08100205 CITY OF CUPERTINO ��a,�.�+ A >nl �2t�® `�
BUILDING DIVISION PEyr,yyyyy y Wo;�:l,NTA
BUILDING
9x�,7..G. frra2bR.'rd2=ukSa=L'rvtl:; S°'-srzk`: -
BUILDING ADDRESS: PERMIT NO.
10750 RAE LN AZZARELL ' S TRUCK- -
OW NEWS NAME: PERMIT ISSUE DATE
S CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
INSTALL AN UNDERGROUND PIPE
X00 LICENSED CONTRACTOR'S DECLARATION FROM NEWLY INSTALLED
ec1 basby atfrm Net 1 am Reenacts mater Provisions of chapter 9(commencing lob Description
with Stion70(80, Division3ofthe Bud.and Pmfcstima Code.and my licensee
in full forte end fiam
I License Class Lt..0
95
' D Due - Covuactor
a F W ARCHITECTS DECLARATION
`` 7 1 uMersaml my plans"I be used as public rtwNs
It
g Lice rad Puefeaivnal
OWNER-SUILDER DECLARATION
I I hereby aRrm that 1 am exempt from the Contractors Liano Law for tha
p o fallowing woo.(Sadao 7031.5,Bust.and Pmfcasiou Code:My city or county
3$ Which requires a permit to contract aivr,hnprme.demolkh.or repair any svuama
Prior to it isuarce.ma rcquirm de applicant for such permit no filca sigadmuerna,
ESD this hu is licensed pursuant W the provisions of the Cosmonaut's Lice=Law(Chaptcr9 Sq.FL Floor Area Valuation
e F-$ (commencing with Suction 7000)of Division 3 of the Business and Professions Code)or
that he is esempt therefrom and the assts for the alleged evmptiav Any violation of
Section 70315 by any spplkut for a permit subjects the Applicant o a civil penalty of APN Number Occupancy e
not mole than five hundred dollen(S300). P y?YP
0 1,u ovencr of the property.or my suployw with wages as Nee ole ampenssa0en,
will an the wank and Ne swarm is not intended or offered for sale(Sec.70M,Bust.
and Professiam Coat The Contractors License law dors oat apply to an owner of Required Inspections
popery who Wilda wimpo ea lMaan,aMwho doe,such wolthimself or through his
owvcmployeas,provided east such improve menta ere not tntarldrd o 0flarea forsale.If.
however,the building a Impovemrnt is sold within one year of completion,Ne owner-
Wild a will have Ne burdrn of proving that le did rot build a improve for purpose of
sale.).
0 1,s u toner eq es popery..B unessivnd contracting with limned cousases U.
coamee Uc project(Sec.to a x,Rau.ave property
who Wilds
Cade)The Conuama'a lid SAN
cense law dna rot chpro to o wither of proleny who builds or improv therew,rets,
who contracts for such Do%cuvnN a conuanor(s)licensed pursuant o the Convectors
limn:law.
0 lam aemptand Sec B&PCfor Nismame
Owner Dari
W 5�$ATI�RATION
1 booby affnw under penalty ty of perjury aof the following daluatioa:
1 hart and will maintain eCadficateof Consent to elf-insure for WartcraCompen-
n,a ical for by Saturn 3700 of the Labor Code,for the perlowartm of do
wart for which this permit is house.
0 1 have and will maintain Workch Compensation Inaaance,as required by Section
37(D of the Labs Code,for the peeamaaxof de Wert for which NU permit is issued. -
My Workers Compensation Insurance,carrier and Policy number am:
Career. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TtuseNan need not becanpmud ff ft permit Is faave hunNW tstdars(SIM)
or lea)
I cenffy Nnt in Ne pafom moc of the wort for which this pewit is issued.I chail net
employ any Forms in any matter an as e become subject to Nvi
e Woes'Compeaation
Laws of Califomiee,,��tic
Applirw S AA 6's.? 1A
NOTICE TO APPUC-Af1l':IL aMr matlng tit nifcam of Escmpfia.you should
became subject us the Worker Compensation provisions.10.Lehr Code you muss
.J O forthwith comply with such provisions a Nu pewit shall W deemed rooked
Z "i CONSTRUCTION LENDING AGENCY
F > do was therebyi�N that Nem is a conswcaon funding agency fw the pert rmaae of
E
pareft is issued(Sec 309'1.Civ.C.)
fA Q Landers Ad
]z LeasM
ers ew
U 0 1 certify that 1 has mad this application and state that Ne shove information is '
IU causes.i agree to comply with all city amts county ordinances and awe laws relating w
.0 building conswcdon,and hereby authaice representatives of Nis city to enter upon las
W atone-mentioned property for inspection purposes.
(•+gy (We)agree to ave,indemnify mad keep hun leu tK City of Capetian against
Vl liabilities.judgments,can and caahas which may many way same aimu aid City
fJz AcPLICANT of Negrantin{of this permit /meq
APPLICANT UNDER NDS AN WILL COMPLY WITH ALL NON-POIM' Issued by: Date
SOURCE REGU
1 Re-roofs
unof Appii on r Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicau or future building occupant sore or handle huallous material
as ddined by the Cupertino Municipal Code.Casper 9.11,and the Heath and Safety
Cak. yer ONO 25532(a)?
OAll roofs shall be inspected prior to any roofing material being installed.
Yes
Wel the applicant or future building occupant sax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t hmardoa mu def
air canuminta ued by the Bay Area Air Quality Management all new materials for inspection.
r a?
Y. ON.
I have mal the huaNmumewfaHwquiremenu under Chaperh.95 of the Califor.
his NalN&S etyCale,Sadao 25503.25533 and 25536.1undcasand thuifthc Wilding
does not tennt
mly have a aNat is is my map n ibiliny to hotly the occupant lir do
men n of.Certificate or0c Signature of Applicant Date
Owner aa h rsd agcn Dau'
All roof coverings to be Class'W'or better
CITY OF. CUPERTINO
(40Q` REPIPE/SEWER/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN# — 0 7_ 04 Date:to
/3 1/,,aoO$
Building Address:
Owner's Name: C ` Phone #5
1O .3 90- 766
Contractor: Phone#: 3 9
Cll,k5 42-2011,0110, Fax #: 40
Contact: h� 'Agn9 or r,5An� Phone#:P* Q415--LA a $'S eh
-10 390 -o76 6 1 O4ipg 376 -o,7 a
6 a,+s
Fax #:
Contractor License #: 3 -79990
Cupertino Business License #: '
Job Description:
f -the-'4// a,7 ur�o�ei gqroan pipe �'r��n n�cvy ir�afzi l/eq�
L 44er4/ fa �zxt`srri`.�9 -SeW41J?e k4et Whovse.
esidential Commercial ❑
Valuation:
Project 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
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
arxv�,,-, CITY OF CUPERTINO
ge. REPIPE/SEWER/MAIN SERVICE
Cm or
CUPER,TiNO FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Permit Type
Group
IPRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS 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
1BPGAS 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
1BUSLIC Business License B
Revised 6-16-08
•
CITY OF CUPERTINO .
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 35607076 . 00
DATE ISSUED. . . . . . . : 10/31/2008
RECEIPT # . . . . . . . . . : BS000006516
REFERENCE ID # . . . : 08100205
SITE ADDRESS . . . . . : 10750 RAE IN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHANG CHRIS ET AL
ADDRESS . . . . . . . . . . : 10750 RAE LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CHRISTOPHER CHANG
CONTRACTOR . . . . . . . : CHARLES G. AZZARELLO LIC # 30374
COMPANY . . . . . . . . . . : AZZARELLO' S TRUCK-N-HOE
ADDRESS . . . . . . . . . . : 38 NICHOLS AVE
CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037-9326
TELEPHONE . . . . . . . . : (408) 778-4942
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 5, 190 . 00 0 . 60 0 . 00 0 . 60 0 . 00
1PPERMITFE FLAT RATE 1. 00 40 . 79 0 . 00 40.79 0 . 00
1PRSEWER UNITS 1 . 00 20 . 40 0 . 00 20.40 0 .00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0. 00
--------- ---------- ---------- ----------
TOTAL PERMIT 102 . 58 0 . 00 102 . 58 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 102 . 58 1114
---------------
TOTAL RECEIPT 102 . 58
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 400 SEWER/LATERAL
507 FINAL PLUMBING
•
Community Development
10300 Tone Avenue
X
% Cupertino CA 95014
Telepbone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
1015Z) a �
OWNER'S NAME: C-11k6r Ch4nfl5t en 4o PHONE #
GENERAL CONTRACTOR: , / FAX #
I am not using any subcontractors:
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
Tile
Owner/ tractora Date