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10040125 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6397 COTTONWOOD CT CONTRACTOR:CUPERTINO PLUMBING PERMIT NO: 10040125 OWNER'S NAME: CHEN KUO HWA&CHONG MAN L 1300 DELL AVE STE C DATE ISSUED:04/20/2010 NER'S PHONE: 4085258922 CAMPBELL,CA 95008 1 PHONE NO:(408)253-0618 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT f— PLUMB License Class 3(, Lie.# �P a `'—� MECH RESIDENTIAL COMMERCIAL P e Contractor ��— P Dattet`—2 t!— JOB DESCRIPTION:COPPER RE-PIPE&WATER HEATER I hereby affirm that I am licensed under the provisions of Chapter 9 (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.Ft Floor Area: Valuation:$4000 1 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 anc Type: Occupancy permit is issued. APN Number:36918016.00 P Y YP 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 EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source re r the Cupertino Municipal Code,Section Issued by: Date: 9.18. Date ' T lJ /o Signature f RE-ROOFS: Li OWNER-BUILDER DECLARATION All roofs 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 inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,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). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I 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. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,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 contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Com,Sections 25505,25533,and 25534. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's r or auth Compensation laws of California. If,after making this certificate of exemption,I % -'' D e: 7 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 hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender'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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save unify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36918016 . 00 DATE ISSUED. . . . . . . : 04/20/2010 RECEIPT #. . . . . . . . . : BS000010224 REFERENCE ID # . . . : 10040125 SITE ADDRESS . . . . . : 6397 COTTONWOOD CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CHEN KUO HWA & CHONG MAN L ADDRESS . . . . . . . . . . : 6397 COTTONWOOD CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : FRANK L CARDIA CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612 COMPANY . . . . . . . . . . : CUPERTINO PLUMBING ADDRESS . . . . . . . . . . : 1300 DELL AVE STE C CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 253-0618 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 000 .00 1. 00 0 . 00 1 . 00 0 . 00 1BPFIXTURE NO OF FIXTURE 8 . 00 64 . 00 0 . 00 64 . 00 0 . 00 1BSEISMICR VALUATION 4, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0. 00 1PRREPIPE NO OF FIXTURE 1. 00 11. 00 0 . 00 11 . 00 0 . 00 1PRWHEATR UNITS 1 .00 25 . 00 0 . 00 25 . 00 0 . 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 185 .50 0 . 00 185 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 185 . 50 VISA --------------- TOTAL RECEIPT 185 . 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEI�TINO PERMIT APPLICATION FORM Date: APN # l " (4 '� C) G� Building Address: �fi (10 e3 C7 `�� Phone#: Owner's Name: 5- k k^ Phone#: 2-5 3 --0C,1 Contractor: Fax#: Phone#: 30 S /� Contact: Fax#: Contractor License#: (,,2 t�4 0 5 Cupertino Business License#: Job Description: e Residential Commercial El Valuation: d C Project Size: Express an and 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 Buildin Points: Fee Description Fee Permit Type Quantity Fee ID p Grou 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer _ 1BPREPIPE Commercial re-pipe per fixture P 1CPRP IP GASCOM Commercial Gas Piping System P 1-4 Outlets �,I, PERMIT 1BCBSC Cal Bldg Standards Commission B TYPES Fee 1BSEISMICOM Seismic Commercial P 8 P ly TZ. N -� CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1 BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1 BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B