09110026 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10524 S TANTAU CONTRACTOR:XIONG LIU PERMIT NO:09110026
OWNER'S NAME: XIONG LIU 10524 S TANTAU DATE ISSUED: 11/05/2009
VER'S PHONE: 3108697188 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG[_ ELECT f— PLUMB
License Class Lic.# MECH f— RESIDENTIAL F_ COMMERCIAL
Contractor Date
JOB DESCRIPTION:REPLACE PLUMBING FOR TOILET,ADD VENT
I hereby affirm that 1 am licensed under the provisions of Chapter 9 FOR
(commencing with Section 7000)of Division 3 of the Business&Professions TOILET,SHOWER,VANITY;REPLACE PLUMBING FOR SHOWER
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 Sq.Ft Floor Area: Valuation:$2000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:37537020.00 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
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
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 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point sou regulations per the Cupertino Municipal Code,Section Y //�_ S
9.18. ` C Issued� Date:
Signature
Date
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that 1 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,
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date:
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).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's 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 California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
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 with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or a ized a ent: Date v / `' o/
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this pen-nit shall be deemed revoked.
CONSTRUCTION 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
nify and keep harmless the City of Cupertino against liabilities,judgments,
u, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point sour re ulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18. r .
Signature
Dat (�o Licensed Professional
CITY OF CUPERTINO
8 ITEMS OF 14 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 37537020 .00
DATE ISSUED. . . . . . . : 11/05/2009
RECEIPT #. . . . . . . . . BS000009131
REFERENCE ID # 09110026
SITE ADDRESS 10524 S TANTAU
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA
OWNER XIONG LIU
ADDRESS . 10524 S TANTAU
CITY/STATE/ZIP CUPERTINO, CA 95014
RECEIVED FROM XIONG LIU
CONTRACTOR LIC # *OWNER*
COMPANY XIONG LIU
ADDRESS . 10524 S TANTAU
CITY/STATE/ZIP CUPERTINO, CA 95014
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---------- ----------
1BCBSC VALUATION 2, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00
1BPFIXTURE NO OF FIXTURE 3 . 00 48 . 00 0 . 00 48 . 00 0 . 00
1BPWATER UNIT 1. 00 84 . 00 0 . 00 84 . 00 0 . 00
1BSEISMICR VALUA�rION 2, 000 . 00 1. 00 0 .00 1. 00 0 .00
1PPERMITFE FLAT RATE 1. 00 84 .00 0 . 00 84 . 00 0 . 00
1PRREPIPE NO OF FIXTURE 3 . 00 66 .00 0 . 00 66 . 00 0 . 00
1PRSEWER UNITS 1. 00 42 . 00 0 . 00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 84 . 00 0 . 00 -----84_00 ------0_00
---------- ----------
TOTAL PERMIT 411 . 00 0 . 00 411. 00 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
_ --
----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
OqI � 0C) 2-b
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
OF
CUPEi�TINO PERMIT APPLICATION FORM
Date:
Building Address: T A^ TA .
Phone#:
Owner's Name:
• - � �,�( � � o1fs -7 (&&
Phone#:
Contractor: 7S �S
Fax#:
Phone#:
Contact: ?WSJ
Fax#:
Contractor License#:
Cupertino Business License#: i
Job Description: A o(d Ue, J�-r --f-a t e-f, Sk-L't",
ctc
i
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
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
ZIITYO
REPIPE/SEWER/MAIN SERVICE
CUP ( TINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
i 1BCBSC Cal Bldg Standards Commission B ALL PERMIT
I Fee TYPES
1 BSEISMICR Seismic Residential P
f 1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
3 1PRREPIPE Residential re-pipe per fixture P 1RPRP
IBPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
/ 1BPWATER Install/alter Water Pipe P
I
3 1 BPFIXTURE Plumbing Fixture P
1 PGASRES Residential Gas Piping System P
1-4 Outlets
1 BPGAS Gas Piping System 5+ Outlets P
I 1PPERMITFEE Plumbing Permit Fee Issuance P
1PLMBLNCK Plumbing Plan Check P
1 PLMBINSP Other Plumbing/gas Insp. P
/ 1TRAVDOC Travel & Documentation Fee B
I BUSLIC Business License B
;
M.Indoor Air Quality and Finishes
1.Use L.OAWVOC Pmt-. 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0
3.Use Lowltyq yOG11 3 IAQ/Health pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
71_S 114 +gid itltl 4IAQ/Health. pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring B Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Malerials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts Ayes 0
1 1
i I 1
Total Points Available: C 1401 130 57
Total Points Project Received: 001 0 0
2
9 ��
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