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10020024 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10212 COLBY AVE CONTRACTOR:DRAIN DOCTOR PERMIT NO: 10020024 OWNER'S NAME: SIYING YANG 1775 WINCHESTER BLVD DATE ISSUED:02/03/2010 VNER'S PHONE: 4084802777 CAMPBELL,CA 95008 PHONE NO:(408)370-3082 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class C— Lic.# �O Ll3L�t�iS CITY CLEAN OUT Contractor. MC-CAL& bCc,+0,( Date Z^3' Ly I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Q' Code and that my license is in full force and effect. I 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: valuation:$3600 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 APN Number:31628036.00 Occupancy Type: permit is issued. „ APPLICANT CERTIFICATION y I certify that I have read this application and state that the above information is PERMIT EXPIRE IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS 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 FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply � with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. /� RE-ROOFS: Signatur Date 7��c�'�a 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 inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: permit is issued. 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 CONSTRUCTION LENDING AGENCY 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 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 relatin€ to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION "mnify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. g.anting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF C'UPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 316:8036 . 00 DATE ISSUED. . . . . . . : 02/03/2010 RECEIPT #. . . . . . . . . BSOO0009683 REFERENCE ID # . . . : 100:'.0024 SITE ADDRESS 102:12 COLBY AVE SUBDIVISION . . . . . . . CITY CUP:-,RTINO IMPACT AREA . . . . . . OWNER SIYING YANG ADDRESS 10212 COLBY AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2420 RECEIVED FROM . . . . : DRAIN DOCTOR CONTRACTOR JOHV H. LIM LIC # 24784 COMPANY DRAIN DOCTOR ADDRESS 1775 WINCHESTER BLVD CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 370-3082 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ____ ---------- ------- ------------- ---------- 1BCBSC VALUATION 3, 600 . 00 1. 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 3, 600 .00 0 . 50 0 .00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 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 220 . 50 0 .00 220 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------ CHECK 220 . 50 2250 --------------- TOTAL RECEIPT 220 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO ' REPIPE/SEWERJMAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM I APN # Date: 1 LP ��-� z--3- 10 Building Address: Z% o1 Owner's Name: Phone#: 5i iv1 Contractor: Phone#:53 co k \t 5-1 � Fax#: Contact:mam Phone#:%LOS - i�S 7 -$S j Q a%x Fax#: Contractor License#: (041 WG7Z Cupertino Business License#: Job Description: c �k-,J G leck&^ G v Residential Commercial ❑ Valuation: 43,66CJ Project Size: Express Standard ❑ Large ] Major Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & 1he sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER an building P 1CPSS sewer/sanitary s-1wer 1BPREPI E- Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Ga3 Piping System P 1-4 Outlets 1BCBSC Cal Bldg Stand�xds Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commi;rcial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWERIMAIN SERVICE CUPE�TiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential building; P 1RPSS . sewer/sanitary sew4,r 1PRREPIPE Residential re-pipe per fixture P 1RPRP IBPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Di,,posal System P 1 PCESS Cesspool P IBPWATER Install/alter Water:'ipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Ch,:ck P 1 PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documeitation Fee B 1 BUSLIC Business License B ,Li Community Development ` y 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ;UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # t z�z I p(3 2-U,)Z,4 OWNER'S NAME: 5 11,1' PHONE # ctg0 U Z 7 7-?- GENERAL CONTRACTOR: VXZo X h oc,f, r I am not using any subcontractors: Signature Date Please check applicable-subcontractors and compTete the follow' 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 LI Roofing Septic Tank Sheet Metal Sheet Rock Tile _ 1 -3-IU er/Contractor Signature Date DISTRICT MANAGER-ENGINEER �'z's►®gAMi TI``�p�O'+�'J► F30ARD OF DIRECTORS 1`� WILLIAM A.BOSWORTH MARK THOMAS&COMPANY.INC. 46 r JOHN M.GATTO RICHARD K.TANAKA (41 CURTIS 13.HARRISON MRS 01 DISTRICT COUPISEL s 6RVICl. f WENDELL MI-KERR.JR. ATKImSON•F'ARASYN.LLP. �Pf401011a6®%*Se CHRISTOPHER C.LRE HAROLD S.TOPPEL 209sa grEVENS CREEK BOULEVARD,SUITE 104 CUPERTINO,CAUFORNIA95014.215A 1408)21937071 PHONE: 9 (408)253151'73 FAX www.cup ertlnosanitarydistrict.COM File: CUSD—MOP Building Dept.—Cupertino City of Cupertino Attn.: Building Department 1.0300 Tone Ave. Cupertino,C,A.95014-3202 Subject: Sewer Line Repair Name: Siying Yang Residence Address: 10212 Colby Ave APN: 316-28-036 Permit No. 10020024 ■ Videotape and Plroperty Lane Clean,)ut inspected. .No additional conditions/requirements by the District. Inspector: George Santos/Tony Soflres.. . ..................................... Date:...02-4-2010................... sanitary Sewer Location: cc: property Owner S' Dee �:4' R P/L 29' Long P SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITYSOO U EF UN N,0PORTIONS TII NS O AREA-9 CITIES OF SARATOGA,SUNNYVALE,Los ALTOs AND