07050039 77777777777--777
CITY OF CUPERTINO
PERMIT
BUILDING'DIVISION Pi_7�'il�lYli T
PERMIT NO.
BUILD X1NG6 ESS:
RED FIR CT DIJOSEFF' S PLUMBING INC 07050039
PERMIT ISSUE DATE
`OWNER'S NAME:
KWAN, THOMAS 2867 KILO AVE 05/07/2007
SANITARY NO. CONTROL NO.
_)NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: RE—PIPE HOUSE (HOT AND COLD BLDG ELECT PLUMB MECH
i p p LICENSED CONTRACTOR'S DECLARATION Job Description
%V C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z m with Section 7000)of Division 3 of the Business and\Professions .and my license is
>>y in full force and effect
)vn 2 License Clask •>< r L�
F m Date_T� � Cona2clar 7!,f.5
.a ARCH1TECfS DECLAVATION
j < 1 understand my plans shall be used as public records
>yU
a y Licensed Professional
y< OWNER-BUILDER DECLARATION
I hereby affirm that I arts exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
<.9
.9 which requires a permit to construct,alter,improve,demolish,or repair any structure
rA prior to its issuance,also requires the applicant for such permit to file a signed statement q,Ft.Floor Area Valuation
-Z a li
that he is licensed pursuant to the provisions of the Contractor's cense Law(Chapter 9
rF=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ApN Number Occupancy Type
not more than five hundred dollars(5500).
❑I,as owner of the property.or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements arc not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of Proving that he did not build or improve for purpose of
sae.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li.
cease Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. B&P C for this reason ARY
Owner Date NIT
WORKER'S COMPENSATION DECLARATION bA
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worrkees Compensation�Insurance
carrierp&P,CC?#cy number
am-
Carier9'Qyz-ft -e7
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,t shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
,z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
H-II hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(See.3097,Civ.C.)
W Q Lender's Name
� In Lender's Address
U 0 1 certify that 1 have read this application and state that the above information is
(L rr correct.I agree to comply with all city and county ordinances and state laws relating to
0Ubuilding construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOURC REG ATIONS. � �
(/�f r 10, 5 _�'� Re-roofs -�
SignatumorApplicant/ContractorDam T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed.
❑Yes
If a roof i;installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection.
District?
❑Ycs ft
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant that it is my responsibility to notify the occupant of the
require is whi must be m pruance of a Certificate of Occupancy.n Signature of Applicant Date
?- All roof coverings to be Class"B"or better
Owncr or authorized agent Date
CITY OF CUPERTINO
ITEM 1 OF 1 PERMIZ RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN . . . . . . . . : 35S05065 . 00
DATE ISSUED. . . . . . . : 05/07/2007
RECEIPT #. . . . . . . . . : BSC00001221
REFERENCE ID # . . . : 07C50039
SITE ADDRESS . . . . . : 21( 52 RED FIR CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KWIN, THOMAS
ADDRESS
CITY/STATE/ZIP . . . : PLE,ASANTON CA, 94588
RECEIVED FROM . . . . : REC:EIPT INTERFACE
CONTRACTOR . . . . . . . : ANDREW DIGIUSEPPE LIC # 22796
COMPANY . . . . . . . . . . : DIL--OSEPH'S PLUMBING INC
ADDRESS . . . . . . . . . . : 28(,7 KILO AVE
CITY/STATE/ZIP . . . : SAlf JOSE, CA 95124
TELEPHONE . . . . . . . . : (4(18) 365-2058
FEE ID UNIT QUANTITY INOUNT 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 REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 38.37 1939
---------------
TOTAL RECEIPT 38.37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------- -------- ----------------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
CITY OF CXPERTINO
REPIPE/SE ERS/MAIN SERVICE
CUPEkTiNO PERMIT APPLICATION FORM 3
APN# 2 / _ a-5— Date: 7 _ D
Building Address: lD S 2- FI'K
Owner's Name: /��0 t-7 Phone#� v2 ^ `1,2 S^2
Contractor: pIlk Phone: � p�f' License#:
Contact: Phone: � Cupertino usi ess License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description: {�jk/,-,(- S (:�
Residential Commercial ❑
Cost of Project:
Qty.Y• 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
MAY-17-2007 09:39 MARK THOMAS CUP 4082535173 P.01i01
`moo S ILK(r,�4po
DISTRICT MANAGER-ENGINEER �A �P BOARD OF DIRECTORS
MARK THOMAS&COMPANY,INC. �'4� � i STEPHEN C.ANDREWS
DAVID E.ROSS 9WILLIAM A.BOSWORTH
DISTRICT COUNSEL YEA'R5 Of JOHN M.GATTO
ATKINSON FARASYN,LLP. �4f i.E.AV.. 9��
CURTIS B.HARRISON
'*e41;18HILS 1 WENDELL H.KERR,JR.
HAROLD S.TOPPEL
20833 STEVENS CREIiK BOULEVARD,SUITE 104
CUPERTINO,CALIFORNIA 95014-2154
(408)253.7071 PHO JE • (408),2535173 FAX
www.cupertino:an itarydistrict.com
F:le: CuSD-- MOP
Building Dept, —Cupertino
City of Cupertino
Attn.: Building Department
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: Re-Pipe water line
Name: Kwan Residence
Address: 210.52 Red Fir Court
APN: N/A
Permit No.09050039
No additional conditions/requirementsby the District.
Inspector: George Santos/Tony Soares,Joe Sullivan
Date:...05-17-200"7................... Sanitary Sewer Location:
J
" WAyW
cc: Property Owner
SUPPLYING SANITARY SEWERAGE SERVICES FOR:CITY OF CUPERTII10,PORTIONS OF THE CITIES OF SARATOGA,SUNNYVALE,LOS ALTOS AND
SURROUNDING UI(INCORPORATED AREAS
TOTAL P.01