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081201264 upCpC Zto ntt>_ ni- iiI < >yU gLL�, ryryel O `C O _zr gc fig? 02 Z r a= a "s UC O F >i C U< CITY OF CUPERTINO A'°- Pim raa. sit�'�� "a� _-1 "1,�'` '�" CLINTRALTQii I�1kOLLMATION BUILo1Ne�'on'2slar: PERNUT .. 1...,'+:,?tt,.� BUILDING ADDRESS: PERMff NO. 1141 S SrPFLT,TNG RD PROROCITER ()P11 2ni 9r OWNER'S NAME: PERMIT ISSUE DATE 0 A 'O 8 e 8 CONTROL 10. 510)670-1115 ARCHTTEC rENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTORS DECLARATION Job Description IJ 1 hereby affirm Nal 1 am limmod under pmvisimts of CMptu 9 (commencing with Scnion ]000) ofDiviuon 3 ofthe Businusand Prossumm Code, end my license is infull I.And ef L h 65S;t RPLMNT APPX 35 FT OF 41N MN SWR LINE FM HSE Dae- Clws �'or no Dam < ConoracR Tt<ff-� OUTLT /.I TSDEmr ARCHTfELTS DECLARATION I understand my plain shall lis used upublic records UP TO B4 SIDEWLK/TRNCHLESS SWR& INSTLTN OF 2 CLENOUT ACCESSES LiecmedPmfessional OWNER -BUILDER DECLARATION I hcmby mirm Nn 1 em MCMpt from the Contncusea License Law for the following moon. (Section 7031.5. Business and Professions Code: Any dry or county which requires a permit in conurML aper, improve. demolish, or mpmr any structure prior to its issuable. also on,tims Rha applicant forsuch permit to file a signed suumcnt Contractor's Liccnse Law(Chapmr 9 Sq. Ft. Floor Area Valuation that Ito is licensed putauam to Nc provisions of the (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 4000 that he is exempt therefrom and the boas for this chole i esemptiom Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit aubjecu the applicant to a civil penalty of nut mom Nan five hundred dollar (55001 36222014.00 Q 1, u owner o! the progeny, a my wployua soled wage w they sole campenwtion, Required Inspections wE do the work, and the su acuue b not intended coffered for sale ($cc. T(ad, BusiM•• And Professions Code: The Contractor's License, Law does Our apply m an owner of property who Wilds orimprovss thereon, and who time suchwark himselfor through his awn employees, provided that Mods improvements Am notimmnded oraffered forsah. If. hmvever. the building orimprovement 4 sold within one year of completion. the owner - builder M0 have the burden of proving that M did WE bold a improve for puryase of sal'.). ❑ I, As owner of the property. and uelusively convecting with licensed cuntracmrs m catstruct the project (Sec. 1014, Business and Rofecdons Cade:) The Contracmfs U. came Law does not apply in an owner of property who builds or improves thereon, and. who contracts for such projects with a co mesion(s) licensed pursuant in due Contractor's License law. Iamuemptunder See .BAPCforthiAmmm Owner Dam WORKER'S COMPENSATION DECLARATION 1 Mosby affirm under penalty, of peljAry one of die following declarations: ❑ 1 ham and will munW n ofCamera for a eCenif37W r Code.fum performance ce of the weals, provided for a 3]00 of the labor Code, far the perfomlance of the Ss soak for which Nu permit u issueC. r mi issued. have and will mountain Workers Compensation Insurwce, As required by Section 3]00 of the labor Code, for Ne perlormmce of Ne work for which this permit is issued. My Workers Compenstn Insurance carrier and Policy number are: Canner. ac✓NO Policy No.: CERTIFICATE 07 EX64 MON FROM WORKERS' COMPENSATION INSURANCE (Ihb xNon reed not becampiemd tribe permit b felon hundred dollars (SIM) nr less) 1 mnify Nat in the performance of to work for which this permit is issued. l shut not employ any person in ally mMnerjnl aSCWbCLomc M bject to the Workcri Competssation ' Laws of Califumig. Date L/ / S Applicant 121V NOTICE TO APPLICANT. If, after making this Cenifnte of Eacreption, you should become subject to the Wohvb Compensation pmvisimn of the labor Codc, you must ' foMwiih comply with such provisions or this permit shall W dccmed revoked. CONSTRUCTION LENDING AGENCY Ihorw ich tin Net Nert is agency for the performance of issued (Sec. for which this permit b issuW (Sec. Jo9], Civ. C.) ' ' Leweds ndefa Name , Li Lsndefs Address 1 Certify Net I have read this application and sum Net the aWve information is correct. ) agree m comply wit uI city and county ordinances and arm laws relating th Wilding connrochon, and hemby aushorme teprtwnudws of thia city to enter upon tW ahuve-mcntiened property for inspersion purposes (We) agree to save, indemnify And kcap harmless the City of Cupertino against j liabilities,judgments. costs and eapuuns which may in My way came agumtsaid City in eomaquuu or the grwting of this permit. ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date 12 SOURCE REGULA ONS. Re -roofs Type of Roof 1 /�/ f �e Signature of pplica/ DaTc— HAZARDOUS HAZAUS MATERIALS DISCLOSURE ri Will the applicant or fu building occupant atom ornddle haArdOns material r 9.12. and ore Health and Safety e Cupertino Municipal Cade. Chapter a defined by NM Cale, Section 255324)? All roofs shall be inspected prior to any roofing material being installed. �Nc ❑Ye10 If a roof is installed without firs[ obtaining an inspection, I agree to remove Will the applicant or future building Occupant use equipment or devise which Amit harardnus air conuminants As defined by to Bay Area Air Quality Management all new materials for inspection. District? QYes _zala 1 have read! Ne hwankus material, equircmentsundet Chapter 6.95 of the Califon nu Hud" Safety Code.Savau 255)5.25533 and 25534. I understand! that if Nc Wilding does Out currently hart a mmol that it is my to,,xis hility to notify As, oceupmt of NC requirements which myy lm mct prior ssuanceofa CeniliMof Occu cy. Signature of Applicant Date ran" / /q Wo& All roof coverings to be Class'W' or better D m' Ownero am rii<dagcm D Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS:/�/ S. 5'�C(zN6 RO• PERMIT # ©&/ 2-d(2-6/ OWNER'S NAME: M CC&I PHONE # e�Og o2*Z 35-8 GENERAL CONTRACTOR O gOOt,< :rPC- FAX # I am not using any subcontractors: ny" (�ndr2 - /,;L/Wo �— Signature Date Please check applicable subcontractors and complete the following information: 17 r/Contractor Signature a a� Date 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 17 r/Contractor Signature a a� Date w • 4 ITEMS OF 4 0 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36222014.00 DATE ISSUED.......: 12/19/2008 RECEIPT #.........: BS000006864 REFERENCE ID # ...: 08120126 SITE ADDRESS .....: 1141 S STELLING RD SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: CHU CHIEN-HUA M AND FUNG-SHI ADDRESS ..........: 1141 S STELLING RD CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5020 RECEIVED FROM ....: PRO ROOTER INC CONTRACTOR .......: JIN OH DBA PRO ROOTER INC LIC # 24097 COMPANY ..........: PRO ROOTER ADDRESS ..........: 2306•AMERICA AVE STE 7 CITY/STATE/ZIP ...: HAYWARD, CA 94541 TELEPHONE ........: (510)670-1115 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 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 ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 102.48 ---------102.48 VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING REFERENCE NUMBER -------------------- AMEX VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING } IN OF • CUPEI�I r L 08/ao/C2,G CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE PERMIT APPLICATION FORM APN# p2C]l Lr U (3 Date: /CSC Building Address: 11 f S S r�ui �+ pn /� / C� Owner's Name: C rr Phone #: Y09 3Sg9 Contractor: PRD p O �(I'� o, S Pic. /�Fax Phone #: 51'9750 _ o0a6 P #: -5 0 6 7 p — III)S Contact: -ropy GROW 0 Phone #: `10 750 -ODa 6 Commercial re -pipe per fixture Fax #: 510 6 70/�/.S Contractor License #: 6 3 66 -5,?- SoZCu ertino Business License #: Cupertino Commercial Gas Piping System 1-4 Outlets Job Description: R iV11W AQ/u-T OF A-4 O t/j 3S xNC%/ /144Y,Al S eivve,P L Z�*e Fe 61V bW7(e oVT- e7- 7 gCFclee SS/J� IA Cl -P 01 -17- sv'w -e I'MO xNsT�N cc ase P Residential � Commercial ❑ Valuation: ( && = 1BSEISMICR Project Size: Express Standard ❑ Large ❑ Major ❑ p 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. 1PRSEWER Green Buildin Points:-" P Quantity Fee ID Fee Description Fee Group Permit Type 1PCSEWER Commercial building sewer/sanitary sewer P 1CPSS 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System 1-4 Outlets P 1BSEISMICOM Seismic Commercial P 1BSEISMICR Seismic Residential p 1PRSEWER Residential building sewer/sanitary sewer P 1RPSS zantclm- CITY OF CUPE(�TINO CITY OF CUPERTINO REPIPE/SEWERIMAIN SERVICE FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1PRREPIPE Residential re -pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System 1-4 Outlets P 1BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P I 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B Revised 6-16-08 0 • 0