06080120 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 'CON "fo
BUILDING ADDRESS: s CUP RTINO PLUMBING """TNO'06080120
7577 HEATHERWOOD D
OWNER'S NAME: PERMIT ISSUE DATE
CHEN YU 1300 DELL AVE
NE: SANITARY NO. CONTROL NO.
(408) 253-0618
ARCHITECTAU4GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loll LICENSED CONTRACTOR'S DECLARATION lob De�yys an n
1 hereby affirm Ne I am licensed under previsions m Chapter 9(commencing
Us yt7�"tM'Jav ,1 //��
.� niu3ecrrcoennd.1'car Divido113 fshc Busrcss ane/�r�ofen/`a/i�oru Code,aed mylicenmu REPAIR MAIN WATER LINE [7 pU(I/glit'{yYY'ALED'
,n. License �S
DowConuacbr u « Y yl#-114 i(!
ARCHTIECFS DECLARATN
ION ?Z 2906
i I undersand my plans shall keused a public records
Iii
I
o ti Licensed Professional fy rrni BR
p
sy3 OWNER-BUILDER DECLARATION B yq�I�
<x I berehy aRvm she 1 am aempt from the RATION License Law for du ''1'Vrr511tfJ+T 'tl /t
,D c following mason.(Section 7(D 1.5,Business and Professions Cade:Any city of county (�t�,�
129 which requires a permit m q constualtar.Impmw,demORM,or rean
Palr y ummum \ti 194
.Ziprior m its issuance.also requites tMapplicam far such Permit to r.leasigesd statement
that he is licensed pulsumtm the pervismnsarthm Connatal.License Law(CNptar9 Sq.Ft.Floor Area Valuation
3 (commencing with Section 7000)of Division 3 Club,Buslnraaand Professions Code)w
that he is eumpt Ummfrom and the basis for she alleged emmpsion.Any violation of
Section 7031)by any appllaut for a permit subjew she applicant In•civil Penalty of r V U Occupancy Type
not mom than five hundred dollars($500).
I,a owner of die pmprny,or my employers with wgesa Neer mlecompensadon,
will Eo the wart.and thaawmua is natmunded car offered farwe(Sac.]a..Bossu„ Required Inspections
and Psortum osis nh
Cade:The Coeceres License Law does nes apply m an owner of q P
property who Wilds no imprmathawn,mdwhodoesauchworkhimsdfees through his
own employees,provided mat such Improvements are not minded oraffsred forsake.IL
however.the Wilding o impmvemmt is mid within oro you of ccrplmon,the Come-
Wilder will have the burden of poring Dat M did ret Wild tar Improve for purpose of
sate.).
❑1,a owner of the property,am Uselusveky contracting wish licensed comae m,W -
construct the pumice,(See.7044.Business and Professions Code)The Caallaemr's U-
come Law 4.not apply in se owns or property who Wilds or impmw marten,and
who canuacu fat such project wed aronuumr(s)licensed pursuant to the Cuorms er
License Law.
❑ I am emmpt under See .B k P C for this reamn
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby anon under penally of perjury am of the folbwing declealions:
1 have and will maintain a Cenifiata of Common to self-alum for WorkeYs Compen-
sation,a provided for by Semon 3700 aro the labor Conn.for the performance of she
work for which this permit u isaued.
❑1 haw anis will minim Wotrta ancemwdm Insurance,h respired by Sermon
37W01 of1W and
Conn.for Ore performance ompenthenarkfat which mu permitislaved.
My Workmes�mn�P�insursnsm carrier and Policy nu
917Z-3c a3
CERTIFICATE OF EXEMPTIOFROM WOKERS'
COMPENSXnON INSURANCE /1I I OIn
(Tht=I.met!set W compkud if the permit Or faro..hundred dollars(SIU.) y//A
tar law)
1 certify that in On performance of On work for which this permit is Wised.I shall not
employ any person In my marnerse as to become subjel in de Wolters'L•MnpenHllm,
Laws of California.Data
Appliant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject in the Worloces Compensation provisions of she Inbar Cede,you mot
.J O forthwith amply with such provisions Or this Permit shall bo deemed rooked.
Z'^ CONSTRUCTION LENDING AGENCY
[-r Ihemhyafrirmthe,temisacomuuctimt lendingagensYfnrsheperformmec.f
IY,> she work red which this Permit t issued(Sec.3097,Civ.C.)
d Q Lenders Name
a z Lenders Address
U Q I canify that I have mad this application W sum me me above information is
Correct.I agree to comply with all city and county oNimeas and state laws mlating to
Q U Wilding Construction,and hereby aulhadm en
mprcatives of this city to enter upon the
W about-menliuned Property for insr<Cdon PuP
lmea
gyt (We)agree to taw,indemnify and kss th
eep harmless City of Cupcnino against
rl'"iy Iiabilities,JedgmcnW tato andapwawhich maysh anywyacrneagarmised City ('+
V Z in consequence of the gaming of this permit. .F 1 / l�
•+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-PoINT Issued by: Date Ll / v Cs,_.
SOURCE REGU ONse2-
/4 )(2 Re-roofs !�
Signa pplianVComrewr 1thin --
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W a de applicant a room building occupant mom or handle hvandous material
m Outlined by she Cupertino Municipal Cade.Chapter 9.13,and On Health and Safety
Code.Seetion 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
41 [3 Y. �Z`Nu
Will the applicant or future Wilding aavpant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.mit hvardna air contaminants a del ned by the Bay Area Air Quality Management all new materials for inspection.
DimicO
❑YesNu
I have mad the haarthms matarials requiremcros under CWptar,6.95 ofshe Califor. !
nu Fhalshk Safety Cade.Sections 73505,25533 and 25534.1 uMcmand dual if the Wilding
dos not curenlly haw a wnmt.0w It a respOentality to notify de aaupam of the
requirements whkhm e n an=oft CeniOcam of Ocropm 764 Signature of Applicant Date
Oren vmagml / 'Dam All roof coverings to be Class"B" or better
CITY OF CUPERTINO
sm 1 of 1 PERMIT RECEIPT OPERATOR: aniyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN 35926058 . 00
DATE ISSUED. . . . . . . : 08/17/2006
RECEIPT # . . . . . . . . . : 35665
REFERENCE ID # . . . : 06080120
SITE ADDRESS . . . . . : 7577 HEATHERWOOD DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CHEN YU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : FRANK 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
---------- ------------- ---------- ---------- ---------- ---------- ------ ----
BPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
----- ----- ---------- ---------- - ---------
TOTAL PERMIT 47 . 37 0 . 00 47 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ---- - ------- -- ------------- ---
OTHER 47 . 37 VISA
TOTAL RECEIPT 47 . 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
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4§UPERTINO
Building Department
JOB ADDRESS: s 7� I PERMIT # !O
es er o r D
OWNER'S NAME: ( e v I PHONE # 08 S3-06 /9
GENERAL CONTRACTOR (uarrknz, o,, ,) IFM#
I am not using any subcontractors: 710
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
Owner/Contractor Signature Date
CITY OF CUPERTINO ULeced«
Q� REPIPE/SE�J ERS/MAIN SERVICE
UPEkTiNO PERMIT APPLICATION FORM
APN# 35q_210-058 I
Date.
Building Address:
/ ea r✓ of-
Owner's Name: CPPhone
� V
Contractor: 1 a /U ' n Phone: ` J 06 �8 License#:
L1V -Cf4i
Contact: G 1 Phone: J Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
YYI a,'0 l,✓A-� /"
Residential Commercial ❑
Cost of Project: n c� 0 0
•
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 Repipe of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•