08110064 CITY OF CUPERTINO /�-� -` p� �,F++ ' p'�'� '`^ " ` r •��°
BUILDING DIVISION PERMIT lvO ll[?4iQA � 1��N J.
BUILDING ADDRESS:• PERMIT NO.
10471 PINEVILLE AVE GIANT PLUMBING,
W
ONER'S NAME: PERMIT ISSUE DATE
NE: A 0. CONTROL NO.
(408) 445-8507
BUILDING PERMIT INFO
ARCHITELT/FNGINEER: -
BLDG EIF.CT PLUMB MECH
0 0 0 0
pop LICENSED CONTRACTORS DECLARATION Job Description
U 1 brachy alum that 1 sen lkenacd under Provisions of CNp ca 9(commrmcing
with S=t1W 7=)of DivWom 30fde BudressatM Profcssimm Conn,sed my lleenm u
oh in full form andcffesm COPPER RE-PIPE, GAS RE-PIPE ,
p x License Ciass La.0 -
=Fp Dale COmmocor -
ARCHITECTS DECLARATION
w< 1 understand my puns shall W used as, m public names,
a
Cin Licensed Professional
OWNER-BUILDER DECLARATION
sP�M 1 bertby affirm that 1 am exempt from the Commences License Law for the
i
00 following ream..(Section 71131.5.Business and Profession Code:Any city Or county
K m_ which requires;a penult to ennuuet abut.impmw.nnmolich,car-Fair my strunurt
Lz> prior at its issuaxe.Alan requires to applicant for such permit Le file A signed statement
s Gthat be is m licensed pursuant the provisions of the Common's Ucve Iaw(Chapter 9 Sq.Ft.Floor Area Valuation
9�$ (commencing with Semon 7000)of Division 3 of ft Business and Professinm Code)or
that thau6800
`t— at he u exempt fsom and the basis fm de alleged ascription.Any violation of
Section 7031.5 by my applicant for a permit mhjccu the applicant to a civil penalty of APN Number Occupancy Type
ant mare Oban five hundred doll.(115am. 36913021 . 00
0 Lssowmrofthe property.ormyemployces with wagesas deircokcompewdon.
will da the work and the atructurt W not intended orORertd tarsale(Sa.70U,Businev .
and prefeadov Coda:The Co uncmr's Llcnua Law dens nut apply to std owner or Required Inspections
property who builds m improves memo.,and w ha does such work himml f Ot Wrought his
awn employees.provided Nn such improvements are not intended aroffercd for sale.It.
however,Ne building or improvement is mid within arta yes,of completion.the Omear-
builder will love the burden of proving that lex did not Wild Or improve far purpose of
mW.).
,0 1,as owner of the property.am exclusively,contracting with licensed conaacta,to
construct the project(Sec.7014.Business and Profession Code:)The commences u.
cause law does not apply to an owner of property who Wilds or improwa thereon,and,
who contracts for such pmjcm with a contranus(s)licensed pursuant m the outdistances
IJcena law. .
01 am exempt uncle a Bdl P C fa thatmswn
Ower Dam I(/1u)/4
WORKERS COMPENSATION OECLARATION
1 hereby anum under penalty of perjury me of the following dechuations
I haw and will maintain a Certifiauof Conant m xlf-insure rmworkcfs Compen-
'on,as pmvided far by Section 37M of the labor Code.far the performance of the
wok for which this permit is ism W.
0 I have W will maintain Workers Compevnian Insurance,as requited by Section .
3M athe labor Cann.for me pufomsatwe of the work for which this permit is issued.
My W.W.Compensation hourrsoc Moire and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section reed not be completed lima Permit is fn o ve hundred dollen($100)
or less)
I certify that in the performance of the work for which this pc.I,is issued.I shall not
ample,any person in my manrerm as to become subject in tbe W'orceri Compensation -
laws of Califomi
Applicata
NOTICE To APP mr mzldng this Cattificam of Exemption.you should
became subject m the worker's Compensation provisions of the UWr Cada,you most
.J z forthwith comply with such provisions or Nu permit shall W accrued revoked.
za y . CONSTRUCTION LENDING AGENCY
[-v Thereby affirm that Wert is a construction lending agency for de p Orfernasxe of
E
.moi lie wart for which this permit is issued(Sec.30Ys,Civ.C.)
Q lenders Name
,z Lcndeea Address
V Q I m.ify Nat I have read this appikamn and sou that the move information is
LU F corse..I agree On comply with all city and county on insnces and sure laws relating to
.0 building construction,and hereby aumori>e repmmntatiws ofthis city to enter upon the
LLl shove-mmuoned property far inspection purposes.
(hoc)agree to saw,indemnify and keep ba culess the City of Cupertino against
uF,th Lothiliftsjudgmcnu,cosu and exponent which may In my way accrue agaivtseid City
U z in consequence of the granting of this permit
^� APPLICANT-UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINr Issued by: Date
SOUR EGULATIO S. IN
---�� Wl ar r l Re-roofs
Signature of AMI s un Contmcnor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant Or future Wilding acupantsrore or handle haraNuv material
as dented by the Cupertino Municipal Code.Chapter 9.13.and the Health and Sa@ty .
Code.Section M32(.)? 177 e
❑Yv All roofs shall be inspected prior to any roofing material being installed.
Will IW appbc tit or rave Wading Occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
in bzndnv air... nu as nnfued by the Bay Arra Air Quality Management all new materials for inspection.
atrict7
DYm C(No
I have mad the ha>vdws mauriabrcquimmentsunderchapur6.95 of the Califar.
nth&SafnyCede,Sosuw Us05.25s33 atW]SS3a.l unnnrsaM Nmifde Wilding
J rot currenmY haw a eturq that it u my mpondMlitY b nai(Y Use mcupant of dx
hiebm Ai t� `f Sr+uficauorampuuy. Signature of Applicant Date
owner ormthan>=a.ea.t D,te All roof coverings to be Class'%¢"or better
w
CITY OF CUPERTINO
• 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36913021 . 00
DATE ISSUED. . . . . . . : 11/18/2008
RECEIPT # . . . . . . . . . : BS000006639
REFERENCE ID # . . . : 08110064
SITE ADDRESS . . . . . : 10471 PINEVILLE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : . DAVID LU
ADDRESS . . . . . . . . . . : 10471 PINEVILLE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DAVID K LU
CONTRACTOR . . . . . . . : DONNY GREGG LIC # 24389
COMPANY . . . . . . . . . . : GIANT PLUMBING, INC
ADDRESS . . . . . . . . . . : 2111 DRY CREEK RD
CITY/STATE/ZIP : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 445-8507
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ ------ ---- -- ----------
1BPGAS OULETS 1. 00 61 . 19 0 . 00 61 . 19 0 . 00
1BPWATER UNIT 1. 00 40 . 79 0 . 00 40 . 79 0 . 00
1BPWSVCS WATER SERVICE 1 . 00 20 . 40 0 . 00 20 . 40 0 . 00
1BSEISMICR VALUATION 6, 800 . 00 0 . 70 0 . 00 0 . 70 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0. 00
1PRREPIPE NO OF FIXTURE 1 . 00 10 . 20 0 . 00 10 . 20 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
TOTAL PERMIT 214 . 86 0 . 00 214 . 86 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- - --------
CREDIT CARD 214. 86 VISA
---------------
TOTAL
-------------
TOTAL RECEIPT 214. 86
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ------ ----------------------------
301
--- --- -
301 ROUGH PLUMBING 507 FINAL PLUMBING
•
ICITY OF CUPERTINO of l l 0 o Y
REPIPE/SEWER/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
(o°l ( oaI- o v n
Building Address: p
l0�7 1 Pyvvlllf AV-C.
Owner's Name: Lv`
pay; Phone #: lfQ�,R34 -912?
�
Contractor: //� ff Phone#: Zfo&, #4S- gS0'}
(7iAl1{ �IAiY1bFItG�
o Fax #:
Contact: Phone #:
Don ��e55
Fax #:
Contractor License #: 65$07
Cupertino Business License#: 2 yd 89
Job Description:
Coppr Refire G" re -PiPc
Residential 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 Buildin Points: - Qos
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
IBSEISMICOM Seismic Commercial P
1BSEISMICR Seismic Residential P
1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEkTiNO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
IPRREPIPE Residential re-pipe per fixture P 1RPRP
Q 1BPWSVCS Water Service P ICPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFLYTURE 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
/ ITRAVDOC Travel &Documentation Fee B
1BUSLIC Business License B
Revised 6-16-08
•