08100062 CITY OF CUPERTINO n 77-� 4 r 1 t � 0b- 3 �'
BUILb1ii G'D11YS{aJN PERMIT ,��I TRACrOw NFORMAkTION
BUILDING 4DRESS: PERMIT NO.
20riS6 HOGUE CT TBD — TO BE DETERMINED 08100062
OWNER'S NAME: PEi'WTL4UEDAIE
DOMINICK WONG 10/10/2008
NE: SANITARY NO. CONTROL NO.
ARCHITECTPENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION
1 hereby strums that 1 am licensed under providana of Chapter 9(commencing lob Description
with Scene.7OXd.fDivisdonlofthan IS ssudlarediomCode.andmylianscu REPLC WTRMN FRM MTR TO HSE — DUPLEX***
run fbhca rod crt
>'q_ Lianma . IY.g NOTE: CLEAN ROOTER & 'PLUMBING PD FOR BUSLIC
conusnar
uuuy��� CHTECrS DECLARATION
< 1 undersand my plan shall W used aspublic mord
g o
iLicenLicensedccd professional
3 OWNER-BUILDER DECLARATION
<i I hereby arum that I am peempt from the Conuacto',License Law for the
0 o following reason.(Section LD Id,Business and Profession Cade:Any city or county
e m which requires a Permit to cmuuuct alcor,improw,demolish,or pepsin my structure
a=m prior to its issuawc,Also requires the applicant for such permit o rile a signed tammem
p < thatheislicensedpursuanttothepmvislnnoftheContractor'sUcammLaw(Chapmr9 Sq.Ft.Floor Area Valuation
yelcpmci
mcnngwithSeed..7")ofDivision3aftheIsnumsmdPmfessim
Cock)lir $2200
e 5 s_ that W is exempt throfmm and the bub for tW alleged emmption.Any violation Of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty or yp,I�t Number Occupancy Type
not mare Nan rive hundred dollars(M). 3162440 :V17,
bona oftupropeny,mmyemploymwiNwariau kmkcanpensatan,
will m the work and the structure is notinunded Cir aRemd tartare(Sec.70H.Business
and Prafesaans cod:The conuaemrs Lienaa Law does our apply m an Owner Of Required Inspections
reopen wW build.orimp—tharmn.and whodoessuch workhimselfor through his
own<mplaynes,provided matwch Impmwaienu tie not Intended conflicted forsak.If.
however,one building or improvement is mid within am year of completion.an,owner-
builder wBl Aave the burden of proving that W did ret build or improve for puryose or
ale.).
❑I.As maw of the properly,aro eselusively communing wide lianed mnuanau in
cmutrtut the pmjem(See.706x,Bunions and Pnfestions Code:)The Cmuacmis U.
cense law docs not apply in an owner of property who Wilds or improves thereon,rel
who emusca for such pmjeeu with s eanvamor(sI licensed penmm at the Cominstta's
Limn law.
❑I am exempt mdm See B k PC for Nis nems
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby afTirm under pelally Of pudw,One Of the follPNlrrg dClsoma n:
I hsve anld will maintain a Certificate of Consent to seIf4aama fm Workers Compen- _
salon.As provided for by Schon 77W of the labor Code.fm tW perfmnanm Of the
work f hicIs Nis permit is sapped.
haw and will maintain Workers Compenadon Inane.as raq iced by Section
3700 of the labor Code,for the performance Of the work for which this permit b issued. -
MyWorkcesCompensationWeroneam liry number are:
Cartier. i �wn S�Fn Polity No.: 2YC
RTIFI TE OFEXEMMONFROM O KERS'
COMPENSATION INSURANCE
(This section hand ret W cmnplemd Uthe pctmh is rare=hundred do0ara(51011)
Cir less.)
1 codfy that in the performance of the work for which this permit Is issued.l shall not
employ any person in my mancerm As As become subject to the Workers Cmopensatim
Laws of Califtral .Data
Applicant .
NOTICE TO APPLICANT:If, for making Nb Certificate of Exemption,you should
become subject to the Wmkers Campention provitian of the IaWer Code,you nom
O faMwith comply with such previsions or this pemit shall W rimmed peaked.
'E M CONSTRUCTION LENDING AGENCY -
F I Wreby affnm that there u a crostmmlan lending agency for the lerformance of
ato work for which this Permit Is bound(Sec.3097,Civ.C.)
WUndoes Nameti A
.7 z Lenders Address
U O I mrtify Nat 1 have mad this application and sou that Uta+cove Information is
CL E comm.I agree to comply with all city and county ordleanca and apse laws resting In
C) Wilding conswcton,and hereby antharire repmsenutiws of this city to enter upon the
W about-mentioned property for impcnian purposes.
CA (Wer)agree to ave,indemnify and keep harmless the City of Cupertino againt Ir
rel liabilities,judgments,oma and expenses which may in my way weave against said City
U z in consequence of the granting of this Ismaili.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. – ��
Re-roofs
Sign "of ApplicanUCOnuanar
Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant score or handle haurdam material
as d0ned by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Com.Section 35532(+)7All roofs shall be inspected prior to any roofing material being installed.
❑Yen gKo�
Will the applicant or future Wilding occupant use equipment or mviors which If a roof is installed without first obtaining an inspection,I agree to remove
t harardnus air contaminants u mfhned by the Bay Area Air Quality Management all new materials for inspection.
Oisuict7
❑Yen Nu
I have read!the hmardam materials requirements under Chapkr 6.95 of the Califor- //' _lam /O
nu Heolth&Safcry Cada Scodon25505,25533mdM534.lunmaandthmifthc Wilding
dam not currently hove a tenant.that It b my rmponibility to notify the oaupant of the
reggmments which must tu met Prior AnissuanafaCertificate ofaapmcy.
U Signature of Applicant Date
Owner or mthmimd gcm Dau
All roof coverings to be Class'W'or better
a '
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31624040 . 00
DATE ISSUED. . . . . . . : 10/10/2008
RECEIPT # . . . . . . . . . : BS000006323
REFERENCE ID # . . . : 08100062
SITE ADDRESS . . . . . : 20186 HOGUE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DOMINICK WONG
ADDRESS . . . . . . . . . . : 20186 HOGUE
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2342
RECEIVED FROM . . . . : CLEAN ROOTER & PLUM
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . 1 :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BPWSVCS WATER SERVICE 1. 00 20 .40 0. 00 20 . 40 0 . 00
1BSEISMICR VALUATION 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---- ---------- ---------- ----------
TOTAL PERMIT 101 . 98 0 . 00 101 .98 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 101. 98
---------------
TOTAL RECEIPT 101 . 98
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- -------------------- -------- -------- -----------
106 SEWER & WATER 301 ROUGH PLUMBING
507 FINAL PLUMBING
•
CITY OF CUPERTINO
I
REPIPE/SEWER/MAIN SERVICE
• CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
to-jp -cp
Building Address:
Owner's Name:
Contractor: / Phone#:
A00 er, G7✓� r G Fax #:
Contact: Phone#: '
Fax #:
Contractor License
Cupertino Business License #:
Job Description: L.� tag t ✓. �r w� l .� r c,- LFv �e
Residential ] Commercial ❑
Valuation:
Project Size: Express L] Standard'J52r 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
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
/ 1BSEISMICR Seismic Residential P
1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
.
CITY_OF CUPERTINO
e� REPIPE/SEWER/MAIN SERVICE
CUPEkTuvo FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1PRREPIPE Residential re-pipe per fixture P 1RPRP
IBPWSVCS Water Service P ICPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
113PGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1PLMBLNCK Plumbing Plan Check P •
1PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel &Documentation Fee B
IBUSLIC Business License B
Revised 6-16-08
•