09110060 CITY OF CUPERTINO BUILDING PERMIT
:MASTERSERV INC PERMIT NO:09110060
BUILDING ADD�2ESS: 7449 ROLLINGDELL DR CONTRACTOR
OWNER'S NAME: TANG STEPHEN N
560 LIBRARY ST DATE ISSUED: 11/10/2009
'ER'S PHONE: 4084016922
SAN FERNANDO,CA 91340 PHONE NO:(800)806-7674
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# MECH f- RESIDENTIAL COMMERCIAL
Contractor Date
JOB DESCRIPTION:WATER MAIN REPLACEMENT,(7)COPPER
I hereby affirm t licensed under the provisions of Chapter 9 REPIPE TO
(commencing with Section 7000)of Division 3 of the Business&Professions EXISTING FIXTURES& I DRAIN LINE
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. Valuation:$4000
I have and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floor Area:
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:35932007.00 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 PENT EXPIRES 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 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expensLsourceegulations
rue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this py,the applicant understands and will comply
with all non-poinper the Cupertino Municipal Code,Section Date:
9.18. Issued by:
Signature Date f( U
RE-ROOFS:
[� OWNER-BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,as owner of the property,or my employees with wages as their sole compensation, Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant:
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).
1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
ent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 oft e
I have and will maintain a Certificate of Cons
Compensation,as provided for by Section 3700 of the Labor Code,for the complianCaliforniace Health Code, fain
with the Cupertino Code,Chapter 9 1 h 2 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 'th the Cupertino Municipal Code,Chapter 9.12 and the
p Health&Safety Co ,
I certify that in the performance of the work for which this perm is issued,I shall Sections 25505,25537T/
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 77t:
Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. TRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
1 certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
i nify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
L. 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 regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35932007 .00
DATE ISSUED. . . . . . . : 11/10/2009
RECEIPT #. . . . . . . . . BS000009168
REFERENCE ID # 09110060
SITE ADDRESS 7449 ROLLINGDELL DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER TANG STEPHEN N
ADDRESS . 7449 ROLLINGDELL DR
CITY/STATE/ZIP CUPERTINO CA, CA 95014-5812
RECEIVED FROM IE INC.
CONTRACTOR GEORGE ANDERSON LIC # 30854
COMPANY MASTERSERV INC
ADDRESS . 560 LIBRARY ST
CITY/STATE/ZIP SAN FERNANDO, CA 91340
TELEPHONE (800) 806-7674
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS__ REC- --NEW-BAL-
------
----------
1. 00 0 . 00
1BCBSC VALUATION 4, 000 . 00 1 . 00 0 .00
1BPFIXTURE NO OF FIXTURE 7 .00 56 . 00 0.00 0 . 00 56 . 00 0 . 00
0 . 00
1BPWSVCS WATER SERVICE 1.00 21 . 00 0 .00 20 . 50 0 . 00
1BSEISMICR VALUATION 4, 000 . 00 0 .50
1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
1PRREPIPE NO OF FIXTURE 7 . 00 77 . 00 0 . 00 77 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 ------0_00
TOTAL PERMIT
239 .50 0 . 00 239.50 0 . 00
METHOD OF PAYMENT AMOUNT --REFERENCE NUMBER
--------------- -
CHECK 239 .50 #1081
---------------
TOTAL RECEIPT 239 .50
VOICE ID DESCRIPTION VOICE- --------
ID DESCRIPTION
-
---------- ___ 507 FINAL PLUMBING
---- -- -----------
-
301 ROUGH PLUMBING
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's Name: Phone#:
�J "-0--6-0 • (-I C5
Contractor: Phone#: 7k3 "04 D
Fax #:
Contact: Phone#: ? 3 1;� Y 7
Fax #:
Contractor License#:
Cupertino Business License#:
Job Description: (�1c�E-� t w2�: ��('�0�.
Residential Commercial ❑
Valuation: -
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& 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
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
TYPES
Fee
1BSEISMICOM Seismic Commercial P
Revised 01/07/09
CITY OF CUPERTINO
x.
`µ F REPIPE/SEWER/MAIN SERVICE
CUPEf�T
'TMTINO FEE SCHEDULE
Fee Permit Type
Fee Description Quantity Fee ID p Grou
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Residential P
1 PRSEWER Residential building P 1RPSS
sewer/sanitary sewer P 1RPRP
1 PRREPIPE Residential re-pipe per fixture
P 1CPWS or
1BPWSVCS Water Service 1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
IBPFIXTURE Plumbing Fixture P
1 PGASRES Residential Gas Piping System P
1-4 Outlets
1 BPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
/
1 PLMBLNCK Plumbing Plan Check p
1PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel & Documentation Fee B
B
IBUSLIC Business License
Community Development
10300 Torre Avenue
;a Cupertino CA 95014
t .
Telephone(408)777-3228
Fax(408)777-3333
CITY OF
.;UPEkTINO
Buildin De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: c �- ✓ FAX #
I am not using any subcontractors:
ign a ate
Please check a licable subcontractors and complete the follow in information:
—0--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 Date
am 4310N a
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10218 SANTA CLARA AVE CONTRACTOR:TBD-TO BE DETERMINED PERMIT O:08060146
DATE ISSUED:01/30/2009
OWNER'S NAME: HONG-TSZ PAN
PHONE NO:
O VS PHONE: 4086881706
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# MECH f— RESIDENTIAL f— COMMERCIAL
Contractor Date
JOB DESCRIPTION:ADD 213SQ FOR ADD'L BDRM&HLLWY&ENTRY,NO
I hereby affirm that I am licensed under the provisions of Chapter 9 STRUCTRL
(commencing with Section 7000)of Division 3 of the Business&Professions 11/20/09 REVSN IINTERIOR WALL&PARTITION(CONVERT
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 Valuation:$40000
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area:
permit is issued.
APPLICANT CERTIFICATION APN Number:32622007.00 Occupancy Type:
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
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section _.—�
9.18. L_. �— - 1' � Date:�l
Issued wy
Signature Date
OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
'
I have and will maintain a Certificate of Consent to self-insure for Workers
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I Ororized agent: (�� 2-00
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:wner or an
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
it ify and keep harmless the City of Cupertino against liabilities,judgments,
C( nd expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-poit t source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
7'
Signature
Date Licensed Professional