07020057 CITE'OF CUPERTINO
BUILDING DIVISION PERMIT
TC'iIIURrITIflI •
PERMIT NO.
BUILD 11151 ftTRIDGE LN NEW ST1 UCTURE PLUMBING INC 07020057
PERMIT L98UE DATE
OWNER'S NAME:
ZIMING ZHOU 631 KENNETH AVE 02/09/2007
ONE. SANITARY NO. CONTROL NO.
(408) 3E14-2143
BUILDING PERMIT INFO
ARCHITECTIENGINEER:
BLDG ELECT PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION lob Description
e v I hereby affirm that I am licensed under provisions of Chapter 9(commencing
=Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is WATER T lA I N REPLACEMENT FROM METER TO HOUSE
y in full force and eff 11
j Z LiceLie,M T
t Datense Contractor
h ARCHITECTS DEC ON
D
U 1 understand my plans shall be used as public records
0
C y Licensed Professional
n y OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
!:0 O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K$ which requires a permit to construct,alter,improve,demolish,or repair any structure
Z} prior to its issuance,also requires the applicant for such permit to file a signed statement $ Ft. Floor Area Valuation
=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q 2 O O 0
yI- (commencing with Section 7(00)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type
not more Ulan five hundred dollars($500). 35906021 .1"
❑1,as owner of the property or my employees with wages as their sole compensation,
will do the work and the structure isnot intended oroffered forsale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or impmves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractoes Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractoes
License Law.
❑I am exempt under Sec. B&P C for this reason
OwnerDate
EC
WORKER'S COMPENSATION DLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's r mp ton lns nce carrier and Policy number arc: gg?`d
Carrier. + +t Policy No. JT
CERTIFICATE OF EMPTION FRO WORKERS'
COMP ATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date—
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
ZCONSTRUCTION LENDING AGENCY
(12
F.c r-r 1 hereby affirm that there is a construction lending agency for the performance of
IYi> the work for which this permit is issued(Sec.3097,Civ.C.)
W QLender's Name
0 z Lender's Address
V 1 certify that I have read this application and state that the above information is
W correct.1 agree to comply with all city and county ordinances and state laws relating to
O V building construction,and hereby authorise representatives of this city to enter upon the
above-mentioned properly for inspection purposes.
> a (We)agree to save,indemnify and keep harmless the City of Cupertino against f1
liabilities,judgments,cos expenses which may in any way accrue against said City �j 1
in consequence of ng of this pe_ Date V
()Z APPLICANT U STANDS AN LL COMPLY WITH ALL NON-POINT Issued t y:
SOURCE RE Tf0
" 7� Re-roof s
Sign ure of ApplicanUContractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle ha•+ardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cotte,Section 25532(a)? All rooks shall be inspected prior to any roofing material being installed.
❑Yes
If a roo"is installed without first obtaining an inspection,I agree to remove
Will the applicant or folate building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes )0o
1 have mad the hazard m mals requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sc 505.25533 and 534.1 understand that if the building
docs not currently have nano that it i onsihilily to notify the occupant of the
roqufrcmcnts whit ust be me cc of a Certificate of Occupancy. Date
�- Signatu-e of Applicant
All roof coverings to be Class"B"or better
Ow er or authorized agent Date
Community Development
10300 Torre Avenue
g:.
r Cupertino CA 95014
Telephone(408)777-3228
CI71f OF Fax(408)777-3333
%KkTINO
Building Department
JOB ADDRESS: PERMIT# --�O�O��
"-� .,�
OWNER'S NAME:.-r,''1-r PHONE # ems' 3 4-<s
GENERAL CONTRACTOR: Fes#
I am not using any subcontractors: 'M
Signature Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSI:vESS 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
CITY OI' CUPERTINO
4 ITEMS OF 4 PERM--:T RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: B---k: Lot:
APN . . . . . . . . . 3_`)906021 .00
DATE ISSUED. . . . . . . . 0:/09/2007
RECEIPT #. . . . . . . . . . BS000000434
REFERENCE ID # . . . : 0'020057
SITE ADDRESS . . . . . : 7723 HUNTRIDGE LN
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . . Z=:MING ZHOU
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4262
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : LEON FRIDLIB LIC # 26052
COMPANY . . . . . . . . . . : NEW STRUCTURE PLUMBING INC
ADDRESS . . . . . . . . . . : 6-A KENNETH AVE
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . . (2:08) 364-2143
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
BPERMFEE VALUATION 2, 000. 00 83 .16 0. 00 83 .16 0. 00
BPWSVCS WATER SERVICE 1 . 00 9 . 00 0. 00 9 .00 0. 00
BUSLIC FLAT RATE 1. 00 107 .00 0. 00 107 . 00 0. 00
PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00
----------- ---------- ---------- ----------
TOTAL PERMIT 237 .53 0. 00 237 .53 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 237 .53 VISA
---------------
TOTAL RECEIPT 237 .53
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------- -------- ----------------------------
103 UFER 106 SEWER & WATER
507 FINAL PLUMBING
CITY OF CUPERTINO 01(D2M
REPIPE/ E ' er /MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # � o ' Dat
Building Address: 1
'77 " S . ry1
Owner's Name: Phone#:
-76
Contractor: ,� Phone: License #:
Co tact: Phone: Cupertino Business License#:
Z c?" ��,`� ��3 .36' i t lam.3
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑
Job Description:
Residential PCommercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE _Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE P epipe of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING