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08120133ugh op og M J Z JyU gar !L^y(p < iG0 Sm� CITY OF CUPERTINO — �.' Q .�. v7 0 z Q F U FLl 6 ,x ^s 6r«y�?s,ka•1'-E*-''�"'� BUILDING OIVISIC`N PERNIIT r.C'O RACT�aR INFUsRMATIOIV BUILDING ADDRESS: PERMIT NO. 10392 OWNER'S NAME: PERMrr ISSUE DATE p SA CONTROLNO. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELER PLUMB MECH RE—PIPE COPPER PIPPING PER O t 2 O LICENSED CONTRACTOR'S DECLARATION CODE lob Description 1 hereby affirm mvI 1 am licensed under provitlons of Chaper Y (commrxing with Section 7O(0) ofDiviaion 3 of me Budressvmd Professions Code.uW my I&eras u in full forte and effect Liccmn Class Lie. Dela Contractor ARCHITECTS DECLARATION 1 undcnu rd my plans shall M used u public mcends Licmucd Professional OWNER -BUILDER DECLARATION I hereby dBren that 1 am cxempl from the Contractors License Law for the following reawn. (Section 7031.5. Busiocim and Pmlesaons Cade: Any city or county which requires a Permit to emtswn. alar, impmvs, demolish, m repair say suueto. prior ou its issuance, also Cal de applicant for such permit to rile a signed su¢mem Ft. Floor Area Valuation then M u licenxJ pummel to dm proviaioss of the Comencuri liecnm Law (Chaptcr9 Sq. (commencing with Section 7000) of Division J of the B ustness no Professions Cattle) or that he u exempt lherUmm and doe basis for the alleged exemption. Any violation of APN Number Occu ane T e P y yP Section 70313 by any applicud for a permit subjects the applicant to a civil Penalty of am lame Nov five hundred dollars ❑ 1, u ownv of die property, m my moployma calla wages as IMv sole cmnpewdon, Required Inspections will do lM weak. and me strumure u not intended m offered for sole (Sec. 7054. Business Nd Professional Cade: The Camaacm'S U. law don ant apply m N oavner of properly who builds w improves thereon. and who dots such work himsel f or duvugh his own emplayera, prodded that such improvements are mminended oroffe Tal for sale If. however, the Wilding or improvement is sold within ane year of compledon, me manner - builder will have the burden of proving that M did rot build or improve fm Purpose of ole. 1. of the , amminc s contraNng with licensed mnaanws b t Cher the Pmjen (Sec. 70s4, Bminrw and Professions Codc:) The Comraculs Li- motSec.70 and ¢nue law don a0t apply as am owner of propeny who builds or improves thereon, and, whocontncu for Apr 'Its wi onuanar(s) licensed pumuant m me Contractors License r ❑lam exemp der e. ,B&PC fm u; n Owner Data W 0 I ON DECLARATION lhereby�rmunderpendl perjuryoacoftherellawingdcusimmts: O l haveandwillnuume, aCeru u, ofConsenuo self-insulafor WoakctsCompel- sation. as provided for by Section 3700 of lM labor Code, for the Performance of the were for which this permit is issued ❑ 1 have and will mention Worker's Compensation Insurance, n rryuired by Section 3700 of the labor Code, for me performance of me work for which this Permit is issued. ' My Wallace, Comperwtiun Insurance prier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEM PITON FROM WORKERS' COMPENSATION INSURANCE mans inion need nate M completed if me permit is forom hundrrddollars ($100) w Ina) I certify out in the Performance 0 for which mIs permit 0 issued. I LWI nuc cmployany petrol in any, man an I to the Wahers'Compensstian Laws of Califomla. Da¢ APPliCa n NOTICE TO APPL ICA : I 12af Wrnp on, yo shoo d become subject m the N mN wean proviso sof the labor Code. you moa forthwith comply with sue provisions or this Permit sh It M dccmed revoked. CONSTRUCTION LENWWQ AGENCY 1 hereby, dram mat uert u a comutruct't(in le6ding agency (a, the performance of 6997, me work for which this permit u issued (Sec.Civ. C.) Lender's Name , Umices Md. 1 Cart last 1 have and dtis application and cute the the above information u correct 1 agree to comPly with all city and county ordinances and mute laws relating to Wilding cowaucuan. and hereby aumorix representatives of mu city m enter upon lM alwve-mcmioned property for inspection purpesed (We) agree to save, indemnify and kecp harmless de City of Cupertino against liabiliues,judg.Cma.cosu an pmues which may in any wayacemeagaiast said City inconsequence of lac gran' C of APPLICANT UNDER DS D I COMPLY WITH ALL NON Issued by: Date -POINT Ti SOURCE REGULATIS Re -roofs % r Signature of Applion err Da HAZARDOUS MATER ISCLOSURE Type of Roof Will mevpplinnt are forum buildin p luoremhandlehmardausmaerie as dcRned by the Cupertino Municipal C c. Ch ere 9.12, and the Healthand Safety Code, SoCtion25532(a,, All roofs shall be inspected prior to. any roofing material being installed. ❑Yes 014. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future Wilding occupant use equipment or devices which ..it h.,ml.us air cmuminanu as deOnsal by the Bay Area Air Quality Mamgcme.I all new materials for inspection. Disukt? ❑Yea Nu Ihavemul ard eadmialsr �a7tmanu trader, Chaper6.95afIMCalifor- nuHcdm&Seco v au25505umJ3 aAJ 25534.1undcrsundmuifmc building don mmtcurcnt. h to nam, matf' y pp bi'ly le mufy lie pntaf use �m mLreniraeofD requiremcnu .slM t 6rIRm efo ap SignatureofApplicant Date K All roof coverings to be Class'W' or better Owner or utharirad agcn Dale' 'N CITY OF �UPERTINO • • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: '3g2 S'c ,� C-1- PERMIT # oel L613 3 OWNER NAME: 5 gh PHONE , g-L,�D--Y GENERAL CONTRACTOR. F # I am not using any subcontractors: 72 Sign a Date Please check applicable subcontractors and complete th;LZ information: Owner/ Contractor Signature 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 Owner/ Contractor Signature Date • 4 ITEMS OF 4 • • CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Elk: Lot: APN ......... 35707023.00 DATE ISSUED.......: 12/22/2008 RECEIPT #.........: BS000006874 REFERENCE ID # ...: 08120133 SITE ADDRESS .....: 10392 SCENIC CL SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: SylviaM COPY # : 1 OWNER ............: CHENG CHARLES K AND JOYCE K ADDRESS ..........: 10392 SCENIC CL CITY/STATE/ZIP ...: CUPERTINO, CA 95014 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT ---------123.07 --------------- 123.07 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING REFERENCE NUMBER -------------------- 364 VOICE ID DESCRIPTION -------- ---------------------------- 202 UNDERFLOOR PLUMBING 400 SEWER/LATERAL RECEIVED FROM ....: CHARLES CHENG CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBD - TO BE DETERMINED ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ........: FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BPWATER --------------------------------- UNIT 1.00 40.79 ---------- 0.00 ---------- 40.79 ---------- 0.00 1BSEISMICR VALUATION 6,250.00 0.70 0.00 0.70 0.00 IPPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- TOTAL PERMIT 123.07 ---------- 0.00 ---------- 123.07 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT ---------123.07 --------------- 123.07 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING REFERENCE NUMBER -------------------- 364 VOICE ID DESCRIPTION -------- ---------------------------- 202 UNDERFLOOR PLUMBING 400 SEWER/LATERAL • cm of CUPEI�TINO CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE PERMIT APPLICATION FORM APN # 6� � D Date: Building Address: Permit Type 0 3 p, ii' Q 'rid- 64 ,Sb Owner's Name: Via. -la ce P Phone #: 40 Contractor:Phone R�1 7�? el%r IBPREPIPE #: Q l iCc�» o 1 � Fax #: Contact: C �-1C�� Commercial Gas Piping System 1-4 Outlets Phone#:'1�0 ZS-,,_365—� Fax 4 - Contractor License#: !?L9�� P Cupertino Business License #: 1 C p Job Description: // `jpuSe (a�Cegt�{^�SSSitrw� adove� �/j 6�ti'S,p.Cb��er %c¢J ( Pe a�cQ � � t .i.< uecdvoWa e-e.to ' Residential Commercial ❑ Valuation: _t �% 1R -PSS Project Size:'Express LJ Standard Large LJ 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 Grou Permit Type 1PCSEWER Commercial building sewer/sanitary sewer P 1CPSS IBPREPIPE Commercial re -pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System 1-4 Outlets P 113SEISMICOM Seismic Commercial P 1BSEISMICR Seismic Residential P 1PRSEWER Residential building sewer/sanitary sewer P 1R -PSS awfTmOl" CITY OF CUPERTINO CITY OF CUPERTINO REPIPE/SEWER/MAIN 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 IRPWS IPPRSEWG 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 IPLMBINSP Other Plumbing/gas Insp. P / 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B Revised 6-16-08 0 • E