The URL can be used to link to this page

09090173 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10725 ALDER-BROOK LN CONTRACTOR:GREAT AMERICAN PERMIT NO:09090173 PLUMBING CO INC (""NER'S NAME: WILLIAM CHOW P O BOX 26942 DATE ISSUED:09/23/2009 .NER'S PHONE: 4082537092 SAN JOSE,CA 95159 PHONE NO:(408)279-1515 CJ_"' LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r— PLUMB r License Clas/s,,C'_`3 6o Lic..'# �10 �p S" MECH r RESIDENTIAL f— COMMERCIAL Contructor&CAT AAV4tuKJ 1 Uu WAOQate '1°023'C7 4i I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE SEWER LINE (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. } 'X"`°rAM1 T �i I hereby affirm under penalty of perjury one of the following two declarations: 1 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 + �� Sq.Ft Floor Area: tioiT:$4500 I performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by r Section 3700 of the Labor Code,for the performance of the work for which this APN Nu 3Q3. Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PE EXPIRES IF WORK IS NOT STARTED 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued b ' _ Date: Z with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Si--gtu Date ' RE-ROOFS: v All roofs shall be inspected prior to any roofing material being installed.If a roof is ❑ OWNER-BUILDER DECLARATION installed without first obtaining an inspection,1 agree to remove all new materials for inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Signature of Applicant: Date: I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three 1 have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by 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 Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534. permit is issued. I certify that in the performance of the work for which this permit is issued,I shall OW r er o� aut r',ed a>;er4t�— not employ any person in any manner so as to become subject to the Worker's Date: Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) APPLICANT CERTIFICATION Lender's Name 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 Lender's Address to building construction,and hereby authorize representatives of this city to enter V he above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION .rify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO CJ 0� 0173 SAVK-1 REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: Owner's Name: Phone#: Contractor: Phone#: ctq S-4 4 U U CN2�/ Ayl,(Q2i cA 41 IOLLA P"biN Cr- Fax#: a1.Q —1 ZT3 7 Contact: �'`� Phone#: 7L6,1 D Fax #: Contractor License#: S Cupertino Business License#: a(o Job Description: 4 eta CrrCE S�J�YZ.. Ll�,L Residential X Commercial ❑ Valuation: q S-o 00 IProject 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 1CPRP 1 PGASCOM I Commercial Gas Piping System I P 1-4 Outlets 1BCBSC I Cal Bldg Standards Commission I B ALL PERMIT Fee I TYPES 1BSEISMICOM I Seismic Commercial I P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE OF CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT r Fee TYPES 1BSEISMICR 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 1 PPRSEWG 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 I 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P / 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36921003 . 00 DATE ISSUED. . . . . . . : 09/23/2009 RECEIPT #. . . . . . . . . : BS000008746 REFERENCE ID # . . . : 09090173 SITE ADDRESS . . . . . : 10725 ALDERBROOK LN SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER WILLIAM CHOW ADDRESS 10725 ALDERBROOK LN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4603 RECEIVED FROM . . . . : THE GREAT AMERICAN CONTRACTOR . . . . . . . : CORPORATION LIC # 18061 COMPANY GREAT AMERICAN PLUMBING CO INC ADDRESS P 0 BOX 26942 CITY/STATE/ZIP . . . : SAN JOSE, CA 95159 TELEPHONE (408) 279-1515 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 4, 500. 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 4, 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 ----------------- --------------- -------------------- CHECK 106 .50 #111709 --------------- 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 Community Development .',�; ;S,a ' , 10300 Torre Avenue F^ � Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPERTINO Building Department JOB ADDRESS: PERMIT# g(_06)Zgr 04- CAAj J OWNER'S NAME: W i C L AW', C p.}V w PHONE # gDej GENERAL CONTRACTOR: 00Luwk1oll FAX # ZN-- 19-3 9 I am not using any subcontractors: cl"o23'z�1 Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical I ( Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry I Ornamental Sheet Metal i Painting/ Wallpaper Paving Plastering I I i Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date