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09080228 CITY OF CUPERTINO 13UILDING PERMIT CONTRACTOR:ROOTERS ON DEMAND PERMIT NO:09080228 FBIWILDING ADDRESS: 18731 HANNA DR DATE ISSUED:08/20/2009 329 0 LAKE MEAD DR S NAME: 1lSilJ YIN LIOU PHONE NO:(510)475-8271FRLMONT,CA 94555S PHONE: 6504946024 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB (yic,#�fL�L�-d ---- MECH I- RESIDENTIAL r COMMERCIAL License Class' �, A Contractor�E�s'�z"'� -Date- JOBDESCRIPTION:REPLACE SEWER LINE BEHIND CITY CLEAN- 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 O[T (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 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 at performance of the work for which this permit is issued. Sq.Ft Floor Area: I have and will maintain Worker's Compensation Insurance,as provided for by eeupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this 711N Number:37529011.00 permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT J. WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN �8 AYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses whict n ay accrue against said City in consequence of the Date: granting of this pern}if. Ad itionally,the applicant tands and will comply I sued b with all non-pointsource r gulations per the ertino Municipal Code,Section 9.18. U� Date Signature RE-ROOFS: Ul roofs shall be inspected prior to any roofing material being installed.If a roof is [1 OWNER DER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I ant pt from the Contractor's License Law for one of nspection. the following two reasons _ ------- Date. 1,as owner of the property,or my employees with wages as their sole compensation, signature of App scant:__ will do the work,and the structure is not intended or offered for sale(See.7044, ALL ROOF COVERINGS TO BF.('LASS"A"OR BETTER 1,as owner of the property,am Business&Professions Code) exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: for 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. 1 will mamtaut compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Compensation,as provided for by Section 3700 of the Labor Code, Safety Code,Section 25532(a)should I store or handle hazardous material. hich this permit is issued. Additionally,should I use equipment or devices which emit hazardous air performance of the work for w 1 have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code,for the performance of the work for which this maintain com cc with the Cupertino Municipal Code,Chapter 9.12 and the Health&�tifety 'ocjSections 25505,25533,and 25534. permit is issued. I certify that in the performance of the work for which this permit is issued,I shall ent: not employ any person in any manner so as to become subject to the Worker's Owner./ora g _Date: f Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I/ ONS"I RUCTION LENDING AGENCY" forthwith comply with such provisions or this permit shall be deemed revoked. I h reby affirm that ere is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this per it is issued(Sec.3097,Civ C.) Lender's Name ----- 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 Lender's Address-- to building construction,and hereby authorize representatives of this city to to enter upon the above mentioned property for inspection purposes.(We)agreeARCHITECT'S DELI.ARATION it :ify and keep harmless the City of Cupertino against liabilities,judgments, nd expenses which may accrue against said City in consequence of the I ins shall be used as public records f this permit.Ad . mg oditionally,the applicant understands and will comply granting I understand my p non-point source regulations per the Cupertino Municipal Code,Section with aliLicensed Professional --- 9.18. Date_ Signature_______ - - CITY OF CUPERTINO D Z4 REPIPE/SEWERMAIN SERVICE UPEY TING PERMIT APPLICATION FORM C iZ Date: APN #�,7 ,5xct o I , C-) Q Building Address: CL „� C qq one QLD! - Owner's Name: S ho Contractor: Fax Phone#: Contact: " V0 t' y ���' Fax#: Contractor License#: V�U Cupertino Business License#: Job Description: ,y �j , n� C�Gt r-►.,v�'� Commercial El Valuation: LJ Project Size: Expres andard Large ] Major Building: Please complete relevant portion of the Green Building Checklist & attach it to the Green application or if applicable, include in plan set & the sheet index. Green Buildin Points: Fee Permit Type Quantity Fee ID Fee Description Gro P 1CPSS 1PCSEWER Commercial building sewer/sanitary sewer P 1CPRP 1BPREPIPE Commercial rc;-pipe per fixture 1 PGASCOM Commercial CFas Piping System P 1-4 OutletsALL PERMIT B 1BCBSC Cal Bldg Standards Commission TYPES Fee P 1BSEISMICOM Seismic Com-nercial Revised 01/07/09 CITY OF CUPERTINO #` REPIPE/SEWERNUIN SERVICE CUPEI�TINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT r Fee TYPES 1BSEISMICR Seismic ResidentieI P j 1 PRSEWER Residential buildir g P 1RPSS sewer/sanitary sew er 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 P-ping System P 1-4 Outlets 1BPGAS Gas Piping Systeri 5+ Outlets P 1PPERMITFEE Plumbing Permit --ee Issuance P 1 1PLMBLNCK Plumbing Plan Clieck P 1 PLMBINSP Other Plumbing/g as Insp. P 1TRAVD6C Travel & Documontation Fee B 1BUSLIC Business License B Community Development _ 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ."UPEkTINO Buildin De artment JOB ADDRESS: �-� W/✓11 A- V't- 4 cPERIVIITj�o © 2-�. 601- CO PHONE # OWNER'S NAME: FAX # GENERAL CONTRACTOR: po '°' I am not using any subcontractors: Date Sid, Please check applicable subcontractors and com ple the followin information: LICENSE # SUBCONTRACTOR BUSII ( NAME 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 Date owner/Contractor Signature