06090117 CITY OF CUPERTINO + r�" '/ ��' �"" x x'*' 4q
BUILDING DIVISION PERMIT IsQ1yTl,7lA�.vT � •A �"'
BUILDING ADDRESS: PLUMBERS ON CALL PER"06090117
10329 COLBY AV
OWNER'S NAME: PERMIT ISSUE DATE
VIERECKL ALFRED 520 MEGLIACY LANE 09/15/2006
NE: SANITARY NO. CONTROL NO.
(408) 879-9416
ARCHITECTIENGINEER: BUILDING PERMIT INFO
ELDO lm EIS PLUMB
t� MECHO
lop LICENSED CONTRACTOR'S DECLARATION Job DOSCiIptlOn
i U 1 Wmby affirm that f am limned under provisions of Chapter 9(commencing
:z1uj iniN3ecdfull �ancieffecOlvtlon3afNeBuanevandProfeto�Code.aMmyliceneis t. REPIPE GALVANIZED TO COPPER
DZ
Lice nec Class Lk.0 7/ 2 I SII
g Dam CConuscmr a+-.�/
Fq ARCHITECTS DECLARATION
i a 1 understand my plans shall M used as public records
id
°IOu Licensed Professional
Ite OWNER-BUILDER DECLARATION
Convector',
ON
1 hereby.sect on I em exempt from the Conuncmr's :Any Cnse Law for the
o O following maws(Scotian 7031.7, t.Business and Professions Cole:Any city Of aunty
S$um which mquims n pemdl to construct.then,lira improve,demolish.,fi repair my awewm $6443
y W,W I ts i eased p sista requires Novisio s of for soh odor'w file Law
aratemenT
Fs NatWlslianaJpursantwthcprovislonsafNeConuator'Wmvclaw(chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3afthe Business and Profeasina Code)Of
Nat he is esempt therefrom and the basis for the staged eamption Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant in•Civil penalty Of 3r0 U Occupancy Type
no,mom Na five hundred dollars($5000).
❑1,an owner of the property,or my employees with wages as their ale compensation,
will do The venae and the sosmme is not intended aaffertA fm am(See.70a,Bushed,
and Professions Cade:The Co aramnrs License Law does not apply In an owner,of _ Required Inspections -
property who Wilds or improved dkmon,and he daeasuch.,it lonswifm through his
awn employees,provided that such improvements are not Intended or offered for We.if,
however.the building ar improvement Is sold within on year of wopledoo.the mmus,
builder will have the burden of proving that he did ant build or improve for purpose of
❑1.as owner of project
property,.B esness and
contracting with The Cronwcwrs U.
ronamm d esonot (Sec.704,Bueir of rod Professions Cade:)The Comraemes and.
/
who law owes not apply w an awns of property who builds m Improves thereon,and, 7
ace tomorrow eLow.
0 1m law.far such projects WN n
A eonvaor(s)Iieuksad pursam m the CoGastronome,tGastronome,toes /
�j
I am aempa under Sec. .B k P C for this mann
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby a1Ma under penalty of perjury one of that following declarations:
1 hart and will maintain a Canificam of Consent to self-inaum for Woftes Camper-
satbn,an provided for by Section 3700 of the lair code.for the performance of the
work for which this permlt is Issued.
❑1 haw and will maintain Wallace,Compensation Insurance,u required by Section
3700 of Ne labor Cade for the Performance of the work for which this permit Is laid.
My Workers Compensation I/rmarams artier and Policy number aa:
Cartier. '+ 04`i YUrC•� Policy No.: ass`2/?6S—'7CL
CERTIFICATE OF EKEMP"ON FROM WORKERS'
COMPENSATION INSURANCE
(This action had an,hecomplemd if the permit is fwram hundred union($1000
nr less.)
I«wfy Nat in the performance of Inc work for which Nis Permit is Wood.I shall not
employ any person in any macer an an Of Wcamo subject lathe Workers'CompensaJan
Laws Of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certirtate of Exception,you sbould
become subject in The Worker's Compensation provisions of that labor Cade.you am
.J O rordrwith amply with such provisions Or this permit Nell W deemed revoked. .
zy CONSTRUCTION LENDING AGENCY
E••r 1 hereby affirm that Nem O a construction lending agency for the performance of
CL r�-r the wart for which this permit is issued(Sas.3097,Civ,C.)
W�0 Lender's Naive
z Lender's Addmrs
U 1 certify that I have mad this application and sum Na Ne shove information is
Iy F cormca I agree to comply with all city and county ordinances and stem laws minting to
0 U building eonaaclion,and hereby authorire representatives of this city to enter upon the
W ahovc-mcmioncd lueNny for inspecdon p.,was.
(We)agree 1w ave,indemnify and keep harmless are City of Cupenino against
N
U',z in consequence of the granting of this FMOOIL
Iiabilitia.judgmcnts,eosu and expenses which may in any way accmc against aid City6i
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of Applicom ..uranwr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding mcupantlom or handle hanew ,ore material
as defined by the Cupertino,Municipal Code.Chapter 9.12,and the Health ad Safety
Code,Section 25532(a)7 CK. All roofs shall be inspected prior to any roofing material being installed.
❑Yes
WIII Ne applicant ser for=Wilding occupant era equipment ver devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haawom air conumimnss u defined by the Bay Area Air Quality Managers M. all new materials for inspection.
Distinct?
❑Yes
1 have mad Ne bvardnm mamrialsmquimmenu under Chapmr6.95 ofthe Califar-
nuHalthkSafctyCwde,Sccuau25505,25533ad233N.lundcnund Naif Nc Wilding
does not currently haw a unarm.that It Is my msponsihility to notify time occupat of the
requirements which muss be met prior w issuance ofa Cerurata or Occupan Sig nature of Applicant Date
�`� 1?""A4 0''5� All roof coverings to be Class"B"or better
Owner or authorial agent Date'
F, Y Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
3 2 C( LLI--6 0 GD D /�
OWNER'S NAME: PHONE # yak) �r7�( G�lFr3
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature 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
oC Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
em 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31629025 . 00
DATE ISSUED. . . . . . . : 09/15/2006
RECEIPT # . . . . . • • • . : 36057
REFERENCE ID # . . . : 06090117
SITE ADDRESS . . . . . : 10329 COLBY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VIERECKL ALFRED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : PLUMBERS ON CALL
CONTRACTOR . . . . . . . : ROBIE DOBKINS LIC # 27158
COMPANY . . . . . . . . . . : PLUMBERS ON CALL
ADDRESS . . . . . . . . . . : 520 MEGLIACY LANE #12
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 879-9416
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- - - ----------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 443 . 00 137 . 16 0 . 00 137 . 16 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 175 . 53 0 . 00 175 . 53 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
CUPEI�TIN0 PERMIT APPLICATION FORM
APN # Date:
GG
Building Address:
Z `Y Ca 1
Owner's Name: Phone#:
Az v h e,-�-� 6 - z
Contractor: Phone: License #:
) Sf7q-r, is 71 z r1gel 4f 3
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
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 Re i e of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•