07060237 77
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
10838 BUBB RD. YE-LONG CHIOU 07060237
PERMIT ISSUE DATE
OWNER'S NAME:
YE-LONG CHIOU 10838 BLBB RD 06/27/2007
SANITARY NO. CONTROL NO.
IE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p LICENSED CONTRACTOR'S DECLARATION Job Description
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 70(10)of Division 3 of the Business and Professions Code,and my license is REPLACE AN EXIST I NG 75 GAL. WATER HEATER.
t y in full force and effect.
r vn z License Class Lic.N
p Date Contractor
F ARCHITECTS DECLARATION
i a< 1 understand my plans shall be used as public records
iyU
O h Licensed Professional
OWNER-BUILDER DECLARATION
'> 1 hereby alTirm that 1 am exempt from the Contractors License Law for the
3 in following reason.(Section 7031.5,Business and Professions Code:Any city or county
<m Pi which requires a permit to construct,alter,improve,demolish,or repair any structure
y prior to its issuance,also requires the applicant for such permit to file a signed statement t;q Ft.Floor Area Valuation
Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $750
2!- (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
3$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of A�t��Tt Number
not more than five hundred dollars($500). 3620205:2 .
U V
❑I,as owner of the property.or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(See.7044,Business Required Inspections
and Professions Cade:The Contractors License Law does not apply to an owner of
property who builds or improves 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.).
i,as owner of the property,am exclusively contracting with licensed rnntractors w
truct the project(Sec.7044.Business and Professions Code:)The Contractors 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 Contractors
License Law.
❑I am exempt under Six. B&P C for this reason
Owner `7iu�+�^� �N"�—Dateodd
WORKERS PENSATION RATION
I hereby affirm under penalty of perjury one of the following declarations:
LJ I have and will maintain a Certificate of Consent to self-insure forwerkees compcn-
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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION 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 Wo 3 pcnsation
Laws of Califo . Date
Applicant
NOTICE TO APPLICANT:If,aftc king this Ccrtifr of Exemption,you should
become subject to the Worker's Compensation provi' sof the Labor Code,you must
O forthwith comply with such provisions or this permit shall be deemed revoked.
Z C4 CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
az Lender's Address
U 0 1 certify that 1 have read this application and state that the above information is
H correct.1 agree to comply with all city and county ordinances and state laws relating to
r�U building construction,and hereby authorise representatives of this city to enter upon the
a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against /
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z on consequence of the granting of this permit. Date c_
►'+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOURCE REGULATIONS.
Re-roofs
Signature of Applicant/Coqjleamr Datt
Type of R oof
HAZARDOUS MATERI DISCLOSURE yP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Calc,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes %Na
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new n aterials for inspection. ,
District? �`[[
❑Yes o
1 have read the hazardous m.n.Is requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must be met prior to nonce ofa Certificate of Occupancy. Signature of Applicant Date
o > o All roof coverings to be Class"B" or better
Owner or authorized agcn are
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT' RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B13:: Lot:
APN . . . . . . . . . 36202052 . 00
DATE ISSUED. . . . . . . : 06,'27/2007
RECEIPT #. . . . . . . . . : BS000001810
REFERENCE ID # . . . : 07060237
SITE ADDRESS . . . . . : 10838 BUBB RD.
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER YE--LONG CHIOU
ADDRESS 10838 BUBB RD
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ME:_ LING WANG
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : YE--LONG CHIOU
ADDRESS . . . . . . . . . . : 10838 BUBB RD
CITY/STATE/ZIP . . . :
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
BENERGY PERMIT FEE 38.37 34 .86 0. 00 34 .86 0. 00
BPWHEATER PER HEATER 1. 00 10.79 0. 00 10.79 0. 00
PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00
- ----------- ---------- ---------- ----------
TOTAL PERMIT 84 . 02 0. 00 84 . 02 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 84 . 02 VISA
---------------
TOTAL RECEIPT 84 . 02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
07v( oz37
CITY OF CUPERTINO
a
WATER HEATER
CUPEkT NO PERMIT APPLICATION FORM
APN# 3 6 L — 02- DS 00
Date:
Building Address:
1 oS 3 2 &a,6 �oh-D , (-ufe-AI ratio, ,,-4 ��-
Owner's Name: Phone#:
�— vtiGT Cry/oaf
Contractor: License#:
Contact: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect Plumb Mech
Job Description: y�
Residential Commercial ❑
Cost of Project:
Strapped On Platform Jul Bonded Cl
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
I BPWHEATER 'Vater Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY I`nergy BUILDING
BUSLIC Business License BUILDING
OWNER-BUILDEIR VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. All the work autho ized by this permit
B. — A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
erformed
...............................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse side).
Property Owner's Signature: C' > . - Date: e�
r
Job Address: 1`42X34' 134i,4Z � yz`ti�T � �/� Permit#
Any changes to the information provided or this form shall be submitted to the City of Cupertino Build
Department.
Community Development
10300 Torre Avenue
la
s
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
''UPEKTINO
Building Department
JOB ADDRESS: PERMIT #
tel, ?06
OWNER'S NAME: 46 T_ L z Nc,l PHONE # - s -
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: /,/2
2?ti 7
Signature Date
Please check applicable subcontractors and complete the following information:
21 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
7-
OwnerfContracVrr Signature Date