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08010131 (2)CITY OF CUPERTINO BUILDING DIVISION PERMIT ,,eCmFNT.Ri�0RTNFORMATI1� aulLq�r�c�A81�LEsVICKSBURG DR PACIFIC PLUMBING 08010131 , OWNER'S NAME: PERMITLSSUHDATE DU XIAOLIN AND YANG HAI-LIAN 2138 O'TOOLE AVE 01/22/2008 NE: SANITARY NO. CONTROL NO. r (408)452-8633 ARCH11EC7/ENGINEER: BUILDING PERMIT INFO 9LDGO ELECT� PoUM MECH t [� LICENSED CONTRACTOR'S DECLARATION Chapter - Job Description It p I lereby affirm dust 1 am licensed under provisions of 9 (commencing with Section 7000) ofDivislon 3 oftthe Business and Professions Code, and my license is INSTL CLEANOUT BY HOUSE In full force and effect D. rl Cl Lk Date r ict-1 Date �2 CTS CHITECTS DE CLLLA ATION ARCHITE 1 mWemunJ my plans shall W used an Public rtenNa Licensed Prefect anal OWNER-BUILDER DECLARATION 1 hereby alum that i am exempt from the Conhsctor's License Law for the following mason. (Section 703 1.5, Business and Profusion Cole: Any city or county which requires a permit to conswtt alter. improve, demolish, or minor any structure pow 0i issuance. Bled milulma the applicant for such permit in rile a signed statement that he is licensed on the of the Contractor's Liana Law (Chapter 9 Sq. Ft. Floor Area Valuation pursuant previsions 100 (commencing with Section 7") 9Division 3 of the Business unit Professions Cock) or that he is exempt therefrom and Ne buss for the alleged emmptian. Any vlolm an of 3 6 914 016 Occupancy T'pe Section ?031.5 by dry applicant for a permit subjects time applicant in a civil penalty ofNumber mol roam Nan five hundred dollars (S5010). ❑ 1, u ower afthe Property, or mY amPloyw with wage u their sok compenotion,. ' Required Inspections 70 N, Busiwa dathewad, andCods, saucturelatotktenesses and The Contractors Nd RafWkN apply m coo eWaf Law does of apply -1 P rod me oci uch or is builds ves Wha daaoYchended lmYlfar through his property heabnlproMed ft such far ulcer, auchimprowmatsamne ear awnamr, the bt,paviori pr ofc mplaered builder, Nebuildingarimpmwment 4.midwiiinaneyev ofamplefortheowner- builder will have the burden of paving that W did not Wild or improve for purpose of��j��rt��( ask.). ❑ 1, as ower of the Property, am eaGusivelY contis<ting with licensed amrmao in construct the project (Sec. 7044. Bushed aM Profusions Cade:) TW Corrientes l- ame law does net apply in an owner of property who Wilds or improws themon, and. who contracts for such pmjeeu with a canuacmr(a) Ranged pursuant in the Contncmr's License Law. ❑Tom exempt under gee ,B&PC far Nis aeon Owner Dam _ - WORKER'S COMPENSATION DECLARATION I bend w lRrm under penalty of Perjury one or Ne fallowing declaWorkerrations: Co Wa ono will maintainsction37Mrimic of the ent W LabrCrack. fortre erforma Campers- on. r provided for mi Section J7000( the Labor Code. far Na performance or the wad for which Nis permit u iodic. y ❑ I have and will Wnker'r Co n ksurma, required by Section �TAR ce of ofduelata Cade, for the ptrRermsua of Ne wt for which this permit hbroad. ode. fon h SAN My My Workelsa_,Co�mlen don oaaem moior and Poliry number am: �r Ld fe Cameo 1 of s+ �''r PoIIry Na.: i CERTIFICATE OF EXEMPTION FROM OW RKERS' COMPENSATION INSURANCE (Thu seetian aced not be completed iftW permit ie faros hundred &Jim (SHIM nr leo.) 1 amh that in the Performance of the wad for which this permit is bound, l &hill not employ any Poison in any mam¢r an as in become subject to Ne Workers' Campenamon Laws of California. Data Applicant NOTICE TO APPLICANT. IL after making this Cenifiuu of Exemption, you should become subject m the Wodu', Compensation prov itioru of Ne Labor Code. you run faMwith comply with such provisions or this permit shall he decmae rooked. CONSTRUCTION LENDING AGENCY , I hereby afarm Nn Nert a. construction lending gency for the performma of the work for which this permit u issued (Sac. 3097, Civ. C.) Lender's Name , 1 certify that I haw read this application and state Out the above information is control. 1 agree in comply with all city and county andinances and mute laws coling in Wilding construction, and hereby authorme mpreaenutiws of Nie city in enter upon Ne above-mentioned property for inspection purposes. (We) agree to une. indemnify and keep harmless the City of Cupertino against Iiabilifiu, judgments, coats and exPemsu which may in any way scan against aid City in consequence of Ne Staining of this permil. j APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLN N-POINT L. Issued by: Date SO RCER UL ONS. D Re-roofs Type of Roof SignmancofAWficamKonommor Date HAZARDOUS MATERIALS DISCLOSURE Will Ne applicant or rumm Wilding oesupmtdone or WrWIe locomotion; material , is, defined by the Cupertino Municipal Cade, Chapter 9.11, and the Health and Safety Cole, Section 255324)? All roofs shall be inspected prior to any roofing material being installed. Own, [7Na If a roof is installed without first obtaining an inspection,agree to remove 1k Will the applicant or future building occupant use equipment m deviW which .1 hemre a air contaminants u defined by the Bay Arta Air Quality Management i all new materials for inspection. t7 ❑ Yu 4'Na I have mad the havandousmakriaurtqueemem under Chaper6.95 of the Caller. niaHulN&Safely Code Sec mM50A25533uW25534.lundemwdthmiftet Wilding Jaa nct cumentiy Ww a wmm4 Net It u my responsibility m natil'y Ne aecupant of Ne requirements wh' le not Is, met price miss dna ofe CeniOcete of Occupan Signature of Applicant Date All roof coverings to be Class "B" or better woes or adthari < egcnt Dm 01/22/2008 09'.50 FAX 408 777 3333 CITY CUPERTINO O �j{� I�I R001/002 CITY OF CUPERTINO 0 V REPIPE/SEWER/MAIN SERVICE ® CUPEltTINO PERMIT APPLICATION FORM APN # o b Date: Fee Description Building Add ss: Permit Type jDaOO �/lcksBWZC, D2. Group Owner's Name: Phone #: Commercial building X1lAD ;/1 w 1CPSS Contractor: Phone V/onc � SQL St7ZuiCl (. Commercial re -pipe per fixture Fax#: 1CPRP Contact: Phone Commercial Gas Piping System J� {i I ct�u1AT I Fax #: / S Contractor License #: SGj � 1-4 Outlets Cupertino Business License #: Da I --�18 p� (� 1BSEISMICOM Job Description: P L /y 1BSEISMICR Seismic Residential Residential Commercial ❑ Valuation: 0 . Residential building P Green Building Check list must be completed and attached to this application. Green Building Points: sewer/Sanitary sewer 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 1BSEISMICOM Seismic Commercial P 1BSEISMICR Seismic Residential P IPRSEWER Residential building P 1RIP sewer/Sanitary sewer 01/22/2008 08:50 FAX 408 777 3333 CITY CUPERTINO Z 002/002 CITY OF CUPERTINO REPIPE/SEWER/1V� SERVICE OCUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1PRREPIPE Residential re -pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWSor 1RPWS 1PPRSEWG Private Sewage Disposal System P IPCESS 1BPWATER Cesspool Install/alter Water Pipe p p 1BPFIXTURE Plumbing Fixture p IF RES Residential Gas Piping System 1-4 Outlets P 1BPGAS Gas Piping System 5+ Outlets P / 1PPERMUFEE 1PLMBLNCK Pl umbing permit Fee Issuance Plumbing Plan Check p P 1PLMBINSP Other Plumbing/gas Insp, P / 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B 0 ® 4 ITEMS OF 4 11 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36914016.00 DATE ISSUED.......: 01/22/2008 RECEIPT #.........: BS000003752 REFERENCE ID # ...: 08010131 SITE ADDRESS .....: 10200 VICKSBURG DR SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER DU XIAOLIN AND YANG.HAI-LIAN ADDRESS ..........: 10200 VICKSBURG DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3319 RECEIVED FROM ....: PACIFIC PLUMBING CONTRACTOR .......: JOSEPH BECHWATI LIC # 22640 COMPANY..........: PACIFIC PLUMBING ADDRESS ..........: 2138 O'TOOLE AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95131 TELEPHONE ........: (408)452-8633 FEE ID UNIT ----------------------- QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL 1BSEISMICR VALUATION ---------- 100.00 ---------- 0.50 ---------- 0.00 -------------------- 0.50 0.00 1PPERMITFE FLAT RATE 1.00 40.79 0.00 40.79 0.00 1PRSEWER UNITS 1.00 20.40 0.00 20.40 0.00 1TRAVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 TOTAL PERMIT ---------- 102.48 ---------- 0.00 ---------- ---------- 102.48 0.00 METHOD OF PAYMENT ----------------- AMOUNT REFERENCE NUMBER --------------- CHECK 102.48 -------------------- #16769 --------------- TOTAL RECEIPT 102.48, VOICE ID DESCRIPTION- ------------------------------------ `VOICE ID DESCRIPTION 106 SEWER & WATER -------- 202 ---------------------------- UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING