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07080137 CITE'OF CUVERTINO BUILDING DIVISION PERMIT PERMIT NO. BUILDI b%)D FFrSS:SHELLY DR CHANG WFNG-YANG AND CHIANG 07080137 L �j / j PERMIT ISSUE DATE OWNER'S NAME: CHANG WANG-YANG AND CHIANG 20678 SMELL SANITARY NO. CONTROL No. E: T AT BUILDING PERMIT INFO ARCHITECT/ENGINEER: BCL DG ELECT PLD MLE�CH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing U withScIhrcbction affix thaton3o(thcBusincssandPro(essionsCodc,andmyliccriscis TRENCHL]sSS WATER LINE FROM METER TO HOUSE MAI in full force and effect- WATER LINE z License Class_-----Contractor o Date u ARCHITECTS DECLARATION I understand my plans shall t>c used as public records U Licensed Professional a OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the ,o following reason.(Section 7031.5,Business and Professions Code:Any ctry or counre Valuation Li which requires a permit to cornet the applicant improve, forsuchperm permit r asignc structure men Ft.Floor Area ti prior to its issuance,also req $2400 a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �q o (commencing with Section 7000)of Division 3 of the Business and Professions Code)or lation of Occupancy Type c Number that he is exempt therefrom i of a perms°Subjects the applicant a civil n.Any ppenalty of 359150 0 3 V V Section 7031.5 by any app not more than five hundred dollars($500)• 0 1,as owner of the property,or my employees with wages as their sok compensation, Required Inspections will do the work and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of Property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale'). I,as owner of the property,am exclusively contracting with licensed contractors to constroct the project(Sec.7044.Business and Professionsobuildsr improves tractoes Li- cense Law docs not apply to an owner o(propeny who congi is for such projects with a c tractor(s)licensed pursuant to the Contractor s L rcensq'Law B&P C�or Itrt reason 0 lam uetnpt under Sec \� Date 0wn01 A O DEC TION ER' O 1 herdby affirm under penalty of perjury one of the lowing declarations: 0 I have and will aintain a Cerlifrcate,of Consent to self-insure for workces compen- sation,as provided or by Section 3700 of the Labor Code.for the performance of the work for which to rmit is issued. 0 I have and will maintain Worker's Compensation Insurance,az required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OOENSA T ON ROM WORKERS. (This section need not be completed if the permit is for one hundred dollars($100) or less.) /t 1 cenify that i performance o �vr k o wkichlthis permit is issued.I shall not employ any rson in any manner sVbje�t io the orkers'Compensation Laws oC Cali riii.yDate Applicanttion,you should NGTICE TO APPL�tA •If,after making is Certificate of top become subject to c Workers Compensation provisions of th bot Codc you must z forthwith comply tth such provisions or is permit shall be dccmed revoked. � �CONSTRUCTION LENDING AGENCY ,(n., I hereby atfirlrf that there is a construction lending agency for the performance of $> the work for which this permit is issued(Sec.3097,Civ.C.) 7 Q Lender's Name + Lender's Address �z I certify that 1 have read this application and slate that the shove information is to correct.1 agree to comply with all city and county ordinances and state laws relating he U building construction,and hereby authorize representatives of this city to enter upon U above-mentioned property for inspection Purposes- and agree to save,indemnify and keep harmless the City of Cupertino agamsL liabilities,judgments,costs and expenses which may in any way accrue against said City Date in contej�cn�ce of the granting of this crmit. .z-+ APPLICANT UNDERSTANDS A WILL COMP Y WITH ALL NON-POINT Issued by: SOUR.E OGULATIONS. Re-r00 fs Signature of ApplicandContract Date Type of Roof / HAZARDOUS MATERIALS DISC SURE rial Will the applicant or future building occupant sto r handle hazardous mato as de ed by the Cupertino Municipal Code.Chapter 9.2,and the Health and Safety Code, section is3z(a>? All roofs shall be inspected prior to any roofing material being installed. ❑Y ) No If a ro�f is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or deviacs which all nes✓materials for inspection. emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? Q No 0 Yes I h read the hazardous materials requirements under Chapter 6.95 o(the CaliCor- niaHea)XISafetyCode,Sections25505, 5533 and 25534.1 understand that if the building Date docs no currently have a tens t,drat it i my responsibili to notify the Occup Signal ure of Applicant require a hi Rp to t?an& a Tic of Occupancy. 1VA� All roof coverings to be Class"B" or better Date Owner or a �rized agent Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 7UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # ..�0� ?0 O R'S NAME: PHONE #4-10 U GENERAL CONTRACTOR: 6 FAX # I am not using any subcontractors: J Si gnature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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 2 ITEMS OF 2 PERMI'.' RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Bl]c: Lot: APN 35915003 .00 DATE ISSUED. . . . . . . : 08 /14/2007 RECEIPT #. . . . . . . . . : BS)00002379 REFERENCE ID # . . . : 07 )80137 SITE ADDRESS 20578 SHELLY DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHaivG WANG-YANG AND CHIANG JAN ADDRESS 20678 SHELLY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2903 RECEIVED FROM . . . . : MS JANET CHIANG CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : CHANG WANG-YANG AND CHIANG JAN ADDRESS . . . . . . . . . . : 20678 SHELLY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2903 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---- BPWSVCS WATER SERVICE 1. 00 9 .00 0. 00 9 .00 0.00 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 47 .37 0. 00 47 .37 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 47 .37 VS --------------- TOTAL RECEIPT 47 .37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITE' OF C'UPERTINO u ��� /FAIN SERVICE REPIPE/ H" °F�tio PERMIT APPLICATION FORM CUPEkT / Date: APN# Z� Buildmn Address: ' CA .>t 19 P Owner's Name: phone: Li cense #: Contractor: Contact: Phone: Cupertino Business License#: Building Permit Info: J 1A !�" Bldg ❑ Elect ❑ Plumb Job Descri tion: p Residential Co ercial ❑ Cost of Project: Qty. if Fee Description Fee Group Applicable Fee ID BUILDING BPERMFEE Bldg. Permit Fees PLUMBING AS Gas Piping System Fee PLUMBING PPER1vIITFEE Plumbing Permit Issuance PLUMBING BPREPIpE R i e of Fixtures PLUMBING BPFIXTURE Pblg. Fixture Min Water Service PLUMBING BPWSVCS aPLUMBING BPSEWER Sewers Sewage Dis osal PLUMBING BPSEWAGE BUSLIC Business License BUILDING OWNER-BUILDE R VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. — All the work author:zed by this permit B. A portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2. A_ state licensed contractor will be hired to do: A. All of the work B. — A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to be performed 3. _ I will utilize unlicensed person(s) Dther than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. PersorVFirm Address/City Phone Number Type of work to be performed ............................................................................. ... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information, rse side). t Date: , 07 Property Owner's Signature: Job Address: �� ` ( Permit# �CfU j 7 Ani changes to the information provided ori this form shall be submitted to the City of Cupertino Build Department.