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09090033 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7930 FALL CT CONTRACTOR:JA PLUMBING PERMIT NO:09090033 OWNER'S NAME: ('ORINNA&TERRY FU 28306 INDUSTRIAL BLVD STE B DATE ISSUED:09/08/2009 PER'S PHONE: 4083661584 HAYWARD, CA 94545 PHONE NO:(510)266-5125 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUIetB License Class Lic.# S 9 /11 `, , MECH RESIDENTIA�COMMERCIAL Contractor I �1�r'� _Date ��1-, 1 hereby affirm that I am licensed under he provisions of Chapter 9 106 DESCRIPTION: COPPER RE-PIPE REPLACE WATER PIPE (commencing with Section 7000)of Division 3 of the Business&Professions FORM METER Code and that my license is in full force and effect. THROUGH OUT HOUSE INSTALL NEW WATER HEATER 1 hereby affirm under penalty of perjury one of the following two declarations: Eft T I have and will maintain a certificate of consent to self-insure for Worker's C' A I A D V 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: 11lu i 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:36213007.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is PERMIT EXPIRES 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 theR�8"�� granting of this permit. Additionally,the applicant understands and will comply Issued by: �• Date: _+ C f with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: offing Signature___ Date All roots shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection,1 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. 1 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 maintai-i 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 hav?and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section7205,25533,and�254. Section 3700 of the Labor Code,for the performance of the work for which this AG )1-179 permit is issued. Owner or authorized agent: Date: 1 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 CONSTRUCTION LENDING AGENCY 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 _ 1 cernty 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 ARCHITECT'S DECLARATION ainif} 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. granting 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 CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36213007 . 00 DATE ISSUED. . . . . . . : 09/08/2009 RECEIPT #. . . . . . . . . : BS000008620 REFERENCE ID # . . . : 09090033 SITE ADDRESS . . . . . : 7930 FALL CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CORINNA & TERRY FU ADDRESS 7930 FALL CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JA PLUMBING CONTRACTOR . . . . . . . : NIGEL EDWARDS LIC # 30554 COMPANY JA PLUMBING ADDRESS 28306 INDUSTRIAL BLVD STE B CITY/STATE/ZIP . . . : HAYWARD, CA 94545 TELEPHONE (510) 266-5125 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 300 . 00 1 . 00 0 . 00 1. 00 0 . 00 1BPWATER UNIT 1. 00 42 . 00 0. 00 42 . 00 0 . 00 1BPWSVCS WATER SERVICE 1 . 00 21 . 00 0 . 00 21. 00 0 . 00 1BSEISMICR VALUATION 5, 300. 00 0 . 60 0. 00 0 .60 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 1 . 00 11 . 00 0 . 00 11. 00 0 . 00 1PRWHEATR UNITS 1 . 00 25. 00 0. 00 25 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 142 . 60 0 . 00 142 . 60 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 142 . 60 4896 --------------- TOTAL RECEIPT 142 . 60 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/SEWER/MAIN SERVICE CUPEt�TINO PERMIT APPLICATION FORM APN # 3 � U� ..(-Z.J Date: Building Address: Owner's Name- Phone#: _ Contractor: Phone#: _ Fax#: ( �� (17J—/ Contact: Phone#: Fax#: Contractor License#: 2' Cupertino Business License#: Job Description: , �' E �( � -0- Residential Commercial ❑ Valuation • j � I\ Project Size: Express tandard F-1LargeMajor❑ 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 Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES I 1BSEISMICR Seismic Residential P 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP I 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B P92 ��