06050057 CITY OF CUPERTINO
BUILDING DIVISION PERMIT "Co INF�ORMATIQN
BUILDING ADDRESS: ABLE SEPTIC PERMIT NO,06050057
22434 RIVERSIDE DR
NER'S NAME: PERMIT ISSUE DATE
OW
ANDY CHENG 520 REED ST. 05/08/2006
IRV ONE: SANITARY N0. CONTROL NO.
(408) 377-9990 -
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 (�
i0Z' LICENSED CONTRACTOR'S DECLARATION
IZ C 1 hcmby affirm that 1 am licensed under pmvivons of Chapter 9(mmmcncing Job DCSCTi
<t� wi0S 6on7")of Division3of NCBusinrssand Prof u Cade,and mylicevc is FINALED
in rnn force arta efrm •� �7nN�5 INSTALLING NEW BACKFLOW
j�a Licence Clans Co.—'N �-� N`
irw Dole C il�rv� Cod if M a {ttGl �J ins
Tv-- ARCHf1ECTS DECLARATION "•��CJ{.Y 2006
E w i 1 uMcrsund my plans shall he used u public records
t; LicensedPmfcssianal
to OWNER-BUILDER DECLARATION
1 hy aRfm that em esdmpt from Uta Cornerstones LimLaw for the
O o W re
following team".(Section 701.5,Business and Professions Cole:Any city at county
i S K which requires a permit to convect,altar,improve,dcmislbu.or repair any amctum $552
�zw, prior In its issuance.auu mquima the applicant for such permit to file a signed stavmcnt
mm< thatheulicensedputmanuotheprovisionofNeCmuracmr's)JanneLaw(Chapttt9 Sq.Ft. Floor Area Valuation
[F� (commencing with Section 7000)of Division 3 of NC Business and Profusions Celli or
y Nu W is exempt threfrom and the basis fm the alleged assumption.Amy violation of
Section 7031.5 by any applicant for a permit subjects the applicant th a civil penally of 3 r U Occupancy Type
not team than fin hundred dollars(S500),
❑I,uowm4 of the pmprty.omy wployeu with waguadtah sole compevauon,
will dothcwons and themunurtunots License
Law
does not apply in an Owner
Required Inspections
and Professions Code:The Co ttrandoo License Law dons not apply lf an owner of tl p
own,em whobuildsoimprove Hereon,andwbo doessuchwort himselfterthroughh.
humns.lth ens.providrI Wt wch improvemdnu in net ear oft moffred for ale r-
builder.Nebuilding terImprovement aheld withinone year v I Improve
the purpose will have the burden of proving that M did not Wild m improve far purpose of
sale.).
❑1,as mwoer of the property am exclusively convicting with licenced contracmm to
canstmct the project(Sec.7014.Business and Prafesu mus Cede:)The Ci nmacmri Li.
came law does out apply an an owner of property,who Wilds or improves thereon.and.
who contracts for such projects with a contractur(s)licensed persons to the Commoner
License Law.
❑I am aempsunder Sec. ,B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 Wmby aRno under pointy of perjury ane of the fallowing declarations:
I haw and will mainum acrtificam of cogent to self-Insure fmworlcesCompen-
smism.as provided for by Section 37M of the Labor Code,fm the performance of the
wart for which this permit is issued.
❑I ban and will maintain Wofhers Compensation Insurance,as requited by Section
3700 of the laborCode.for Ne pcdomunce of the wall,for which this Permit Is '
My Wm1nlss•)CZSye dh IInsumsc ca and Policy number se:
Gain: JT0.1C�1aI Ut� Policy No.:I
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE v
(rhu aeetion need and W completed if the permit is Forane hun&cddollan(SIM)
or jus)
e ploy that t tW inperf
my n tha of the work Im which this permit u issued.I snail not
employ any person in any manllerso as to Weamt subject in the W9rkra'Compensation
LawsCalifamia Data
NOTICE
OTApplI ca a t
NOTICETO APPLICANT.If.after sharing this Certificate of Faemptiodyou should
.JObecome scoop m tiro WmrW1svision r this armiisom of tse labs Code you most
foMwiNcomply with such Provision or Nu permitshaliW deemed mated.
7 CONSTRUCTION LENDING AGENCY
r/
F Ihemby affirm that Nem is a construction lending agency for the pisfurmanec of
2' the won for which this permit is issued(See.3097,Civ.C.)
aQ Landers Name
7,Z Umbers Address
U Q 1 certify that 1 have mad this application end sesta Nat tW above information is
U,P correct.I agrm to comply with all city and county oWinartas and aunt laws relating to
OU building conswction,and hereby authorim mpmecnutivu of this city to toter upon the
rty
purpo
W ahbvctes.judgmenw.cat fond epcNon which ms.
t„•i p5. (Wes)agree to save,indemnify and seep harmless use City of C"Penlmm against
N liabiliuu.Judgmcnu.emu and exposes whichmayin any wayamue agaietsaid City
C.)z in conseque Ne gr g of this permit.
APPLIC U ERS NDS AND WILL COMPLY WITH ALL ON-POINT Issued by: Date .\J
EGULA Sn �� 70'
slgnmum— of App R�'it for ZOO
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding mcupentzom other dlc huudous material
ar defhtad by 0m Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cods.sectio"23532(a)?
❑Yes --Ly No All roofs shall be inspected prior to any roofing material being installed.
40 Will ties applicant Of future Wilding occupant use equipment or devices Mich If a roof is installed without first obtaining an inspection,I agree to remove
emit Wrasnu air cmumimmus an defined by the Bay Ama Air Quality Management all new materials for inspection.
District
❑Ye /u
I haw rad the harmdoss maurialsrcquimmenm under CTapter6.95 ofthe Califm.
nia Hcalth&Safety Code.Sacions x5505.25533andx5534.1.ndc.dthaifft Wilding
doorrotca tenons thus it u my mamusindity to rmufy Nthe
e Occupant or
no men ww hie an =Ip�uandeafacmrxi;.f.ffotcQ. 6 SignatureofApplicant Date
d
Owner or authormdd agent Data All roof coverings to be Class"B"or better
-^, Community Development
10300 Torre Avenue
J Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
WUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: NNd G V2.N PHONE #30 67 - '7
GENERAL CONTRACT FAX #
I am not using any subcontractors: I
Signature Date
Please check applicable subcontractors and complete the following information
60 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
T'
5-9-0 6
Owner/Contractor Signature Date
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35602004 . 00
DATE ISSUED. . . . . . . : 05/08/2006
RECEIPT # . . . . . . . . . : 34290
REFERENCE ID # . . . : 06050057
SITE ADDRESS . . . . . : 22434 RIVERSIDE DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : ANDY CHENG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3959
RECEIVED FROM . . . . : ABLE UNDERGROUND
CONTRACTOR . . . . . . . : GILBERT, GLEN LIC # 21407
COMPANY . . . . . . . . . . : ABLE SEPTIC
ADDRESS . . . . . . . . . . : 520 REED ST.
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050
TELEPHONE . . . . . . . . : (408) 377-9990
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 38 . 37 0 . 00 38 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 38 . 37 3792
TOTAL RECEIPT 38 . 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
•
oL005 005
CITY OF CUPERTINO
a REPIPE/SEWERS/MAIN SERVICE
• CUPEkTINO PERMIT APPLICATION FORM
APN# -J'5lD' OaQ^00L Date: O C�
Building Address:
AX4,S"i or-
Owner's Name: Phone#:
ANd G\(\Q-0 Cq 3
Contra c be. C Phone:3 � 990 License#: L)
Contact: Phone: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb B
Job Description: ( \\
\ nl�.cJ � Gr c,J
Resident Commer al ❑
Cost of Project:
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 Repi e of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•