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10060020CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21074 MARCY CT I—INER'S NAME: HSU DARREN S AND SANDY S t .. NER'S PHONE: 4088949072 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Contractor Lic. # Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the 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 accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. S'~ •gture Date 14 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) 1, as owner of the property, am exclusively contracting with licensVTt actors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, IXtfl►sj forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes. (We) agree to save mify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -poi o rce regulations per the Cupertino Municipal Code, Section 9.18. �r Signature Date b A v CONT RACTOR: SANDIUM PERMIT NO: 10060020 4223 N ERDIGRIS CIR DATE ISSUED: 06/04/2010 SAN JOSE, CA 95134 PHONE NO: (408) 894-9072 BUILDING PERMIT INFO: BLDG ELECT F PLUMB F MECH r RESIDENTIAL r COMMERCIAL r JOB )ESCRIPTION: INSTALL A/C Sq. Ft Floor Area: I Valuation: $3800 APN 1Qumb6r: 32654029.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: `T -" 10 RE -ROOFS: All ro afs shall be inspected prior to any roofing material being installed. If a roof is instal ed without first obtaining an inspection, I agree to remove all new materials for inspe,:tion. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the Calif )rnia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain coml liance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safely Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Heal th & Safety Code, Sections 255059 25533, and 25534. Owner Vthorized age t Date: CONSTRUCTION LENDING AGENCY I her ;by affirm that there is a construction lending agency for the performance of work's for v hich this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Cin OF CUPEI�TINO CITY OF CUPERTINO FURNAt�E/AC PERMIT APPLICATION FORM 100b'00'3 -C APN # -� �� Date: J to 0 Building Address, � A Owner's Name: IPhone # 36 $ S Contractor: Phone #: q 07c), 'SQL1 - Fax #: Contractor License #: Cupertino Business License #: g 8 11 Contact: Phone #: f� 7 I ' sdl �k (A Fax #: � Sb - 644 -- -Ps OS Building Permit Info: Elect ET---- Plumb Mech [�— Residential IN Commercial ❑ Job Description: For Residential Installations: Attic F11St floor El2°d floor 1:1 Adhere to minimum setback requirement. For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation [] New installation Planning Approval Required ❑ Cost of Project: Type of Const:-uction (Usage Class): Strapped ❑ On Platform n Bonded L New Location Replacement > Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Valuatio 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. a n 1 ince inn 1\GV 1.l.Gu V1/V//VJ CITY Of CUPEkTINO CITY OF CUPERTINO FURNAI-E/AC FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1 MRAPPVNT Residential for the 1 nstall/relocate/ or replacement of ea appliance vent install & not incl in an a pl permit. M FURNACE FURN/AC 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1BPGAS For each gas pipi ig system of 5 or more per outlet. P 1 BCBSC Cal Bldg StandardE Commission Fee B ALL PERMIT TYPES 1BSEISMICR Residential Seismic; B 1MECPLNCK Mechanical Plan Check M 1MFR=<100 Furnace Syst <=100k BTU install or relocate ea forced- iir/gravity type furnace/burner, inc 1 ducts/vents attached to such appliance up to and include 100,000 B u/h M 1 MFRN> 100 Furnace Syst > 10 )k BTU install or relocate ea forced-air/gravity type furnace/burner, incl ducts/vents attached to such appliance over 100,000 Btu/h M 1EPERMITFEE Electric Permit Fe: E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel Documentation B 1 BUSLIC Business License B CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: ak0-1 MOr PERMIT # U 6 4 OWNER'S NAME: I Stf a A. PHONE # — GENERAL CONTRACTOR: BUSINESS LICENSE # g� ADDRESS: 44b w, WD 6 CITY/ZIPCODE: c ke *Our municipal code requires all businesses working in the city to nave a %.uy u, ..upvl t...0 —3111.aa NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCON RACTO HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. r I am not using any subcontractors: ! 3 Signature Date Please check annlicable subcontractors and complete i he following information: Ij— 6131 Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Ij— 6131 Owner / Contractor Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RE2EIPT Sec: Twp: Rng: Sub: Blk: LDt: APN ........: 32654029.00 DATE ISSUED.......: 06/04/2010 RECEIPT #.........: BS000010557 REFERENCE ID # ...: 10060020 SITE ADDRESS .....: 21074 VARCY CT SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OPERATOR: TraciC COPY # : 1 OWNER HSU DARREN S AND SANDY S ADDRESS .......... CITY/STATE/ZIP CUPERTINO CA, 95014-1658 RECEIVED FROM ....: SANDY LEE CONTRACTOR .......: MICHAEL LEE LIC # 28867 COMPANY SANDIUM ADDRESS ..........: 4223 VERDIGRIS CIR CITY/STATE/ZIP ...: SAN JOSE, CA 95134 TELEPHONE ........: (408) 894-9072 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 3,800.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BREMAIRHA NO.UNITS 1.00 63.00 0.00 63.00 0.00 1BSEISMICR VALUATION 3,800.00 0.50 0.00 0.50 0.00 1MFR=<100 UNITS 1.00 126.00 0.00 126.00 0.00 1MPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 0.00 ---------- TOTAL PERMIT ---------- 274.50 ---------- 0.00 ---------- 274.50 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 274.50 --------------- 274.50 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- 1065 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CUPERTINO rnNTR ACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: `� /ZCaS S?"�Ut�'�S �2cz• Cl/ PERMIT # eQ 00 G OWNER'S NAME: �n r� C C� PHONE # GENERAL CONTRA TOR: ,.�c� —T IW64 �o BUSINESS LICENSE #31 ADDRESS: o po�A li,�y y S^c , CITY/ZIPCODE: C ST / *Our municipal code requires all businesses worxing in ine city to nava a ...ty v, —.•N— ••••� •-��•--���-________ NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SU TRAGAIRS HAVE OBTAINED A CITY OF CUPER INO BUSINESS LICENSE. I am not using any subcontractors: Date at are plPn-.P rhPek annlicable subcontractor and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR - BUSINESS 74AME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date ;us.# 317q$ u� the tfenEniess co. y J: • 1'• a' • �! Jamba Juice #0004 21265 Stevens Creek Blvd #201 Cupertino, CA 95014 RE: CIPP Lining Project — Cupertino, CA 4GNED) This set °t Arms and be L Ilawtul make fob a��� 28, 2009 on sane without r khan`'" r <�rterations Tt e to pining 0 illir"ent, om Gt -�'a�n it HAL_ mptn9 ° this Wan and I no. -1 approval NOT be held t° P9Rnri aeons Of .any `trtthe violation °t t" be an Y C)rdinance or �w The Trenchless Co (TTC) has inspected the sever line at the property mentioned above and found bottom of cast iron piping rotted ou and in need of pipe rehabilitation TTC recommends the following work:�� • TTC to prep jobsite as needed to make room for cured in place line Ayipment. .� • TTC to build and install approximately 30' of 4" cured in place liner to nstl from the access points. • Cure time is 10 to 12 hours. • After liner is installed and cures, TTC ,vill video inspect the liner to insure that it meets all standards and specifications. • TTC to install clean outs as needed to ;;ain access. • TTC to clean jobsite as needed. • TTC to hydro jet 2" line and replace fl for sink. Warranty: 10 year warranty on all material z nd labor. All work will comply with all industry standards. Total Cost: $7,500.00 ): C wner's or Agent's signature Date Salesperson Signature 600 Broadway, Site. C, Sacramento, CA 95818 • Office: (916) 455-4433 • Fax: (916) 454-4859 The Trenchless Co is a Division of _,ree:nberg Clerk Inc. • Uc. #x775703 Jamba Juice Location: 2 Inspector, Date.