08100043 CITY OF CUPERTINO �' "
BUILI)Ii9C DIVISeON PERNUT ' COk�ITRAcTaR INFOT2MATA,
.�
BUILDING ADDRESS: PERMIT NO.
10544 ORANGE TREE IN IBEEPLUMBING - 08100043
OWNER'S NAME: PERMIT ISSUE DATE
FUJIKAWA RICHARD S AND ATSUKO 1701 S 7TH ST 10/08/2008
op NE: (408) 278-0178 ITSANARY NO. CONTROL NO.
ARCHITECMXNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0, LICENSED CONTRACTOR'S DECLARATION -
!uL hereby affirm that 1 me licensed under provisions of chapter 9(mmmcncing Job Description
^� with Salion7")ofDivision 3of the Business and ProlessionsCode,and mylicenacr REPLC MN SWR LIINE & -INSTL FNDTN & PROP LINE
mc,EEEL urn area
ea had ureet. O
^G7 p�nmx�r �' CLN-OUT
ARCHITECTS DECuaAnoN
a1 understand mty y plants shall be used as public records
7y
g p Licensed Professional
0 5 OWNER.M'exam.DER DE Ce ContrON
f I herebyhbecom 1Em that 1 1. atmpt from Nc CanuactCod Liccnx law for the
S00 which rt rearon.(Saito 7M r.cataract.ducts and Ra,it..ns Cork:Any city or munty
$ which itsisa,permit naithe +mer,improsudcermitt orminorsir ay Nuctum
thtrbir ceased c,alsarequithe thovianieir far suchpemilmfiba Law(next uumont
< NommencingwitSectiotbNeprovisiowofNeConusinem; niansel�w(CNpmr9 Sq.Ft. Floor Area Valuation
eEa (commencing wird Section 70 nal the
3 of the Business and on.Any
Coit)or $16200 .
Nu k u exempt thmfrom and Ne aper for be alleged aemant W Any l violation of
Section de. by five
dreddontraapermitsubjectasiteapplbhntbadvilPenaltytf Number Occupancy Type
mm more Nw fisc hundred dtllva(550(). 31634016 .� p y yP
L u ovicr of sins property,a my cmployaut wird water m ilimsele cempeossdw,
will do the work,and Ne suncture is notimended atffered forsde(Sec.7044,Bud.
and Professin.Coder The Comlraemr,Liermx Law doer rot apply b am$arca of Required Inspections
pmpenr who bunds a i m proves Neuron,and who dam Bach work himself or through his
awn empltyca,provided thatsah Improvesnwta an,not intended aoRered farsala V.
however,the building or improvement ihsold within one year of completion,the owier-
builder will have the harden of proving Nal he did wt build or improve for pumoe or
SAN
III--------x''---777 rr��1.
m u owier or to plyproperty,ow acof propvely wnbxting vied ncensed mmtenme.a d ��' "'�,�mwtmet Ne project(Sec.1044.Businum and Professions Code:)Tne Contractors W. II11[fIIIL\-\/C\wf/'Icease taw dors rsuchPr je is owns of pmpeny who builds or rnpmwa Cmeam and
sham Law.far such project wird aconuacmr(s)licenced punwnl balm Cawsotars
Liccnx Law.
❑lam amps under See ,Bal PC for Nis mason
Dwrer Data
WORKER5 COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury we of Ne following declensions:
1 haw and will mdmain+CmiaaN trconsem in xlf-insure rawmkers Compcn-
avian.at provided for by Section 3700 of the Labor Code.for the perfmmamen of the
work for which this permit in issued.
❑1 have W will maintain Workers Compmeatbn Insurance,u requited by Screw
37Wofthe lana Code.for the performance of not work for which this permit a issued. '
My Waters Co niumeadw Imre.caner and Policy number art:
Carrier.4w.,w 1 VO, Policy No.: i�D C501 ISSN o f
CERTIFlGTE OF E)(EMMON FROM WORKERS
COMPENSATION INSURANCE
(Tar xctim need imlbecmplemd if Ne Permit is forth hundred dollen(SIO)
or Ica)
1 certify Nal in the pcif...of the work for which Nis Permit In isswd.I shall ma
employ any person in any manner cut as to become subject to the Workers'Cmpenudw
Laws of C.ff.nda.Data
Applicant
NOTICE TO APPLICANT:IL after making tido Certificate of Exemption,you should
becme Subject b the Workers Canpcwetion provisions of the labor Code,you must
foMwith comply with such provisions or this permit mail ere Named revoked.
z 0 CONSTRUCTION LENDING AGENCY
ti
F k for which
then Nem r,mnsSecsi3097,Cr.•.)eery for Ne performancem'
IY> La work ror when aider Pmma r issad Iasi.3097,civ.ea
tiz Lcadcra AddName .
O Z Itnders Aaampe
U O 1 cmify that I have.ad Nisi application new rob Nal the above wamadw is .
Ty P coact-1 agree b comply with all city and county ordinances and man fin retailing b
V bung consuuctian.and hemby,uName repraemativw of Nr city in cater open Ne
r Cs1 ,aove-muntioned property fa inspection purpoxs
t„�G (Wc)agree be saw,indemnify and keep haralra ft City of Cupcnino,gainst
CA liabilities.judgments.com and apeman which may in any way,arue Miami add City
(J Z In coweguenee of the grousing of this permit.
ti APPLICANT UtiDERVrANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCER 1
G7vF�aa Re-roofs
Sitnvurt of ApplicaHAZARDO Data l/
HAZARDOUS MATERIALS cap DIS nea,h Type of Roof
edl the applicantm,(MunibuilECg ampaptfare or handle Health anmaterrl
u dmwd by Ne Cupenico Municipal Code.Chapter 9.12.and the Health and Safety
Coda.Semon 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
0 Ya
If a roof is installed without first obtaining an inspection,I agree to remove
can Ne applicant a tutu.building aaapant,.a cgaipman or devim width g
It hevvdrns air conn nano pe defined by de Bay Arta Air Qualify Management all new materials for inspection.
aNa7 T�7'�` ,
❑Ya 7No
Ihavereadtheh W=mmdalamquircmenuunder Chapw6.95oftheCalifor-
nis HcalN k SafayCodc,Sm-4=25%5,25533 vd 25534.1undcntand thcirde Wk ing
dao rot summa w+ l that Il r my nslbii' b"only Ne aeupxt of
mquirtmcnts re met ' rbissu tr. 'eatim_C i� Signature of Applicant Date
0 All roof coverings to be Class'%¢"or better
Ow fill mibmirad,gcnl e-
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31634016 . 00
DATE ISSUED. . . . . . . : 10/08/2008
RECEIPT # . . . . . . . . . : BS000006301
REFERENCE ID # . . . : 08100043
SITE ADDRESS . . . . . : 10544 ORANGE TREE LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. FUJIKAWA RICHARD S AND ATSUKO
ADDRESS . . . . . . . . . . : 10544 ORANGE TREE LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2015
RECEIVED FROM . . . . : BRC DRAIN CLNING IN
CONTRACTOR . . . . . . . : IBEEPLUMBING LIC # 29763
COMPANY . . . . . . . . . . : IBEEPLUMBING
ADDRESS . . . . . . . . . . : 1701 S 7TH ST
CITY/STATE/ZIP . . SAN JOSE, CA 95112
TELEPHONE . . . . . . . . :` (408) 278-0178
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- --- ------------- ---- ------- ---------- ---------- -- --
1BSEISMICR VALUATION 16, 200 . 00 1 . 70 0 . 00 1 . 70 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
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 103 . 68 0 . 00 103 . 68 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 103 . 68 #1866
---------------
TOTAL RECEIPT 103 . 68
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--------------------------- -------- --- -----------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
q6UPEkTINO
Building Department
JOB ADDRESS: i o S cl L l o k p.. c. T3 ce. I-W PERMIT # 1 '
c n gsota l U Ou
OWNER'S NAME: a F� 1 �G p..�w PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:44 01'
/o ar
Signature 6atd
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
' REPIPE/SEWER/MAIN SERVICE
CUPEI�TINO PERMIT APPLICATION FORM
APN # z �� I �� Date:
JJul C>9
c�
Building Address:
SL ra t 2e.c. Z .7
Owner's Name: Phone#:
V�Q
Contractor: -C 3 t� p L . b r S Phone #: t.loy ck-78 01-) ()
Fax #:
Contact: Phone#: ' Ll o$ 3 ci 1010?19
Fax #:
Contractor License#: S>"S1?7 9 Q—)
Cupertino Business License#:
JobDescription: ¢� 1 w�Ga r ��� Se ,erg L i c d T.� S r p L L F-0 �"
Residential Commercial ❑
Valuation:
Project Size: Express L Standard 5d Large 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
j1BSEISMICR Seismic Residential P
1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
G REPIPE/SEWERIMAIN SERVICE
CUPEkTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
IPRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P ICPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
IPCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFIXTURE 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
1 1PLMBLNCK Plumbing Plan Check P •
1PLMBINSP Other Plumbing/gas Insp. P
f 1TRAVDOC Travel & Documentation Fee B
1BUSLIC Business License B
Revised 6-16-08
•