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CITY OF CUPERTINO
b'dk x jBUILDING
DIVISION PERMIT
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BUILDING ADDRESS:
CUPERTINO PLUMBING
PERMITN006070087
11248 CATALINA CT
OWNER'S NAME:
PERMITISSUEDATE
RON JONES
1300 DELL AVE. STE
n7/14/2006
E:
SANITARY NO. CONTROL NO.
(408)253-0618
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG
O O O
LICENSED CONTRACTOR'S DECLARATION
Job Descr�
I hereby 0Rm that 1 under provWons of Chapur 9 (Commencing
is
with Section 70(18) of Divialon 3 of the Business and Pro(casiuv Code,md my license u
3 fthe Bu
w full cams and Me g�90
WATER MAIN LED
License Clan _ Lk. M
,
Da¢ +�COnwl[laf
A CHf1ECTSDECLARATION
1 he used as records
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understand my plans shall public
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Licensed Pmfcnional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Cornelius License Law for the
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following moon. (Section 7131.5, Business and Profession Code: My city or county
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which requires a permit to Construct. alwn Improv, demn ism, or repair any sou«um
Sq. Ft. Floor Area
Valuate n
prior to its issuance. aim requires the applicant for such pem1 to file a signed staumem
Li law (Chapter 9
du Lim
mad
that he is licensed pufma dl in ft provisions of tae
(commencing with Section 7000) of Division 3 of rite Business and Professions Cade) or
that be is exempt therefrom and the basis for the alleged exemption. Any vlolnlan of
ep
Occupancy Type
Soudan 7031.5 by any applicant for a permit subjects tate apPlkant w a Civil Penally of
not mom than fin hundred dollars (5500).
0 I. u owner of the properly, army aoployeex with wages u Neo aalecompemnlon,.
Required Inspections
will eo tha work seri theaha7ure 4notwwnded «aRertd raraala(Sm. 7044, Business
and professions Code: The Communities License Law does oat apply u N owns of
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properly who builds or i mprays thermn, end who dues such work himself err through his
awn emplayeex, provided that such Improvements; am ver in ended «Meats for Gala If,
however, we building or Improvement is wed within am year of completion, the awncr-
builose will ban the w rden of proving that he did Out build or improve for purpose of
sew.).
0 1, as owner of the property, am oclasively conuazling with licensed Conuutan to
Construct the project (Sec. 7044. Business and Profrudov Cade:) The Commicuses LI -
cern Law does not apply to an owner of property who builds or improves thermn. and,
who continues for such projects with acardro or(s) licensed pursuant to the Conwaernes
License Law.
0 latnexcmptumbosie .B&PCfarthtsmasoa
Owner Date
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COMPENSATION DECLARON
WORKERS ATI
1 hereby alarm under penalty of perjurynm of the following dMantwv:
Con
Ihave presided feibyeCanRwm of Consent Code. as Workersce of
fas
cation, u presidedchi (« EY Section 7100 of rite Labor Cade, far W performance a(the
work for which Nis peek b bassed.
1 have and will maintain Warkeh Compensation Ins«ance. u required by ScNan
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00 of the labor Code, for she perfarmance of that work for which this permit is Issued.
y Workers Compensation inaurmce carrier and Policy number a rt: r •�
Geier: �rAvi12 Policy No.:—/45S+V/l/
CERTIFICATE OF EXEMPTION PROM WORKERS'
COMPENSATION INSURANCE
(Thu matim seed natbecamPleud If the permit is f«ane hundred dollars (SIM)
Of CCL)
1 certify that in the performance of the work for which this permit is based. l shall tit
employ anypermn in any mmmrsa an in become subject in the Workers Compensation
Law, of California. Dau
Applicant
NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you should
became subject to Ne Workers Compensation provision of she labor Code, you most
,
forthwith comply with such provisions or this Permit Mall be dcemW remked.
CONSTRUCTION LENDING AGENCY
1 lu m ny aRm that there u a construction wading agency, for the performance of
the work for which this pcmit as issued (Sec. 3097. Civ. C.)
undoes Name
Lenders Addrea
I canary that I have reed this application and sou that the above Information It
mmCL I agree b comply with ail city and county antimatter and slow laws mutual w
building construction, and hereby authorise representatives of Nis city to enter upon the
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above-mcnumcd property for inspection purposes.
(We) agree to ssv, indemnify and Roup lumdeu the City of Cupertino against
liabilidu,judgmcnu, emu endmmpertsu which may in any way scam agaimtsud City
in c«tugmnce of the granting of this permit,
APPLICANT UNDFRUAMW AN ILL COMPLY WITH ALL NON -POINT
Issued by: Date
U0.
Re -roofs
Type of Roof
7 -/S -tit
Sigonurt ecurr ^� A Dow
US MATERIALS DISCLOSURE
HAYARDOERI
Will ft applicant or future building secupsauwro or handle laccuu us material
n defined by tis Cupertino Municipal Code. Chapter 9. dl, and the Health and Safety
C«k, Section 23533()7 ��
All roofs shall be inspected prior to any roofing material being installed.
CY. SNu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building asupant use equipment or devices which
cell he,arduv air contaminants ss d0Med by the Bay Area Air Quality Management
all new materials for inspection.
District? /
0rex &45
Ihow: mal the meadows materials requirements undcrChapmr&95 of the Cali(oe-
nu Health& SafetyCade, Sections 25505,75533 anu 25531.1 understood this ifda Wilding
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(IOL'Snat c send h rya d, that it is my rcapovlhility m the athe
oddly accepted of
uanrtm w metdutirc.¢ofamt�amya4
Sig eof ppli ate
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All roof coverings to be Class "B" or better
O a fmi,reag:M Dow
!m 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35621041.00
DATE ISSUED.......: 07/14/2006
RECEIPT #.........: 35256
REFERENCE ID # ...: 06070087
SITE ADDRESS ......
SUBDIVISION .......
CITY .............:
IMPACT AREA .......
OWNER ............:
ADDRESS ..........:
CITY/STATE/ZIP ...
11248 CATALINA CT
CUPERTINO
RON JONES
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: FRANK CARDIA
CONTRACTOR .......: CARDIA, FRANK L LIC # 612
COMPANY ..........: CUPERTINO PLUMBING
ADDRESS ..........: 1300 DELL AVE, STE C
CITY/STATE/ZIP ...: CAMPBELL, CA 95008
TELEPHONE ........: (408)253-0618
4kEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW SAL
--------------------------------------------------------------- ----------
BPWSVCS WATER SERVICE 1.00 9.00 0.00 9.00 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
TOTAL PERMIT : 47.37 0.00 47.37 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 47.37 VISA
------------
TOTAL RECEIPT 47.37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
- -------- ----------------------------
103 UFER 106 SEWER & WATER
507 FINAL PLUMBING
0
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building De artment
JOB I / :t of S ss: 6,-4r, Itns.. r—+ .
PERMIT #0 V 10O
OWNER'S NAME: o� c-,necPHONE
# 253-06 18
GENERAL CONTRACTOR:,,,, PI,�y,
FAX #
g y t ��
I am not using an subcontractors: i 7—/5 U(o
�Signature Date
Please check applicable subcontractors and complete the following information:
ner/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
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
lambing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
ner/Contractor Signature
Date
CITY of
CUPEkTINO
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN# nl LI
`T
Date:
Building Address:,
BPGAS
/ V8 -L te, ,nti
PLUMBING
Owner's Name:
Phone #:
onszS
C/S/G—/O//
Contractor: Phone:
License #:
CL.,,4j� ,v P1u-v�6 s3-ri
GaU9v5
Contact: 1 V Phone:
Cupertino Business License #:
fang
PLUMBING
Building Permit Info:
Sewers
Bldg ❑ Elect ❑ Plumb
BPSEWAGE
Job Description:
PLUMBING
Residential Commercial ❑
Cost of Project:
BUSLIC
•
0
Qty. if
Annlicable Fee ID
Fee Description
Fee Group
BPERMFEE
Bldg. Permit Fees
BUILDING
BPGAS
Gas Piping System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Repipe of Fixtures
PLUMBING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING