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05100221 CITY OF CUPERTINO - BUILDING DIVISION PERMIT yCONTRAGTOR INF,ORMATON BUILDING ADDRESS: SPEEDY ROOTER PLUMBING PERMIT No.05100221 20298 CLAY ERS NAME: PERMIT MUE DATE TOKUDA HARUO AND FUSAKO H 2176 FAIRWAY GLEN UR . in/27/2ops PHONE: SANITARY NO. CONTROL NO. (408) 234-8134 ARCHITECT/ENGINEER: BUILDING PERMIT INFO 'BLDG ELECT PLUMB MECH :00 LICENSED CONTRACTOR'S DECLARATION - lob Description s C I hereby affirm Nat 1 am lic:med under provisions of Chapter 9(commencing p cu.uiwiNSmdon70W)ofOiviuoa3of Ne Businmsand Pr C dmyliccnmis < in full force and cffuct. ±=„ L� REPLACING EXISTING GALV. W/COPPER Li"m`nh2Tf�—c DEC 2 BATHROOM WATER LAUND 4`W �12 FIXTURES e H Date�� �44T"f171yaEN ££ ARC all bo used DECLARA ION S' f k 1 undcruand my plain shall bo used az public records ]aU COt', Licensed Profesuonsl . OWNER-BUILDER DECLARATION NOV /0 7 1 Weaso a?mm Not 11. acmpt from the GantaelCo License Law for the `0 2005 2 p o following"moa Panton 7(D I.S,Business and ve.d moll ll,or Any city Or county <m which its its s n Permit to stn. t,Jer,improv,h .it,or e..tartir any toucan, primmits issuaxc.Jw inquires lM aPPlicann for such pctmitmfile axigrcdsutemcm < OURhe is licensed p"w®uo the provisioasar the Conummr's Liana Law(Chapter 9 Sq.Ft. Floor AreaVU }' ' , '� eA aValDah$IQ 700 x1- (commencingwith Section]000)of Division 3 or the Business and Praressiav Cadc)or gl a+�� ��>1Qt-7 i�3 that be u exempt tlemfrom and the basis for the alleged exemption.Any violation of 4•.+3' 7% PNNumber Occupancy Type Section]B]LS Ey any applicants far a —it subjects Ne applicanuo acivil penalty of A at mom Nan love huMmd dollars ISM 36939019 . 00 1,u ownerof He propmsy,or I, intended of owagesazHeires.c ,Buiness will dolhcwork.and the he cluseCamusnotmkadese Law does oshas for apply us an Business Required Inspections and nny who Cade The C s therears License law d"a cot apply th an owns of q p Ownempt.,o Wads orimprovuch imprvewho dorafmtenek aimalfar through his owneer,the Wilding pr wenimprowmemsam not euofcded maffemd the Bale If. bwewr,the Wilding ho improvement is said within one year o improve far the owner. Of ank.). will low the WNa of proving that be did not Wild m improv for purpose of talo.). ❑1,as war of Ne property,am ca.b.towly Canvaning with licensed...an.to construct the project(Sec.70aa,Business and Profession,Code:)The Conuxcmr's Li- cease Law does not apply at an owner of property who Wilds or improves Hereon,and who contact for such projcas with a contrmmr(s)lice,ad pursuant to the Cmuscrors License Law. ..pp„„"" ''''1 �rl an'h/aempt under See E X as• -y t ,B @ P C for Nis mason �er l�I( d yQ-IJYA-I't'] Daa J )2 OS WORKER'S COMPENSATION DECLIRATION 1 hereby affirm under perulty of perjury ore of the following declaration,: 1 have and will maintain a Cer ificam of Con,em m ulf insure fm Workers Compcn- sadan.as provided far by Sxuon 37M of the labor Code.far the perfarmana of the wort for which this permit u issued. ❑1 have and will maintain Wmace,Compcn,atian Imursaa,as required by Section 37M of the Labor Code.far Ne perfarmane.of Ne work fm which d u permit is W"d. My Workers Compensation Laurance artier and Policy number are: carria,. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section aced not to completed i(de Permit is facet hunthed dollars(SIM) or lust) I ccm(y Not in the perfarmancc of He work for which this permit is issued.I she]nut employ any person in my sooner on as to become subject o tM Wormo'Compensation Laws of California Dau: Applicant NOTICE TO APPLICANT:If.after Passing His Certificate ter Emramion.you should become subject to the Worker's Compensation previsions of Ne labor Cade,you mut .J z foMwide comply with such provisions or this permit shall be damed mwked. Z O CONSTRUCTION LENDING AGENCY [-i I botchy M.that Nem is a comuuction lording agency for Nc pcdum tom of �i Ne work luf which this permit is Wood(See.3097,Civ.C.) lender's Name =Z lenders Address U Q 1 certify that I have read this application and sun that da above information is gal P correct.l agree to comply with all city and county oNinances and sate laws relating to C)U building camormtion,and hereby minor.mPmxeaatioi a(this city to.rac,,no Nc Y' W shove-mentioned property for iaspccuom purpose: (We)agree to saw,indemnify and kaP hrrmless the City of CuPemioa against F" fA babilides.judgencnu,casts aid expenses which may in any way accme Maimtsaid City L)Z, in consequence of Ne grating Of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 0-2"7 U REGULATIONS. �(1�nAC 2Q2 /' �� Re-roofs J` Sign of Ap,licsinicimi1icoar HAZARDOUS MATERIALS DISCLOSURE ' m Type of Roof Will the,applinnt or future Wilding aau,ama.or MMIC haraNau,material defined by the Cupertino Municipal Code,casino,9.13,sad de Health and Safety e.S❑ es Na y.35532(a)] All roofs shall be inspected prior to any roofing material being installed. Will the applicant”future Wilding occupant use egtipm or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit m afdaus air comamimm.as defined by the Bay Am.Air Quality Managcmcnt all new materials for inspection. Diavict7 ❑Yes I have mad the hmaArwsma Trials mquimmem s under Chaperb.95 of dm Cali(or. Hnoth65afcty Cade,tectiom25t it in; yrsM25534.1 to natiuMeocehc Wilding ao not currently haw a ghost that it u my responsibility a ratify the occupant of the �m �tsawhich mustthe.1 ter isaa aoraCeruOaearOccupancy. Signature ofApplieant Date Owner ur a tnomn ZE z Dass All roof coverings to be Class"B"or better CITY OF CUPERTINO It€m i of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 3 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 36939019.00 DATE ISSUED. . . . . . . : 10/27/2005 RECEIPT #. . . . . . . . . : 31767 REFERENCE ID # . . . : 05100221 SITE ADDRESS . . . . . : 20298 CLAY ST SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TOKUDA HARUO AND FUSAKO H ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4401 RECEIVED FROM . . . . : SPEEDY ROOTER PLUMB CONTRACTOR . . . . . . . : SPEEDY ROOTER PLUMBING LIC # 23086 COMPANY . . . . . . . . . . : SPEEDY ROOTER PLUMBING ADDRESS . . . . . . . . . . : 2176 FAIRWAY GLEN DR. CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054 TELEPHONE . . . . . . . . : (408)234-8134 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL BPERMFEE, VALUATION 4,700.00 115.56 0.00 115.56 0.00 BPFIXTURE UNITS 12.00 108 .00 0.00 108.00 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BUSLIC FLAT RATE 1.00 102 .00 0.00 102.00 0.00 _____ _________ ---------- TOTAL PERMIT 363.93 0.00 363.93 0.00 METHOD OF PAYMENT AMOUNT NUMBER ________ CHECK 363.93 3269 TOTAL RECEIPT 363 .93 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING Community Development �F 10300 Torre Avenue i�tY Cupertino CA 95014 Ks=" • Telephone(408)777-3228 CITY Of Fax(408) 777-3333 IPUPEkTINO Building Department JOB ADDRESS• + PERMIT #� /oa Z Z/ C- Ogg ' g � S OWNER'S NAME: fyA (L - To c:j PHONE # S • ,;L S3 -i 3 GENERAL CONTRACTOR: V—CcY+C-r FAX # I am not using any subcontractors: 16k 716S *nature 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 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 REPIPE/SEWERS/MAIN SERVICE CITY OF CUPERTINO PERMIT APPLICATION FORM APN# �/ �, O1q Date: l © S / 1ola � Building Address: Owner's Name: �u dG Phone S PZL'C� � )ZCD� K Phone 4os ' 7LA License #: Contact: Phone: Cupertino Business License#: Building Permit Info: Car—( f--,1 1�!�(S n5 I Jes— Bldg ❑ Elect ❑ Plumb Job Description: ,�) Vz,0,t,- ILS Residential 121 Commercial ❑ Cost of Project: Qty. 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 2_ BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING