11050125 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20699 RODRIGUES AVE CONTRACTOR:ABLE SEPTIC PERMIT NO: 11050125
OWNER'S NAME: AC&D LIU INVESTMENTS LLC P O BOX 24819 DATE ISSUED:05/16/2011
_"yER'S PHONE: 6504920857 SAN JOSE,CA 95154 PHONE NO:(408)377-9990
L LICENSED CONTRACTOR'S DECLARATION//�� r
� -1 BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class �� Lic.# (011 4 L9
^' - MECH RESIDENTIAL COMMERCIAL
Contractor � � Date `9. 11
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL PROPERTY LINE CLEANOUT
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
Ihereby affirm under penalty of perjury one of the following two declarations:
Nk
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area Va n. 0
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:35910057.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating PERMIT IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 18 YS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Addition th pplicant understands and will comply
with all non-point source regulaf pe t e Cupertino Municipal Code,Section Issued by � � Date•
9.18.
TItSignature Date 15-'W' 'f
RE-ROOFS:
OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance wit the Cupertino Municipal Code,Chapter 9.12 and the
Hea ty de tions 25505,25533,and 25534.
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 Worker's Owne zednt6CTION LENDING AGENCYCompensation laws of California. If,after making this certificate of exemption,I Date:become subject to the Worker's Compensation provisions of the Labor Code,I mustforthwith comply with such provisions or this permit shall be deemed revoked. CONS
I hereby affirm that there is a construction lending agency for the performance of Hork's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
ag of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
., all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY $# 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35910057. 00
DATE ISSUED. . . . . . . : 05/16/2011
RECEIPT #. . . . . . . . . BS000013457
REFERENCE ID # . . . : 11050125
SITE ADDRESS . . . . . : 20699 RODRIGUES AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : AC & D LIU INVESTMENTS LLC
ADDRESS . . . . . . . . . . : 20699 RODRIGUES AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ALEXANDER C LIU
CONTRACTOR . . . . . . . : GILBERT, GLEN LIC # 21407
COMPANY . . . . . . . . . . : ABLE SEPTIC
ADDRESS P O BOX 24819
CITY/STATE/ZIP . . . : SAN JOSE, CA 95154
TELEPHONE . . . . . . . . : (408) 377-9990
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
-ADMIN HOURS 0 .50 39. 00 0. 00 39.00 0 . 00
1BCBSC VALUATION 960 . 00 1 . 00 0. 00 1. 00 0. 00
1BSEISMICR VALUATION 960 . 00 0 .50 0 . 00 0.50 0. 00
1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 .00 0. 00
1PRSEWER UNITS 1.00 21. 00 0 . 00 21 .00 0. 00
1TRAVDOC FLAT RATE 1 .00 42 . 00 0. 00 42 .00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 145 .50 0 . 00 145.50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 145. 50 MC
---------------
TOTAL RECEIPT 145.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA L95014-3255
(408)777-3228 • FAX(408)777-3333 •buiiding(-@cuQertino.org misc
CUPERTINO
PLUMBING MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS n `1) `vt ,A,t APN
10
/ -r
OWNIItNAME�C g. / ;(.� �hvPs�lftflw 5 C.LL PHONE /S'?)-qp2-OW E-MAIL P.(e)[_1 iG[@ (10U.C-00-%STREET ADDRESS 2�7/p�(� CITY STATE,ZIP h u- G 4b, FAX
CONTACT NAME PHONE E-MAII. A�kx w)f,(&@ f
/�-x L►(,C �s`v-�z-108'S� . oro.G on.
STREET ADDRESS n v CITY,STATE, ZIP t u/ ^ L �j t FAX
OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT_
CONTRACTOR NAME/ 1� S LICENSE ILEI LI _It� BUS.LIC I(F�
COMPANY NAME - � EMAIL 2_i_ �L - FAX --O A_L ooB
STREET ADDRESS V POW— �SZO� '^' C1TY9-y- C A 4 S l I c> Tl t- at 1 lt b
ARCHII'ECTIENGINEER NAME 1[Jr LICENSE NUMBER BUS.LIC k
COMPANY NANM / E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
1E OF or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
,-�UCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No
DESCRnMON OF WORK 1-a/ ,A n �`
TOTAL VALUATION:
If
By my signature below,I certify to each of the f0" in I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I ha ovided is Corr I v re the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating o uil ftco tru I au reselrtatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant(Ager Date:
SUPPLEMENTAL ORMATI N REQUMD
MEPMuc:App_Z011.doc revised 03/16/11
0o'A CITY OF CUPERTINO
2 FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: rodriguez ave. DATE: 05/16/2011 REVIEWED BY: bob s.
APN: BP#: VALUATION: $960
'°PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPSS
USE: p PERMIT TYPE:
WORK install property line clean out.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Sewer, Sanitary 1 PRSEWER 1 # $21
TOTALS: $21.00
T7Plumb.Plan Check 0.0 hrs $0.00
Plumb.Permit Fee: 1PPERMIT
Other Plumb Insp. E
hrs
$42.00 - F—] L
NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the Dept-for addn7 info,
FEE ITEMS ( ire Resolution 09-05I 11L-7`1/10 FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $21.00
PME Permit Fee: $42.00
Work Without Permit? 0 Yes (D No $0.00
Travel Documentation Fee: ITRA VDOC $42.00 —7-1
Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee
Bldg Stds Commission Fee: 1BCBSC $1.00 $39.00 IADMIN
SUBTOTALS: $106.50 $39.00 TOTAL FEE: $145.50
Revised: 04/29/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 2Zt?" K Z A4eQ - PERMIT#
OWNER'S NAME: Mf L v PHONE# (40t .
3
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: t0:,1p FQ- 95110 CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY NSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONT R HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
nature Date
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
Painting/Wallpaper
Paving
astering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date