07030073 CITY OF CUPERTINO
&tJILDLNGt)IVISION TIU
PERMIT NO.
BUILDING ADDRESS:
10337 COLD HARBOR AV SAN JOSE PLUMBING 07030073
PERMIT ISSUE DATE
OWNER'S NAME:
LU, PING & GENG 1732 HI_,LSDALE AVE 03/12/2007
SANITARY NO. CONTROL NO.
40NE:
(408) 296-1820
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
VI hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Busin Professions Cade,and my license is
COPPER _ZE P I PE FROM FOUNDATION VALVE
t=w in full forec and t?
? License Cla s Lic•
w Date
ARCHFE, DE
7 K< 1 under nd my plans shall Itc used asI 0lic records
)yU
u F Licensed Professional
y OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
po following reason.(Section 703 1.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
_< that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 Sq.Ft. Floor Area
z t- (commencing with Section 7000)of Division 3 of time Business and Professions Code)or $8425
that he is exempt therefrom and the basis for the alleged exemption.Any violation of �pN
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36910007 :CTU Number Occupancy Type
not more than rive hundred dollars($500).
0 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(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's 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.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's 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 Contractor's
License Law.
0 I am exempt under Sec. B&P C for this reason
Owner Date _
WORKER'S COMPENSATION DECLARATION
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.
0 I 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 Wo ker Compe atian lnsu�=carrier and Policy m raj
71,
Cam E I C F EXE ON FROM WORKERS'
O
COMPENSATION INSURANCE SANITARY
(This section need not he 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,1 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.
Z, CONSTRUCTION LENDING AGENCY
(~-m rA 1 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
am
rLender's Address
U 0 I certify that I have read this application and state that the above information is
w— correct.I agree to comply with all city and county ordinances and state laws relating to
rJ U building construction,and hereby authorize 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 or Cupertino against
t.q liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date ✓�
APPLICANT UNDERSTANDS AND WILL COMPLW74Z
N-POINT Issued by:
SO E CATIONS.
Re-roofsazure of Applicant/Contractor - areHAZARDOUS MATERIALS DISCLType of Roof
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
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0 Ycs No
Will the applicant or future building occupant use equipment or devices which
If a roof s installed without first obtaining an inspection,I agree to remove
.mnit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building
docs not currently have a icnan at it is my responsibility to notify Occup t of the
ri tmiSSr certificatcor crpan . Signature.of Applicant Date
All roof coverings to be Class "B"or better
caner or authorized a nt D
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
`:UPEi�TINO
Buildirn De q0 ,70
ment
JOB ADDRESS: P #
c 300 `?
OWNER'S NAME: PHONE # Q
GENERAL CONTRACTOR: r FAX#
I am not using any subcontrac rs:
Signature Date
Please check applicable subcontractors and complete the followin 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 0'j-D5ciD13
REPIPE/S NV'E -S/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address: Al/
Owner's Name: o / Phone#:
Contractor: P//7jj6 \e^:^ 1}� License#:
Contact: Phone: Cupertino Business License#:
LEI,
Building Pe it Info:
Bldg ❑ Elect ❑ Plumb
Job Description'
�7
LC _ Zz z2 C
Residential JJ Comkieral ❑
Cost of Project
Qty. if
Applicable Fee ID ~ _ - Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Pipin System Fee PLUMBING
PPERMITFEE F lumbing Permit Issuance PLUMBING
BPREPIPE F:epipe of Fixtures PLUMBING
BPFIXTURE F blg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER ewers PLUMBING
BPSEWAGE 'Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec: Twp: Rng: Sub: Blh: Lot :
APN 3610007 . 00
DATE ISSUED. . . . . . . : 03/ 12/2007
RECEIPT # . . . . . . . . . : BSC00000662
REFERENCE ID # . . . : 07030073
SITE ADDRESS . . . . . : 10137 COLD HARBOR AV
SUBDIVISION . . . . . . .
CITY CUPERTINO
INO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LU, YING & GENG
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3329
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : GARZA, KEVIN LIC # 21761
COMPANY . . . . . . . . . . : SAN JOSE PLUMBING
ADDRESS . . . . . . . . . . : 17:32 HILLSDALE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 296-1820
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
BPREPIPE NO OF FIXTURE 2 . 00 18 . 00 0 . 00 18 . 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 163 .37 0 . 00 163 . 37 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 163 .37 VISA
---------------
TOTAL RECEIPT 163 .37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING