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09110051 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19014 TILSON AVE CONTRACTOR:A-TECH PLUMBING&FIRE PERMIT NO:09110051 OWNER'S NAME: GEORGE&MA-LI GAU 3142 WARD LN DATE ISSUED: 11/09/2009 i -R'S PHONE: 4087754749 OAKLAND,CA 94602 PHONE NO:(510)536-5281 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH[_ RESIDENTIAL f- COMMERCIAL Contractor Date JOB DESCRIPTION:REPAIR THE LEAKING GAS PIPE NEAR THE GA I hereby affirm that I am licensed under the provisions of Chapter 9 METER (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 Valuation:$150 performance of the work for which this permit is issued. Sq.Ft Floor Area: 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:37509008.00 Occupancy Type: permit is issued. 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Date: �- -� with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: 9.18. Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: Date: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: I have and will maintain a Certificate of Consent to self insure for Worker's California omp Health&Safety Code,Sections h the Cupertino Municipal Code,Chapter 95,25533, 12 and the Health maintain Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by contaminants as defined by the Bay Area Air Quality Management District I will Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shall `C% not employ any person in any manner so as to become subject to the Worker's Owner or rued agen ' Date: [ 0` Compensation laws of California. If,after making this certificate of exemption,1 become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) application and state that the above information I certify that I have read t�isis Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating Lender's Address to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save -mify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. a Signature `�'" ��Date (u CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 5 ITEMS OF 5 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37509008 . 00 DATE ISSUED. . . . . . . ; 11000009055 RECEIPT #. . . . . . . . . REFERENCE ID # 09110051 SITE ADDRESS 19014 TILSON AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GEORGE & MA-LI GAU ADDRESS : 19014 TILSON AVE CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM GEORGE GAU CONTRACTOR PO WING LEUNG LIC # 28415 COMPANY A-TECH PLUMBING & FIRE ADDRESS 3142 WARD LN CITY/STATE/ZIP O KLA5D, CA 94602 TELEPHONE . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC -_NEW-BAL- ---------- 0 .00 1 . 00 0 .0 1BCBSC VALUATION 150 . 00 1 . 00 5 0 . 0 0 . 50 0 . 00 1500 . 0 0 . 00 1BSEISMICR VALUATION 0 .00 63 . 00 0 . 00 1PGASRES OUTLETS 1. 00 63 .00 100 126 . 00 0 .00 126 . 00 0 .00 . 1PLMBLNCK HOUR 0 . 00 42 .00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 .00 ---------- ---------- TOTAL PERMIT 232 .50 0 . 00 232 . 50 0 . 00 AMOUNT REFERENCE NUMBER METHOD OF PAYMENT __ _ _________ ------------- _ _______ CREDIT CARD 232 .50 MC ---- ---------- TOTAL RECEIPT 232 .50 VOICE ID DESCRIPTIONVOICE ID DESCRIPTION -------- ---------------------- -- 507 FINAL PLUMBING 301 ROUGH PLUMBING litl (-) � al- CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # Date: Building Address: r q 0/ Owner's Name: Phone#: e Contractor: Phone#: UWf' ,�'u Fax#: - 33T� Contact: Phone#: C� Po _ C,��IL e GeiL - Fax #: Con:ertino License#: Cu Business License#: °Z Job Description: s p-e Residential [ Commercial ❑ Valuation: Ay ki 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 TYPES Fee 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 1BSEISMICR Seismic Residential P 1 PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1PPRSEWG Private Sewage Disposal System P 1RPWS PCesspool P Install/alter Water Pipe P E Plumbing Fixture P Residential Gas Piping System P ` 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLM$LNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B M.Indoor Air Quality and Finishes 1 IAQ 1 LW LOOMO-VOC Paw /Health pts y--yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use VMAdh�ves 31AQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes0 5.Use Engineered Sheet Goods with no added Urea 0 Formaldehyde 61AQ/Health pts y=yes 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes7. Wal"Aff 0 41AQ/Health. pts y=yes 0 6.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 6 Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 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 y=yes 0 1 1im Total Points Available: 140 130r- 57 Total Points Project Received: 0 0 0 G:data/progs/greenbuildngguidelines/remodelers/greenpointsfinal2.12.D4protected.xls Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 " µ Fax(408)777-3333 CITY OF .;UPEkTINO Buildin De artment JOB ADDRESS- PERMIT # OWNER'S NAME: e PHONE # 9 fit._- GENERAL CONTRACTOR: �` - FAX # I am not using any subcontractors: Date Signature Please check applicable subcontractors and comDilete the following ' ormation: -Z- 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 !( b Date Owner/ ontracto Signature