize Law(Chapter 9 Sq.Ft. Floor Area Valuation
5$ (commencing with Section 7800)of Division 3 of the Business and Profusions Cod.)or
3 that he is attempt therefrom and Ne bub for the alleged eumption.Any violation of
Section 7031.5 by airy applicant for•permit subjects the applicxt to a civil Penalty of APN Number Occupancy e
nor mare Irn Ove ahundred dollen(11507. P Y TyP
❑1,u owma of Ne Ptrp°tY,a my mPloym wird nigra u the'v sole eompewtion,
will Prfuwork,and -The Comennoruundedorowasstorula(Sec.an an .of
and Rtywhons Code:The Cwnmcmrs Licenseand
law arca not apply lf rt owner is Required Inspections
property ertY wyees,provided
impmvea thereon,and who me not intended bit croelf or through his
t.
howemplay chain Ori provemattruch ent lmprowmenuasemtomoRered the forsids.
r.
however,Ne Wilding mlmpmprovinhut ho within war or mprolefor Ne owner- LJ "-'�LvyI1'1L'I11Ir
buildu will have this tarda of proving that k did rot Wild or improve for purpose of
ale.)•
❑1.u owner a!this property,.Business sis and conuacdng wW licensed ronousen u
cease La the Project(Seco an Owner
and property whoProfessins Cada:)The Conmount.and cense taw don not apply a am wither of isun(s who Wilds in improve thereon,and
who as LaNfoe such gojecu withaeonuaner(s)Ilanxdpunuentm tine Conv¢uM1
Lk I sum law.
❑lam exempt undo See ,BBPCfor NIS reaxn ,
40— Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I ban and will maintain a Cer9Bcate of Conemt to self-IuumfaWarkefaCompco-
station.as Provided for by Section 3700 of the labor Code.for the Ixrfamunm of the
work for which this permit is issued.
❑1 have and will maintain Worker's ComPonsatian Insurance,as inquired by Section
3700 of Ne later Code,for the pedormanceofthe work for which Nis permit is issrcd '
My WorkeYa Compensation Wunmc carrier and Policy number'
Confer. V ty �� by liry Na.:
TIFICA OFEXEM ONFROM ORKERS'
COMPENSATION INSURANCE -
(Thb secdm need ret WcomPleud lithe permit Is(ormu hundreddo0an(SIM) .
1 cerdfy that in the perfarmahse of the work for which this permit is issued,I Nall not
employ any parson litany commerce u u become subject in the Worked Comperuman
lawn of Califomia.Dau
A,Hcam
NGnCETO APPLICANT.If.after making this Cenifiuu of Exemption,you should
become ubjem to the Worker's Compeeeition previsions of the Latour Cade,you muss
.J 0 forthwith comply with such prnvfdnu or this Permit mall be deemed revoked.
y CONSTRUCTION LENDING AGENCY
[-� 1 herehy affirm that Nem Is a construction lending agency for the performame,of
a
the work for which Nes permit It Wood(Sm.3W7.Civ.C.)
0 Lender's Name
] z Landers Address
U O I cmdfy Nat 1 haw rtad this application and sou that the show InromNm is
{T. comon.I agree in comply with all city and county ordinance and sou laws relating in
.O Wilding construction,and hereby authadu repmunutives of this city to noun upon be
[i7 show-mentioned property for inspection purposes
G (We)agree to taw,indemnify and keep harmless he City of Cupertino against
IA IlabililimItalgmants,cord and expenses which may In any my acmue against said City
U Z in consequence,of the granting of Nis perosis
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
NS.
✓SOD Re-roofs Date
LR��TIOy" PV4s4'r,
Signsmkc or IianVConuecur �iTe4 �—
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the apPIIML or future Wilding occupant sure or renals licentious maurial
deRned by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
.Samba 25532(,)7❑Yu ON. All roofs shall be inspected prior to any roofing material being installed.
Will de aPpliu/nt m future Wm
building opant use equipment or devices which If a roof is installed without first obtaining an inspection,.1 agree to remove
..It huardaus Mr communanu u dcOned by the Bay Asea Air Quality Management all new materials for inspection.
District?
❑Ya ON.
I have mad the hoardam onerleb requiremrouunder ,Chaperd.95of Ne Califer.
rias not Co Safety Cade,Sections 75585. my nortM15534.1 undersand that lithe Wilding /n�N
dna not currently how•anent,Net It 4 my rupeuiMlity,b notify,NI rccuput of the
"'TTT66fA 4/)e ✓
requftnewhieh muss be me prior iuuuce of a CcetiOau of Occupancy. —�
pa Signature fApplicant Date
Owner m out "sed agent Daug
All roof coverings to be Class"B"or better
'
• CITY OF CUPERTINO
4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36617027 . 00
DATE ISSUED. . . . . . . : 01/28/2008
RECEIPT #. . . . . . . . . : BS000003781
REFERENCE ID # . . . : 08010151
SITE ADDRESS . . . . . : 7559 WATERFORD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SAMUEL LIU
ADDRESS . . . . . . . . . . : 7559 WATERFORD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5233
RECEIVED FROM . . . . : PLACIFIC PLUMBING &
CONTRACTOR . . . . . . . : JOSEPH BECHWATI LIC # 22640
COMPANY . . . . . . . . . . : PACIFIC PLUMBING
ADDRESS . . . . . . . . . . : 2138 O'TOOLE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 9513.1
® TELEPHONE . . . . . . . . : (408)452-8633
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 1, 800. 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
ITRAVDOC 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 AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 204 . 96 16782
---------------
TOTAL RECEIPT 204 .96
VOICE ID DESCRIPTION ." ' VOICE ID DESCRIPTION
----- -- ----- -- ----------------------------
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING
01/22/2.008 09:50 .FAX 408 777 3333 CITY CUPERTINO0(�_O .D fQ001/002
OYY
• CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
.3 (P ( I oIas ��
Building Address:
owner's Name: Phone#:
MuEL I,L kA
Contractor: Phone #:
��( SIC Q�Um�N� SYC 5 �CE�INC . Fax
Contact: Phone#:
�� I` Ctl W i�TT Fax
Contractor License#: —4T�
Cu ertino Business License#:
• Job Description:
To iW)TWW C l��i 0-1,47
Residential ( Commercial ❑
Valuation: /1
Green Building Check list must be completed and attached to this application.
Green Buildin Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
IPCSEWER Commercial building . P 1CPSS
sewer/sanitary sewer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
IPGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial p
/ 1BSEISMICR Seismic Residential P
/ 1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
01/22/2008 09:50 FAX 408 777 3333 CITY CUPERTINO 16002/002
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEf�TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
IPRREPIPE Residential re-pipe per fixture P 1RPRP
IBPWSVCS Water Service P 1CPWSor
1RPWS
1PPRSEWG Private Sewage Disposal System P
5CESS Cesspool p
1BPWATER Install/alter Water Pipe p
1BPFIXTURE Plumbing Fixture p
1PGASRES Residential Gas Piping System P
1-4 Outlets
IBPGAS Gas Piping System 5+Outlets p
1PPERMTPFEE Plumbing Permit Fee Issuance P
IPLMBLNCK Plumbing Plan Cbeck p
IPLMBINSP Other Plumbing/gas Insp, P
ITRAVDOC Travel &Documentation Fee B
1BUSLIC Business License B
•
Community Development
10300 Torre Avenue
i 1,,,:/ Cupertino CA 95014
Telephone(408)777-3228
�oCITY C�TIA'O Fax(408)777-3333
rC 1 '�l Building De artment
JOB ADDRESS: PERMIT #
4j--s W A r y- F a R iq 'o Q w/o
OWNER'S NAME: P4ejr,1CP44A1616 .PG} NE # a X5? , %l2d
GENERAL CONTRACTOR: / FAX #
I am not using any subcontractors: ��vr f �le/K �Gr�C f
Signature Date
Please check applicable subcontractors and complete the following information:
60 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