06060171 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ..�pitITRA.CTORINFURMA.TIFJN.
Bu1LDINO ADDRESS: SYSTEMS PLUMBING PERMITNO.O 6060171
10313 COLBY AV
OWNER'S NAME: PERMIT ISSUE DATE
WENDELL YEE 3844 HEPPNER LN 06/19/2006
NE: SANITARY NO. CONTROL NO.
(408) 266-8222
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BO EO PLO MO
30p LICENSEDCONTRACTORS DECLARATION IObDesC
�li 1 Mreby affirm Nn 1 am licensed under provisions of Chapter 9(commencing
dft
with Section 700)of Dlvition 7 of Ne Business a pd Professions Ca o.and my license M
/12�� 6 MAIN WATER LINE AND COP � t HOME ON
ire full rartty�aatl afrecj�yt0( t
Licence el s ,IL_Lic.g -Da, /�,�1
` Date I understand my plans ilW l be used d u p public records JU�y Y �� Q
;G LiceuaJProfeviaml 1Utlt1
y OWNER-BUILDER DECLARATION
'� 52 I hcrchy alum that I em exempt from the Con ractaYs license law for the
p o following mason.(Section 713 1.5,Business and Profasiuu Cade:My city or county
$(V which rental.A permit M conamM.altos impraw,demulieb.AS repdr Any saru"um 0 0 0
-Zya prior m its issuance.also requires the Applicant(ormch Permit to Die aalifed al]tement
G mum
Ac laLaw Sq.Ft.Floor Area �n
8 (commcndnlwith Sedon700D)dDivision3of the BuMnmand Pmfmiom CWc)w
— that he b exempt therefrom and the bub for dm ailegW exemption.My violation of
Section 7031.3 by any appilant far a permit Subjects the applicant m a civil penalty of er Occupancy Type
not more than five hundred dollars(55001
❑1,AS owner of the Property,or my employees with wage AS their sale eanpnuiathm.
will do the work and She mu"me is not intended woQemd for We(Sm.1(344,Businm Required Inspections
and ProreWOna Cade:The Canuacmra I.lo me law does rot apply AD owner of q P
property who indicts wimp.maroon.and who does such work Ido W f w through his
own employees,provided that such Improvements me not intended aroQered forsakif.
however,the building or Improvement is mid within atm year of mmploJan,the awner-
builder will low the burden of proving Suit M did rot build or improve far purpose of
ASIA.).
❑1,a owner of the property.San eeclmively comraming with Bceeed conuacron in
comwct the Project(Sea 7041.Business and Professions Cade:)The Conuanoes Li.
cense Law does not apply to an owns of property what builds or improves theman,and,
who common for such projects with a conua"or(s)licensed purseent be the Guarantees
License law.
Q lamesampturder See ,BkPCfarthi...
Owner Dam
WORKER'1 COMPENSATION DECLARATION .w
I he eby"Rim under penalty of Perjury ane of the fallowing deeJwione
1 haw and ids nearby eC"ti0ata of do Lab r Cof-Wum fee Wmkeea Campeo-
ASdm,r provided thi for mi Ss Issued.3700 of due labor Code,for Ne performance of the
worir far which this permit b issmtl.
❑1 haw and will maintain Worker's Compensation Insurance.As required by Sc"ian
My Wmthelabw Gea on Neper(armance "the work for which this permit Is Issued.
37 of eeS Luther
euNan Inann carrier and!Policy number w:
Grtier. F Polity No.:
CERTIFICATE OF EXEMPTION FRO W RKERS'
COMPENSATION INSURANCE '
fNbseNm need rot be completed line permit Is fare..buttered Mi.(Slo)
or lee=)
I citify Jot In Ne performance of the work far which this Permit is issued,)shell mi
employ any person In Any mamrse as to became subject to the werim",Conpenation
Laws of Califamia.Date
Applicant
NOTICE TO APPLICANT.If,&no making this Certificate of Exemption,yon should
become Subic"An the Warkees Composition provisions of the LAW Code.you must
.J Z formwith comply with Such provisions ar this permit still be domed marked.
'Z O CONSTRUCTION LENDING AGENCY
[-� 1heathy M.that ft.Is•emumeednn lending gency for the perform anan.f
[� the work far which ft permit is issued(Sm.3097.Civ.C.)
CL,ALatices NameAddressn7. z Undoes Address
U Q 1 madly that I tive reed this Application and sum WS the above infomuiJutt b
D. F conga I agree no comply with all city and county ordianm and state laws miming to
0(.J building conmmction,and hereby authorim representatives afthis city m enter upon the
W d p
.hove-menti oneroperty far iraccdan ptsmaeAs.
0. (We)agree to ave,indemnify and keep hamJm the City of Cupertino against
to liabilities.judipments.casu and expenses which may in any may amus against Said City
fJ z Inca
n cNorJoe ting of this permlLAPSTAND D WILL COMPLY WITH ALL NON-POINT Issued by: DateZlIqlm SOONS
Re-roofs
SilfiffulliotApplicamVConsi"ar Date Of Roof
HAZARDOUS MA ALSDISCLOSURE Type
Wllltheappilantwfuturobulltim mxupatmom ar handle haardous material
As dented by the Cupertim Municipal Code.Chapter 9.12.and the Health and Safety
Cade,Scomn 23532(a)7 All roofs shall be inspected prior to any roofing material being installed.
40 DYee IO No
VAR the applicant or future building occupant tax equipment Or devim which If a roof is installed without first obtaining an inspection,I agree to remove
call haaMoua air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Danieli
❑Yes 116No
T have soul the hasardnm meypr..'re of mcnuundcrChapter6.95aftheCelier-
niaHWmBSafetYC �iimgg5 5.25$73uW 233N.IuMeamd thnifine Wildlog
Jm not cmrcntly h em ((mat y responsibility m na0fy She ac.pat of the
rtyvisemeA_ M t4d r yuan o nifiam ofOeeu eery1. .
IAI Signature of Applicant Date
Owner o .1 mnzed ager Dae All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
40UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
ve 6 K066t 7
OWNER'S NAME: PHONE # CD ^
GENERAL CONTRACTOR: IFAX #
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete thefollowin 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/C or Signature Date
CITY OF CUPERTINO
ism 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31629026 . 00
DATE ISSUED. . . . . . . : 06/19/2006
RECEIPT # . . . . . . . . . : 34930
REFERENCE ID # . . . : 06060171
SITE ADDRESS . . . . . : 10313 COLBY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WENDELL YEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : MIKE FORNEY
CONTRACTOR . . . . . . . : FORNEY, MICHAEL ALAN LIC # 18073
COMPANY . . . . . . . . . . : WATER SYSTEMS PLUMBING
ADDRESS . . . . . . . . . . : 3844 HEPPNER IN
CITY/STATE/ZIP . . . : SAN JOSE, CA 95136
TELEPHONE . . . . . . . . : (408) 266-8222
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
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
----------------- ------------ ------------------
CHECK 47 . 37 5989
TOTAL RECEIPT 47 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- ---_____ ____________________________
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
0
CITY OF CUPERTINO
• REPIPE/SEWERS/MAIN SERVICE
CUPEkTiNO PERMIT APPLICATION FORM
APN# � ' � _ On r „ Date: � O
Building Address: l�f/
Owner's Name: Phone#:
Lu end vL e,
Contractor: hone: License#: -791
q q0% baa
Conta • Phone: Cupertino Business License #:
tv,e �--Vljrne. 0
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
�I1w; N w 4y r ( ;v^e korn.2 ani
Residential 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 Repipe of Fixtures PLUMBING
BPFLYTURE Pb] . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•
n