10100097 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10741 WUNDERLICH DR COIITRACTOR:GIANT PLUMBING,INC PERMIT NO: 10100097
OWNER'S NAME: LAWRENCE LEE 211" DRY CREEK RD DATE ISSUED: 10/13/2010
IER'S PHONE: 4088387699 SAN JOSE,CA 95124 PHONE NO:(408)445-8507
❑ LICENSED CONTRACTOR'S DECLARATION
BU:LDING PERMIT INFO: BLDG F ELECT F PLUMB r
License Class Lic.#
MECH F RESIDENTIAL F COMMERCIAL r
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOI I DESCRIPTION: SEWER LINE REPLACEMENT
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.lit Floor Area: Valuation:$2500
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APP Number:37529003.00 Occ
i
APPLICANT CERTIFICATION *'
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
PERMIT E I O IS T STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WIT 1 IT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 180 D F. WAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply ',
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by- Date'
9.18.
Signature Date
RE-ROOFS:
Li OWNER-BUILDER DECLARATION All r mofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspt ction.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Sign iture of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I ha,,e read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's Califf ornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safel y Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Addi tionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this cont:tminants as defined by the Bay Area Air Quality Management District I will
permit is issued. mair tain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent:
Compensation laws of California. If,after making this certificate of exemption,I Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hen by affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for w hich this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Len(er's Name
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter Lenc er's Address
upon the above mentioned property for inspection purposes.(We)agree to save
-►nify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I and,-rstand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licei ised Professional
Signature Date
CITY OF CU?ERTINO
5 ITEMS OF 5 PERMIT R;3CEIPT OPERATOR: counter
COPY # 1
Sec: Twp: Rng: Sub: Blk: :,ot :
APN . . . . . . . . : 37529003 . 00
DATE ISSUED. . . . . . . : 10/13,2010
RECEIPT #. . . . . . . . . : BS000011732
REFERENCE ID # . . . : 10100097
SITE ADDRESS . . . . . : 10741 WUNDERLICH DR
SUBDIVISION . . . . . . .
CITY CUPER`.'INO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . LAWRENCE LEE
ADDRESS 10741 WUNDERLICH DR
CITY/STATE/ZIP . . . : CUPER-INO, CA 95014
RECEIVED FROM . . . . : STACY GREGG
CONTRACTOR . . . . . . . : DONNY GREGG LIC # 24389
COMPANY . . . . . . . . . . : GIANT PLUMBING, INC
ADDRESS 2111 I)RY CREEK RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 445-8507
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----- ----- ---------- ---------- ----------
1BCBSC VALUATION 2, 500 . 00 1. 00 0 .00 1. 00 0 . 00
1BSEISMICR VALUATION 2, 500. 00 0.50 0. 00 0.50 0. 00
1PPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 .00 0 .00
1PRSEWER UNITS 1.00 21.00 0 . 00 21. 00 0. 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 .00 0. 00
----- ----- ---------- ---------- ----------
TOTAL PERMIT 106 .50 0 . 00 106 .50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -- ------------------
CREDIT CARD 106 .50 an.ex
---------------
TOTAL RECEIPT 106 .50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING