06020158CITYOFCUPERTINO•*'se.
BUILDING DIVISION PERMIT
,C,Q,iNTRI. R..hI�NFQmRMATiO
BUILDINO ADDRESS: _
GREEN FIELD PLUMBING
PERMITNO06020158
10120 LEBANON
OWNER'S NAME:
PERMIT ISSUE DATE
CHUNG & KAY CHAN
3513 MADRID DR-
02/27/2006
NE:
SANITARY NO, CONTROL NO.
(408)946-5150
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O o 0 D
j LICENSED CONTRACTOR'S DECLARATION
Job Description
1 Mreby almm thin 1 Am licensed under provisions; of Chapter 9 (commencing
of Division S of Ne BUMneas nn PmmWons GndC, and my license is
with Section and
mmnroroeendeffnc4
Slims.
REPAIR SEWER LINE
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License Clue Lk. p
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Dau: COMxw1or
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lyse
ARCHITECTS DECLARATION
I understand my plans shall W used AS public records
r�3 Zu Zoos
Licensedflofessional
l OWNER-BUILDER DECLARATION
License Law
I hereby AM. that I em exempt from the Contractors
co the
i following rceron. Bunters and ns Code: My city st county
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17 conk ow, dem sig any structure
which requires a perm(1 re conswc4 stet. Tmpmw, demolish, ri
permit
, 3 $ 4 0 0
1 e—I
e A
prior oits issuaree.aBu requires the sPPliunl for such permilo Ole aaignW WtemmT
Contractor's Law 9
' Conmhl.
Sq. Ft. Floor Area
u
VaIlPatibn
that he is licensed pur.uenttothe provislonsorthe (Chapter
t (commencing with Section 7000) of Division 3 of the Business and Professions Code)or
that he is exempt Therefrom and the basis for The alleged eaemptian. My violation of
Occupancy Type
Sweden 7031.5 by eny applicant for a permit subjects the applicant m a civil penalty of
not more Nan five hundred dollen (5500).
❑ I, AS owner of the property, or my employees with wages u their sole eompen 0th n,
e
Required Inspections
will do the work end the suumurt is not mounted or offered fos ule(See 7001, Business
and Professions Code: The Conuacmr's License Law does not apply m an owner of
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property who builds a improw.s thereon. and who dou such work hineself or through his
own employees, provided Met Such fmprowmen sam notimmnded oro@red for We. if.
however, the building or Impmwnenl is Sold within one Sear of completion. the owner.
builder will have the Wrtico of proving that M did not build or impraw for purpose of
Sale.).
t 1. AS owr+of Me property, am esclouvely canuauing with licensed coroners to
construct the pmjml (Sec. 7011, Business and Rofessiaru Code:) The CnTncmr. Li.
come law does nod apply an A. owner of Property who builds or improved thertne, and
who contracts for such projects with a condr ec or(s) licensed pursuant to dm Commodes
License law.
❑lam sae to frsec .B k P Cfrthi.roon
Owner F Dam Z. 64
CE CCA ENSAnoNDECLARATION I ft
I touchy A(Mnn order penalty of perjury on of the mllowint dedwastimtc
1 haw and will maintain aCW Bata of Cons m, m WINesum for Worker. Compen.
nn, as provided for by Section 3700 of the Lobar Code, for The performance of the
rk for which this permit is issued.
13710WO
1 baw and will maintain Workees Cmnpemulod lnsusuux, u required by Seedne
of the LborCode, for the performance of the wok forwhich this permit is Issued
D
Workers Compensation Insunme caner nd Policy number art:rtier:
Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed if Tie Permit is forme hundred dollar (SIM)
or IGt)
I ceNfy Net in the performance of the wok for which this permit is indeed, I shall nu
emPlOyany;w.In MymMM,n mbCe9meeagllfJWlhc Woken'Compeaadart
LJW.of CAifamL a _I[i/O
APPlkxnl
NOTICE TO APP 1 NT:If After making TMs Certificate of Exemption, you Should
become subject m the V Compensation provisions of the labor Code. you must
' forthwith comply with a P nvisions or this permit NShI be deemed revoked.
)'
CONSTRUCTION LENDINGAGENCY
1 herebyAMMthi this there is. rending agency for the Mrfurmance of
ed (Sec. 30
' the Souk fM which this permit is load (Sec. 31197. Civ. CJ
r '
Name
Unde's
Lendol. Address
I certify that I Mw mad this application AM sum cost the .bow information is
' ancct. I Agra ro comply with all city end county ONir l And sum laws relating An
building convection, And hereby aulhonn MPmSCUSLI s of this city to enter upon the
above-mentioned property for Inspection purpmea
(We) agree to Mw, indemnify And keep harmless the City of Cupertino against
I IlabslTMes, judgments, cam and expenses which may in my way accrue again, said City
[, In consequence or the Senting of this permit.
v APPLICAlir U DERSTAN ND WILL COMPLY WITH ALL NON.Nf
Issued by: Date.'L?�G
SOURCE A' S.
Re-roofs �--
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MConuSoror D
Signactue.0kPithJA
I IAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the app want or future Wilding occunt swe m handlehuardmu manual
,
As defined by The Cupertino Munk' 1 Code, Chapter 9.11, And de Health and Safety
"
w. Satie. 25532()?
All roofs shall be inspected to any roofing material being installed.
❑Yea o
prior
If a roof is installed without first obtaining an inspection, I agree to
Will the appucnl or more bull ing Occupant ase equipment or devices which
remove
it MSUMms air anMbhM 3 ss rued by tlw Bay AMA Air Quality Management
all new materials for inspection.
strict?
0Yes u
Idox;
1 haw mrd the hnrNtms.=data requirements undcrChapmr 6.95 of the Califor.
Health @Safety COM, Om 15505.25533 and 2553/. l understand ft if to building
not cument haw um 4 w T s my responsibility o notify TM occupnt of
ulremcntsw c comet or WhasecofaCcrificteof0ea
Signature of Applicant Date
2%7
All roof coverings to be Class "B" or better
Owner orauthod>e agent _ _
I
Community Development
10300 Torre Avenue
J Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
UPERTINO
Building Department
JOB ADDRESS: 01-7-c L e9,'
N P 'e l 0 C
PERMIT #
b
OWNER'S NAME:
PHONE # 7 -
GENERAL CONTRACTOR: p /J pI
FAX ,#
I am not using any subcontractors:
Signatur Date
Please check applicable subcontractors and complete a following information:
Owner/ Contractor Signature
Date
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
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE b(o Zo/S�
PERMIT APPLICATION FORM
APN #
1/-
Date:
BPGAS
02-14
--D o'
Building Address:
/0 12o 4:PG q/,J P&
PLUMBING
BPREPIPE
c Ajo, e �
PLUMBING
Owner's Name:
6 J
Phone #:
BPWSVCS
Or
r /1 /\J
3
Contractor:
Phon •
Lic nse #:
BPSEWAGE
Sewage Disposal
PLUMBING
Contact: G—
e�� Phone: 6�0 _ 9 yQ�� y
Cupertino Business License #:
Building Permit Info:
Business License
BUILDING
Bldg ❑
Elect ❑ Plumb LW
Job Description:
REP/90KREP/90K L L AIE
Residential
Commercial ❑
Cost of Project:
00c)
Qty. if
Applicable Fee ID
Fee Description
Fee Group
BPERMFEE
Bldg. Permit Fees
BUILDING
BPGAS
Gas Piping System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i e of Fixtures
PLUMBING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING
X33373
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