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08080024 CITY OF CUPERTINO '+ "-. rte*- -'=rat `" ?` '�✓ BUILDIN45DIVISIOry PERMIT co INI<O7,RMATION, : BUILDING ADDRESS: PERMIT NO. ), 1641. COI.,UMBUS AVE GIANT PLUMBING, INC 08080024 OWNER'S NAME: PERMrrIS'UEDATE I:Ii:ON 11SING 2111 DRY CREEK RD. 08/04/2008 NE: SANITARY NO. CONTROL NO. (408) 241-6341 ARCHITECDFNGINEER: BUILDING PERMIT INFO -BLDG ELECT PLUMB MECH 0 0 0 0 uo0 LICENSED CONTRACTOR'S DECLARATION - Job Description C 1 hcmby sM m that 1 am Iie:vN under provisions of Chapter 9(commencing p C+ wire secure lmB)oroivion3ofmc Budnev aM Prorcssiomtoee,am}nIiu COPPER REPIPE SNGLE FAM HOME ^ u =v, in full affect.e and affect. toy � Licenm Lk.• - F p Dem Co FF 7W ARCHRECiS OECnmno ATION W< 1 maintained my plans NW be mind as Public records g Licensed Pnsfesskol OW NER-BUILDER DECLARATION ii m I hereby affirm Wal I am exempt from the Canmam u`3 Licenm,Law for the p O following match.(Secuan 701.5,Business and Professions Coda:Any city or county 5 g � which recut.a permit m corm tlme improve,domoli h,nr repair any sanctum _Z"e prior to its tYuaMc.alta requires We applicant fhrsueh permit to file a signed Wmment that im a licensed pursuant to to provisions of the Commences came Law(Chapter 9 Sq.Ft. Floor Area Valuation '40 (commencing with Section 7000)of Division 3 of the Busincv and Prefessiona Code)or $7000 my dint he k exempt therefrom and the basis for the alleged etamptan.Any violation of Section 70313 by say applicant for a Permit subjects the appikant in a civil penalty of N Number Occupancy Type oro mom Wan five hundred dollars ISM 3561833 . (� L u owner of the pmpeny.o my ntimmuet offered wgu u Weir Sok a ,Busimers will dothe work and,The CamisnaUnmaied Orrawmnt set apply to amor of tai Nty.1h,ns Cade:The Contractors Liaran law dam rot apply m u awter of Requited Inspections property wai Wilasmimpmsescdaemon.irand who aaexaachwmkhimulfer Wougb his Own employ=.MeuiDmgOr i prsuchimprovements tee not ousdcmo0bred for deIL however.We building Wa improvement is veld within ane id of c prove for the,mm o- .iilder will have de burden of proving Wan K did not 4414 or improve(ar puryaee of .it.). 0 1,as an.of the property...exclusively concocting wild licensed rnnvactam in construct the project(Sec.7044.Business and Professions Cade:)The Contractors U. cense law dote not appy to an owner of property who builds or improves thereon,and, wbo contracts fm such projects wild a eonuacmr(s)licensed pursuant he the Conu a errs Lkmue Law. 0 lore exempt under See ,B&PC far this mann Owner Date WORKER'S COMPENSATION DECLARATION I hereby afram under penalty of perjury arc of de following declarations: I ha.e and will maintain•Cenifiusm of Contcnttu Self-moue fm Workers Compcn- cation,as Provided for,by Section 377 of the labor Cade,for the performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700af the labor Cavi.fm the performance ofthas work fm which this Permit is issued. ' My Walkers Compenamon Inserence ca *rr/aan�ngd.Paliry member am: �— Carta J?1A c,N.,: I a.. COZA l in FlCA �OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Deis aecdnn need not bra completed If 0k permit is furnace hundred dollars($I00) or lea) 1 certify that in We perfares.of the work fm which this permit is Wood.l shell not employ any Penton in any manneran as m became subject in the Workeoi Comp ssation law.i of California Data Applicant NOTICE TO APPLICANT:IL after malting this Certificate of Esempuon,you should became subject in the Wmscra CmnpensNon previsions of the Leber Coda you must .J O forthwith comply with such Provisions or this permit shall he darned handled. z CONSTRUCTION LENDING AGENCY [-� I heroby.Irrom ttit them is.comuucdnn kading.geney,far the performamc of 7. the work far which this Permit 6 added(Sec.ID .Civ.C.) W� A Lcndeh Name = z Leviers Adams t.)Q 1 ceaify that 1 have rand W,application and .in thin We above ihfiernmen u fy V cmmct.l agree to comply with 01 city and county oNlnancaS and sum laws relating he -0 building construction.and herebyaudemim resmentatiwts of Nis City m enter upon the r W above-mentioned property fm inspection purposes (We to lcals the rc/1 liabllhim ju)dagree m nu.claim mande.Kasm which may In my waynty of CoNrum,.c.against said y U Z APPL CANTCof due UNDERrausing of this Nicoll. STANDS AND WILL COMPLY WITH ALL O -POINT RCE REGUfAT10 Issued by: Date Re-roofs ureal ApplimntCon r HAZARDOUS MATERIALS DISCLOSURE Type of Roof �,�-- Will the applicant or furum building sccuPtct stare er IurWle haseadom material as dcfhncd by We Culmina Miicfpal Code.Chapter 9.12..nd the HanN and Safely Code,Section 255324? 0Ym No All roofs shall be inspected prior to any roofing material being installed. win the applicant or future building=upon,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove t heraodno air contaminants an defined by the Bay AeaAir Quality Management all new materials for inspection. s1 E)Y. Nu I have mad the hvardom maerials mquircmens under Chaser 6.95 of the Califon w Health&SafmyCOde.Sevms 25505.25533 ani 25534.I undcwnd that lithe building docs not currently have•amanl that it is my nmponsibility m ratify the aaup.,of the requirements which must deme ar midhmaaf.CeruOanmof r� Signature of Applicant Date O n�a.g�'�0� �6aa-,o All roof coverings to be Class';W'or better CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg • COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 3561833 . 00 DATE ISSUED. . . . . . . : 08/04/2008 RECEIPT # . . . . . . . . . : BS000005677 REFERENCE ID # . . . : 08080024 SITE ADDRESS . . . . . : 21641 COLUMBUS AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : LEON HSING ADDRESS . . . . . . . . . . : 21641 COLUMBUS AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DONNY J GREGG JR CONTRACTOR . . . . . . . : DONNY GREGG LIC # 24389 COMPANY . . . . . . . . . . : GIANT PLUMBING, INC ADDRESS . . . . . . . . . . : 2111 DRY CREEK RD. CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 TELEPHONE . . . . . . . . : (408) 241-6341 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1.I3SEISMICR VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00 .IBUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 IPRSEWER 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 212 . 68 0 . 00 212 . 68 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 212 . 68 VISA --------------- TOTAL RECEIPT 212 . 68 VO�C.CE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 1.06 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING • CITY OF CUPERTINO Sea REPIPE/SEWER/MAIN SERVICE • CUPERTINO PERMIT APPLICATION FORM APN# / JI) Date: Building Address: Owner's Name: ' 1 Phone#: Contractor: � Phone#:� �t�� I V tam, + (AM (1113� Fax#: L{6&- Contact: Phone#:tKja -G- _ac-t,u �a 6C' _ / —CIVI e �" Fax #: Contractor License#: �-� Cupertino Business License#: a 4 g Job Description: o �p<2 Re J , �� S 1 U�� , I� G, ovy\1z . • Residential Commercial ❑ Valuation: Project Size: Express Standard ❑ Large Major Green Building: Please complete relevant portion of the Green Building Checklist&attach it to the application or if applicable,include in plan set&the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P ICPRP I PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BSEISMICOM Scismic Commercial--p IBSEISMICR Seismic Residential p • /� IPRSEWER Residentialbuilding P 1RPSS sewer/sanit sewer Z-0- CITY OF CUPERTINO REPIPE/SEWERIMAIN SERVICE IVPEkTINO FEE SCHEDULE r Quantity Fee ID Fee Description Fee Permit Type Group 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS IPPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 113PFD{TURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P / 1PPERMITFEE Plumbing Permit Fee Issuance P / 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel &Documentation Fee B 1BUSLIC Business License B Revised 6-16-08 • CITY OF CUPERTINO - (,Q� REPIPE/SEWERIMAIN SERVICE CUPEI kTiNO PERMIT APPLICATION FORM APN# Date: Building Address: Owner's Name: Phone#: Contractor: Phone #: Fax #: Contact: Phone#: ' Fax #: Contractor License #: Cupertino Business License#: Job Description: Residential ❑ Commercial ❑ Valuation: Project Size: Express ❑ Standard Large 0 Major Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: 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 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer smmnw Community Development 10300 Torre Avenue It Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 4UPEI�TINO Building De artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: b� Signature Date Please check applicable subcontractors and complete the 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 w er/Contractor Signature Date