07110131 CITY OF CUPERTINO ` ` ' ` '
BUr,LDING I;IVISION pERNIIT ����������������'�
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BUILDING ADDRFSS: PERMIT NO.
19514 GREENWOOD CT STAR R0�)TER & PLUMBING 07110131 .
VER'S NAME: PERMIT LS6VE DATE
CHU LOUIS G AND SUE S ET AL P 0 BOX 490 � 11/26/2007
PHONE: SAMTARY NO. CONTROL NO.
( 510 ) 37'7-4749
ARCHI'IEC[/EWGINEER: BUILDING PERMCC INFO
BI.DG EI.ECf PLUMB MECH
0 � � �
u O p LICENSED COMRACI'OECS DECLARAT[ON JOU DCSCi1pt10I1
u� 1 percyy affirtn that 1 am lixnscd unJer provisions of Chapicr 9(commencing
� z� wi�h Section 700U) of Division 3 of �hc Busincss and Rofcssians Code, and my liccnsc is I N S T L C. � EAN - OUT B EHND S I DEWALK
�� y in full force and eftec � O// f� g�
v� Z Licenx Class ��—C� � Lic. i GL'7
'- ^ Da�c Conuacwr
� � � ARCHI7'ECl'S DECLARATION
� I undcrsiand my plans shall 6c u�cd u public records
m<
d
U
4 O y Liccnsed Pmfcssional �
y � OWNER-BU►LDER DECLARATION
a� t� I hcrcby affirm �hat 1 sm exempt Gum Ihc Comroctors Liccnsc Law for thc
L p O fol►owing rcacan. (SccUon 7031.5, Busincss �nd Ptofcssians Ca1c: Any city or rnunly
K��i which requims a pc�mit to conswc4 aUer, improvc, dcmolish, or mpair any svucture
� y} pnor w ils issuancc, also rcquires Ihc applicant (or such permit �o filc a signed su�cmen�
_< that hc is licenscd pursuant to thc provisiona o( ihc Conuactar's Liccnse Gw (Chaptcr 9 3q. Ft. Floor Area Valuation
Y F� (commcncing wi�h Scc�ion 7000) of Division 3 0( Ihc Busincss and Prokuions Cadc) or � 2 � 0 Q
y�� that Ae is exempl thetetrom and ihe besia for ihe alleged exemption. Any violaGon o[
Section 7031.3 by azry appiicant for a permit subjecu the applicant w a civil penalty of Number Oeeupaney Type
not more than five hundmd dollazs (5500�. 3 6 914 0 3 3��
❑ I, u ownec o[ tlie pmpercy. a my employcw with wages u their sok compensadon,
will do ide work snd ihe stcuctwe is not imm�ded or ofteced for salc (Sa. 7044 s�� Re uired Ins ections
and Ptofesaona Code: The Contcacwr's License Lxw does not appty to m ownec of q P
property who builds a improves �hercon, and w6o does sueh work himselt m theough hia
own employces, providcd that wch improvemenu are not imended or ollered Cor sate. l[.
hawever, the building or improvement ia sold within one yar o[ compleuon, the owner-
buildec will have the burden of proving Uwt he did irot build or improve for purpoae of
sak.).
❑ 1, u owner of the propeny, am exclusively conuacting wiU� lianaed rnnuact�s w
conswa the projea (Sec. 7044, Susines� and Profcssions Code:)'Ihe Coa�xacctnr's Li-
cense I�w docs not apply to an owner o( property who builds or improves Weeeon, md ,
who conuacts tor such p�ojects wi�h a comractor(s) Iicensed pursusnt to ihe Comracror's
License Law.
'1 ( am uempt under Sec . H& P C for this rcaaon
� Dale
WORKER'S COMPENSA'I70N DECLARATION
I hereby �rtn under pena►ry of perjury one of the foilawing declaraGons:
❑ I hsve and wiii mainuin a Certifica�e of Consent to ulf-insum for Worker's Compen-
sation, u provided for by Section 3700 ot the I�bor Code, for �he performana of �he
work for which this permit is istued.
❑ I have and will maintain Worker's Compensation Insunna, u mquired 6y Section
3700 0( �he labor Codc, fw the pedormancc of the woric (or which �his permi� is issued.
My Worke�s Com naaGoa lnsurana �'cr end Poliry numbcr are:
Cartier. y�� Paliry No.: �
CER77FICA'I'E OF EX PI70N FROM WO RS'
COMPENSATIONINSURANCE '
(This section nxd not bc cwnpleted if the permit is far onc hundreA dollars (f 1001
or Icss) '
I cenify th¢t in thc perfamance of ihe work fw which Ihis {xmmit u issucd. 1 shall not
employ any person in �ny manner so u w become wbject to �he Worlcecs' Compensauon
Laws of Califomia. Da1c
AppGcant
N07'ICE TO APPC.ICANT: If, atYcr making �his Ccnificam of Excmp6on, you should
barome subject to Ihc Worker's CompensAtion provisions of �Ac Lstwr Codc, you muu
, O fortMwith comply wi�h such pravisions or this permit shalt be dcemcd mroked.
z ""'' CONSTRUCf10N LENDING AGENCY
[- � I hemby sflirm Uut thcre is a conswctinn Icnding agcncy for thc performa�e uf _
�� ihc work for which �his permit is issued (Scc. 3097, Civ. C.)
W� Q L.endcrs Namc '
� z L.cnders Address
V � I cenify Ihat 1 have read ihis applicuion and siatc �hst thc a6ovc informatiun is
w� cortec� ! a6roe w comply wi�h ali rity and county ordinances and sum Iaws cclating to
� U building consuuction, and hereby authoria reprcsenu6vcs of U�is ci�y to cnter upon tNe
� W aAovc-menuoned propcny for inspcction purposes.
a (Wc) agree to uve, indcmnify and kecp harmless �he Ciry of Cupertino against
�� liabilitiu, judgmcnts, costs and expenacs which may in any way acccuc agains� said City
V,'� in consequence oCihc granting of ihis permiG Date ���"`�
�"� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POl Issued by:
SOURCE REGULATIONS.
�- Re-roofs
nuuroofAppiicant/Conuacwr �e Type of R�of ���
HAZARDOUS MA7'ERIALS DISCLOSURE
wll the applicant rn fu�wc building awpant uorc or handle ha•rardous mamrial
�lefined by the Cupertina Municipai Cadc. Chaptcr 9.12, and the Heal�h and Satety
k. Sccdon 25532(a)? All roofs ;�hall be inspected prior to any roofing material being installed.
❑ Ycs O No
�11 thc applicmt or fuwre building occupant usc cquipmcnt or devices which If a roof i:; installed without first obtaining an inspection, I agree to remove
emil harardaus air conlaminants aa cicfined by the Bay Area Air Qusli�y Managemen� all new m aterials for inspection.
District?
❑ Ycs ❑ No
I havc rcaA ihe hasardous maicrials �equi�cmcn�s undcr Chapmr 6.95 of iMc Califor-
nia Hcalth k Safcty Cadc. Sectiong 25505. 25533 arul 25534.1 unticrs�v+d thu if Uic huilding
docs not curten�y havc a �enant, �wt it ia my mapoasibiliry w rrodfy thc occupant nf ihe
,��;,�„��� �n;�h m„� x�� �o�w;��� or. c«ur�� oro�N Signature of Applicant Date
wncr or aumor'v.ca ascnt o„� All roof coverings to be Class ��B" or better
� 0�7c1v��1
��-� . CITY OF t�UPERTINO
` ' �-�� ` REPIPE/��; ��'���_�/MAIN SERVICE
CUPEI�TlNO PERMIT APPLICATION FORM
APN # �� � � � � �� � �� Date: �
Building Address: . �
� �i' � e v� o
Owner's Name: Phone #: �
� � � C ''�a O -�
Con actor: -� Phone: License #:
���. �. O c� � � � ►� . � �/ - �S" � W
Contact: hone: Cupertino Business License #:
�J� �S�;��n. C -� � �6�c�- - - - -
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ /� ,� �,.�
Job Descriptio :
�c� � C �, c �1 � �' � l/ �
Residen,tj,al--�� Commercial ❑
Cost of Project:
.� � o o `'�
Qty. if
Applicable Fee ID Fee Description Fee Group
ERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Pi ing System Fee PLUMBING
/ PPERMITFEE P'�umbing Permit Issuance PLUMBING
` BPREPIPE Repipe of Fixtures PLUMBING
BPFIXTURE P �lg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER S �wers PLUMBING
BPSEWAGE S �wage Disposal PLUMBING
BUSLIC Business License BUILDING
CITY OF CUPERTINO
4 ITEMS OF 4 PERMI'I RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk. Lot:
APN ......... 36�14033.00
DATE ISSUED.......: 11/26/2007
RECEIPT #.........: BSC00003311
REFERENCE ID # ...: 07110131
SITE ADDRESS .. ...: 19� 14 GREENWOOD CT
SUBDIVISION .......
CITY .............. CUF'ERTINO
IMPACT AREA .......
OWNER ............: CHL� LOUIS G AND SUE S ET AL
ADDRESS ..........: 19_`14 GREENWOOD CT
CITY/STATE/ZIP ...: CUF'ERTINO, CA 95014
RECEIVED FROM ....: ST�,R ROOTER & PLMBN
CONTRACTOR .......: FEI�ERICO R.AMOS LIC # 27372
COMPANY ..........: ST�.R ROOTER & PLLTMBING
ADDRESS ........... P C� BOX 490
CITY/STATE/ZIP ...: SArf LORENZO, CA 94580
TELEPHONE ........: (5�0)377-4749
FEE ID UNIT QUANTITY �,MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPREPIPE NO OF FIXTURE 3.00 27.00 0.00 27.00 0.00
BPSEWER SEWER SYSTEM 1.00 21.58 0.00 21.58 0.00
BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00
PPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 196.37 0.00 196.37 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 196.37 #6813
---------------
TOTAL RECEIPT : 196.37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING
_ Community Development
`� ''' 10300 Torre Avenue
�,
.� ��;�- - Cupertino CA 95014
,�
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
CUPEt�TINO
Buildi:n De artment
JOB ADDRESS: PERMIT #
�-S �,/ C� � � �,.� o �� � � 7 � C G l � �
O R'S NAME: �, �; PHONE # S _
GENERAL CONTRACTOR: a F # C S t�
I am not usin an subcontractor • '�� ,e1
� Y
Si�;nature Date
Please check a licable subcontractors and com �lete the followin information:
SUBCONTRACTOR BUSIl��ESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heatin.g
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing �S �- o , � � �
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
� � ,, _ \ ��
�
Owner/Contractor Signature Date
FROM :CUPERTINOSANITARYDISTRICT FAX N0. :4E182535173 Nov. 29 2007 02:28PM P1
1 � s�NiT�o�
DI�'TR1CT' F�lANAC�a�R��NCylN��R 't � �p� HOARD OF' Q1R�CTdR3
MARK7'h[OMAS 8i COMPANY, INIC. � �� ��+ i7'�PWEN C. ANDREW9
DAVlD E. ROSS � � WILLIAM A. B09WOFtTH
YF.A�t'S � F J�h1N M. GA'ITO
DI6TRtCT COUNSEL, 3 G RV IC G
ATKIIV901V � FARA9�N, LL,p. �fr Ai`[I sMEO S�a� WENDEL WAK�RR, JR.
HAiiO1...P S� TOPP�1.,
R08�9 ST'EVEN6 CR�E1: BOIJLEVA�tD, BLJIT� 104
CUP�RTINO, CAI,i �ORNIA �501 d•� 15a
(406) $8�7071 PF10N �•(408) 2��6 i 73 FAX
www.cupertinosE niferydisPrfcf.com
I�ile: CuSD — �U!'
I3uilding Dept. — Cupertin,o
City of Cupertino
Attn.: Suilding Ue}�artment
l 0300 `rorr� �1v�.
C;upertino, C�A 95014-3202
J
5ubject: Install Property Lino Clcan�0ut
N�une: Chu Rcsidence
Address: 19514 (=reenwood Court
��N: ��9,xa-o3�
PErmit No.07110131
■ Videotape and Prapcxty I.�inc Cleuno��t �n�pected.
.No add�t�unal condition��/req��irerrlents by the �istric�
In�pe�tor: George Santos/ Roger San�:b� W ����y -�------ ___.._
�ate:...11.-29-2007 ................... San�tarv Sew�r Lacat���:
30' L/P�.
4' Ueep
cc: property Owner ll� 24' L,on.�
���u
SUPPLYING SANITARY S�WERAGE S�RVICES FOR: CITY OF CUPE�iTIN J, PUFtTfONS OF �F{� CITI�S OF SARATOGA, SUNNYVALE Los A�.TOS A�
SURROUNDING UNINCORPORATEDAREAS