05080034 r CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION <
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BUILDING ADDRESS: STANFORD PLUMBING HEATING &rATWO05080034
-10749 BROOKWELL DR
OWNER'SNAME: PERMIT ISSUE DATE
GENE MCGHIE 1965 KILE PARK COURT 08/04/2005
NE: SANITARY NO. CONTROL NO.
(408) 286-8931
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION lob Description
m 1 hereby am.that 1 am limnwd under previsions of Chapter 9(commencing P
�ZW with Section)OIM)of Division Sofd, Bosi,u_ss arWPrufc ions Cotic.antl myliccnw is
fullfnme and if 0 i - C ADD A/C
.
yy�? Liccnso Ul - Lk.M
Da¢ Comracmr
CNITECTS DECLARATION
¢< 1 understand my plans shall he used as public meads
>dO
u.N Licensed Pmfcssional
��< Oat I am exempt
from
mDECLARATIONCombra
eC) 1 hereby affirm on 1 1. eusin from the Gmtlrncmra l.icenx Law for the
a o fallowing.cues..Permit
t ]1/31.5,Business andmp ere.de tie h.or Any city or county
<$� which reyuiru a permit m construct,aline improve.Jcmolish,or repair any swemm $3650
u¢i pnonoto issuance,also require the applicant for such permit to file a signed statement
< throlve anwJpunwanuOthcpmvisiortsofthcCOmtxmr''sLisxnxlaw(Chapscr9 Sq. F[. Floor Area Valuation
YFG (commencing with Sermon 7070)of Division 3 ofthe Business and Profusions Couc)or
i $
that he is exempt therefrom and the hue for the allotted exemplfon.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of er U U Occupancy Type
not mare than Eve hundred dollars(1500).
I,as owner of the property.or my employees with wage M their able compenntion,
will do the work.and the structure is not intended Or offered for sale(See.7014,Businw
and P ofessions Conic;The Contractor's Lismme taw it=not apply m an owner of Required Inspections
property who builds Or imprev themon,and who does such work himself or through his
Own employers,provided that such improvements are not intended crORemd f rrsale.If.
however,the building or improvement is sold within one year of impletion,the owner.
builder will hese the protest of graving Nat he did not build or improve for purpose of
sale.).
❑h as Owner of the pmpeny,am exclusively convening with licensed contractors to
construct the pmjca(Sec.7044,Business and Professions Code:)The Contractor's Li.
comm law does not apply in an Owner of progeny who builds or improv thereon,and
who comets for such projects with a eomnctor(s)licensed pursuant to once Convacmfs
License law.
❑1 am neem pt under Sec. .B h P C for the mason
Owner Data
WORK ER'S COMPENSATIONDECLARATION
1 hereby affirm under Penalty of perjury one of the following declarations:
�]I have and will maintain a Ceniftate of Consent o 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.
❑1 have and will maintain Worker's Compensation Insurena,as mquined by Section
37W of the labor Code,for the performance of the wart for which this permit is issued.
My Work nape a60n Inwvrta coni andPolicy n onkram:
Carrio': Policy NO.:
CERITR TE0 CEMITIONFROM ORKERS'
COMPENSATION INSURANCE
(This section recd not be completed film permit is for One hundred dollars(1100)
or Ices.)
1 cevity o, or the Performance sesame O�,work fes y is permit is issued.1 shall nut
employ ahat in
ymancer ayL{�SOr uolMWorken Compendirmt
Laws of C 1 fes ni .gam
ApPlicap�TVAPP G
TVAPPLICANT LICANT:If,after Compensation
Nu C.riflene of Exemption,dyoushould
becomes comp to me Worker's Coons Or
is previsions of the Labor r v doo you mus
.J z foMwim comply with such provisions or this Permit pc domed mwkcd.
Z O CONSTRUCTION LENDING AGENCY
't-• I bcmby affirm that thea is a coombefon lending ageney for the performance of
a the work for which this permit is issued(Sec.3097,Civ.C.)
d Lender's Name
Lender's Address
O O t certify that 1 have read this application and suite that on above information is
Ls. F connect.I agree to comply with all city and county ONinarums and state laws muting ta
0U building construction,and hereby atehorim mpn;wnutiv of this city to enter upon me
W above-mentioned property for inspection purposes.
0. (We)agree to save,indemnify and keep formless the City of Cupertino agame,
f^'i,l liapilides.jutlgments,owtismd a nses which may in any way accrue against said City
U z mmnscqucncc Ofth 9 run fthis r,-
APPLICAKf U RS DS ANO WILL PLY WIT - 6th-P Issued by: 6i Date
SOURCE R T
P Re-roofs
Signau ApplicanUConuulor I
HAZARDOUS MATERIALS DISCLOSU E Type Of ROOF
Will the applicant or future building Occupant store or handle hanotous mammal
asdefined by the Cupenina Municipal Code.Chapter 9.13.and the Health and Safety
Code,Sccuon 15532(x)? All roofs shall be inspected prior to an roofing material beim Installed.
❑Tea ❑Na P P Y g g
—� Will me applicant or future building oecupant use,equipment Or device which If a roof is installed without first obtaining an inspection,I agree to remove
J ,mit hvardnus air'maurim u as defined by the Bay Area Air Quality Management all new materials for inspection.
Disl(Icl7
❑Ycs ON.
I have mad the b�.,aotnusm serials requimmc"'oil rChapur6.95oftheCalifm-
afctyCa6 Saud 5(15.25533 arW 255N.1 ondcnurtl Jut if chuiltlng
oe ort Oy a( ¢ r.�iba it uthe r pant Nes et ttA�rsranc nn cemEeatem t Signature of Applicant Date
q � �� All roof coverings to be Class"B" or better
Own tar I ri.Jagent rale
am
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
UPEkTINO
Building Department
JOB AD RE S: PERMIT#
Ul voo)tu-j&[ C y V v�
OWNER'S NAME: ao-p H r &AiePHONE # Z 2-r
GENERAL CONTRACTOR: aC v�l G V FAX #
I am not using any subcontractors: �ZIA61 D
Signa a date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
to Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO C�
Cel FURNACE /ACCITYOF
CUPERTINO PERMIT APPLICATION FORM
APN # I�t _ OO n Date: G
Building Address: 1
Owner's Name: C MC-
C Phone#:
C ntractor: SAb i t \3 fy\,Iptv\-j 1� �� License#:
Co`d8 �3
Contact: Phone
Applicant/Contractor:
Building Permit Info:
Bldg Elect Plumb Mech
Job Description:
Residential: Commercial:
Sq.Ft. Floor Area: q.Ft.:
Architect/Engineer: Valuation: O
•
Type of Construction:
YP Occupancy Group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY ergy BUILIDNG
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch & Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILIDNG
EPERMITFEE Elee Permit Issuance ELECTRICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
BPERMFEE
Bldg Permit Fees BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG