06060067 CITY OF CUPERTINO
BUILDING DIVISION PERMIT RACGTORI,NURMATION ,y
BUILDING ADDRESS: GOU LI-JAN CHANG p�1AR NO 06060067
1016 BUBB RD
OWNER'S NAME PERMIT ISSUE DATE
GOU LI JAN CHANG 06/08/2006
SANTTKRY NO. CONTROL NO.
ARCHI'fECT(ENGINEEA: BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
0 0 0
c c LICENSED CONTRACTOR'S DECLARATION Job Description
m 1 hereby affirm that,1 n li¢vd under Pour i ran of Caaµc 9(enmdcncing
usS.I n70t0)OfDivitlon Sof Line Buena.and Pru4mtnuu CdO.arld mY Ban:m�Il�fmmaiWeflec. REPAIR WATER PIPE OUTSIDE FRONT YARD
z DamCourcm y r .
t- RCHRECTSD no CONTRACTOR PAID FOR BL 6/8/06 : HENRY HONG GIH
i�� 1 urdcuaal mY plvu Wall h ivN u publk rtsOrds
iyU
and Itcued Pmfcssiasul
OWNER-BUILDER DECLARATION
paC 1 hmiiY.IRnn mu I sm.Busine I.do CrxntraItse.Co lksa 1y O ear Ne
C followingui=. (sesuaa 7031.5.Buunessand .dcuiau Co de:byear 2(r canny .
iKinch nyares.perdu,re caused abc.for eu dPeruit or repair any mtswm
zi Priprn its iawinc.amu rryWro dh appliomfar such puditn fdc asiprctl ^m,
- < ,n,rinl.Ikncapmm�n,munpm.I.laa.erdlecnwr><�.L;��IA.(a.p�o Sq.Ft.Floor Area Valuation
`�° (commenang�V,Saum T0d0)ar Dnrum3ofWC Bvurm aitl Rar�imu Cale)a o $1400
dm be b essmpt O, m eefrand ftluaus fa de,alleged!neumAny viapum huo.M 1
s m7Ml.5by.ny.PPLl LfM&p ill jCM, "Pe tm,awpenwyef APN Number - Occupancy Type
.I mac dean rise buodred dnlbr.ISM
❑L u ovou of le prapcty,a mY emPbyva viN vaFa u th"e sok®lpenavo.. 1 r
.,iumroehusts nde,Twad.brain'eme°'°Bmmreet"Ply an
RequiredIns coons
and Pmfeatlm code Th Ca.ucmrs liana tr don net wPy'n an own ofIK
rOrn=vhobulldsaid da,Ouebcrp reeho tinare.sutedneb a uostlfalemngh his �H W��Gltei/ ���
seedy bymy,poHdeANucdlmp,stadwe uaegOedeodcdaaBertd Towle lf. W V�Q(7
have .me bedding a i rp.e,aeet b mid Wthm ore year Or—PleuM me awver-
buide,vN base u e burden of pmnng uw be,Old.at buW a improve fa purpase,of
alr_I.
71 I•as aver Or the Propvty.am esdusinly ean,rcang vial 6 Oesd enmactan he
cartswn Ore pmpea(sec 7044.Bdulydm.ad P efealae Cn 11 V)The Canuuers Li-
.lav d«,out apply In an ovnc Or pmpeny MOO bum Or a.pvses ft..arid,
who cmecu for such pmjem,v,b a euamama(s)I—andt pareses m We Connors
L 1¢na W.
C]Im.atmµundo Sec .B h P C its this mead
Ow s Dora
WORKERS COMPENSATION DECLARATION
I heehy sffum under penalty or perjury One 0(tan rolbving
1 ba se amviRmdwi.aCenM of Cmautn aur-mart for Water. aft
a I a hots ad for by Scrim,7T(p of de labor code,fa th pcRaman¢N Ne
vat far vbicb ads pmuit is Issued.
❑1 Ease aid*rill malaaln wetWs Compenwdn bnuu m,ast reassured by Scrim
neo of the Latest Code.Tam performacc of the. fa dime alis perrou is issued.
My WariOu"Cmop^ m inmmre carrier and Policy n bc_7'
Cade: Y}!'u Pol4y Na: JRJLL
IFICA 'F rJ MON FROM WORREAS
COMPENSATION INSURANCE
rfnisac9m.xd not b:completed B We perah Is Faure buMW doBia(SIW)
a lav)
I eerufr deo,b dM pufam.ae of dee vert fa which this permlt b issued.I stall oat
empl,any p .in any manrcrm as an bemmc subject In Na WOrers' mm
Liv,of CGliror d .Doc
Applicvu
NOTICE TO APPLICANT:If.after making this Cerdfiuts of Emmpdal.yuan shoud
beemte subjee,n Ne Workers C"NOsaumr prestims Of the Labor Code you due
Ofdribvitb comfy w W sun praviums Or Ibis perneis sba11 be dinned revabcE.
'Z ^ CONSTRUCTION LENDING AGENCY
F. I hereby affha dant dare u.emvucuoa Imding.geu,,for Ott performan¢of
f. 7 Our.ort fa vbicb Nis pmmlt b ivucE(Sas 3M.CN.C)
LL] QLenders Nude
0.0.z Ietrdee.Addm.,
U0 1 cnify Jus 1 base mad Wb appicaum std sate On.the above W.U.b
I.I. P cartca 1 agrtu In ruenply viJr all d,,and county urdi•junees sedum Ian ml.dng On
0U building corutrucuon.and Wreby.udwrix mµcanu,i.'s or Nis raym cner upon Nc
r 0. hove-dcnuaed ru,crty for lupection purpmes.
(We)agree 1.save.indcmtufY.rd!keep hanttka the Ci,y or Cupertino.,aw
rF'i h Tial ilitiu,IWgmew.co="e.penas which MY In any wayamrue si aid Clry
U incaxyuvc a the gruWng Or dins lcvut. l
^ APPLICANT UNDERST NDS AND WILL COMPLY WITH All.NON-POINT Issued by: Date P_'e/t
5 0.CER U 0
ui � Re-roofs
s. rear HAZARDOUS MATERIALS DISCLOSURE Dane Type of Roof
WBINc applicanta(mune bulling aotsnsca ban Ac haaNau m.tcul
u deflOcd by Ne Cupertino Mumeipal Code_Ch.tl,aµc 9.11,and the f{dN amu S+Imy
Carse.Senior 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
61es
W'dl,hc spPlioma fuusen building ottvgaret=equupmentade0c s vhkb If a roof is installed without firs[obtaining an inspection,I agree to remove
it l .=11 air cmuduunts u dcBrtvl by Ute Bay Area Air Quality Msaagenem all new materials for inspection.
Oiurim7
0Yna � Ne
Ib.sa read the banAnm materialsteWbemms Idler Chan 695 Of ft Califs.
nia liNNa Safc,yCodc.Su.2551L5.25333 and 25134.1 undcma d Na Ude buikeng
dues m, lac•.—.v Rb my rupm,um d
bility ory de oeusart of ftreg"iremew,''web^ x�mes nOr.ctrrur.drwoer"pa.nT. Signature of Applicant Date
f-'rriY`N;rntt All roof coverings to be Class"B"or better
Ovum Nair Dad'
'I;
- Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
pF Fax(408) 777-3333
fVUPEkTINO
Building De artment
JOB ADDRESS: PERMIT # /
/O �� c�SS cQ 06 o 6 6. 7
OWNER'S NAME: L cn S PHONE # S— 3 oO-
GENERAL CONTRACTOR: p FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete e following information
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/ ontra for Signature Date
i
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36204023 . 00
DATE ISSUED. . . . . . . : 06/08/2006
RECEIPT # . . . . . . . . . : 34750
REFERENCE ID # . . . : 06060067
SITE ADDRESS . . . . . : 1016 BUBB RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GOU LI-JAN CHANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : HENRY HONG GIH
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : GOU LI-JAN CHANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- - - ------ ----------- --- -------- -- ---- -------- ----------
BPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---- --- -------
TOTAL PERMIT 152 . 37 0 . 00 152 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------ ------------
OTHER 152 . 37 MASTERCARD
TOTAL RECEIPT 152 . 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
•
CITY OF CUPERTINO ����
Sav REPIPE/SEWERS/MAIN SERVICE
OF
CUPEkTINO PERMIT APPLICATION FORM
APN# On 2 Date:
L�
Building Address: � p 1 64 p-tv l u
Owner'sName: 1\O� Phone#:
,4,v u L - �a n C Gla e ms- 4L3 g
Contractor: Phone: License#:
lf�if/ . oI
Contact D Ph ' Z Cupertino Business License #:
wl�ff
Building Permit Info:
Bldg ❑ Elect ❑ Plumb El/
Job Description: yA i Y 0 aA.av
Residential 1 Commercial ❑
Cost of Project:
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
•