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09090145I CITY OF CUPERTINO BUILDING PERMIT I I BUILDING ADDRESS: 1471 ASTER LN I CONTRACTOR: TBD - TO BE DETERMINED I PERMIT NO: 09090145 I OWNER'S NAME: YEE MICHAEL G AND SUZIE C DATE ISSUED: 09/21/2009 BR'S PHONE: 4082528385 I , I PHONE NO: I fl LICENSED CONTRACTOR'S DECLARATION License Class % Lic. # � S�, Contractor. `jJ +SOS P+� �"1• hate ? I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions 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. 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. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is correct. 1 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 upon the 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regula ' er the Cupertino Municipal Code, Section 9.18. Signature Date CJ OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 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. 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. 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 Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 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 to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save i nify and keep harmless the City of Cupertino against liabilities, judgments, G and expenses which may accnie against said City in consequence of the granting of this pennit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature_ Date BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB I— MECH f— RESIDENTIAL I— COMMERCIAL f— JOB DESCRIPTION:REPIPE IN COPPER FROM METER TO ALL FIXTURES; DEMPSTER PLUMBING PD FOR BUS LIC 9/21/9 Sq. Ft Floor Area: I Valuation: $5800 APN Number: 36624004.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued 4 Date: Z{ RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Ow re • au r' da nt: Date: << 11 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPEkTINO CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE PERMIT APPLICATION FORM APN # L?� �0 6 4 D c) `-� ( _ �� Fee ID Date: -f4,2 Building Address: Permit Type Owner's Name: Z 1PCSEWER Phone #: _ ,1 11CPSS Contractor: Commercial re -pipe per fixture Phone #: zmr o l�- 1CPRP Fax #: Contact: �'11 L �• �� i t �� P Phone #: -S--i 7 1BCBSC Fax #: Contractor License #: I SC�s i ALL PERMIT TYPES Cupertino Business License #: 1BSEISMICOM Job Description:, P Residential Commercial ❑ Valuation: Project Size: Express Standard Large Major Revised 01/07/09 Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Group Permit Type 1PCSEWER Commercial building sewer/sanitary sewer P 11CPSS 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System 1-4 Outlets P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY Of CUPERTINO CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type (� 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential P 1 PRSEWER Residential building sewer/sanitary sewer P 1RPSS 1PRREPIPE Residential re -pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System 1-4 Outlets P 1BPGAS Gas Piping System 5+ Outlets P / 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B 6 ITEMS OF 6 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36624004.00 DATE ISSUED.......: 09/21/2009 RECEIPT #.........: BS000008725 REFERENCE ID # ...: 09090145 SITE ADDRESS .....: 1471 ASTER LN SUBDIVISION ...... CITY CUPERTINO, IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER YEE MICHAEL G AND SUZIE C ADDRESS 1471 ASTER LN CITY/STATE/ZIP CUPERTINO CA, 95014-5217 RECEIVED FROM WILLIAM D DEMPSTER CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: TELEPHONE ........ FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC -------------------- NEW BAL ---------- 1BCBSC ------------- VALUATION ---------- 5,800.00 ---------- 2.00 ---------- 0.00 2.00 0.00 1BPWATER UNIT 1.00 84.00 0.00 84.00 0.00 1BSEISMICR VALUATION 5,800.00 1.20 0.00 1.20 0.00 1PPERMITFE FLAT RATE 1.00 84.00 0.00 84.00 0.00 1PRREPIPE NO OF FIXTURE 2.00 44.00 0.00 44.00 0.00 1TRAVDOC FLAT RATE 1.00 84.00 0.00 84.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 299.20 ---------- 0.00 299.20 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 299.20 --------------- 299.20 REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF XPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS- z -%-t SUBCONTRACTOR PERMIT # oq 09 OWNER'S NAME: I Cabinets & Millwork PHONE # GENERAL CONTRACTOR: Cement Finishing FAX # I am not using an subcontractors: /2 l /0 7 Y Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature �,?//e, ? Date 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 �,?//e, ? Date