06070075 CITY OF CUPERTINO
BUILDING DllsIslON PERMIT ,�1!'1TMRA. I1VFO ATI }
BUILDING ADDRESS: DIJOSEPH' S PLUMBING PERMRNO06070675
21746 CQLLINGSWORTH ST
OWNER'S NAME: PERMIT ISSUE DATE
RONNIE FOX 205 WYANDOTTE DR 07/1 -4/2006
NE: SANITARY NO. CONTROL N0.
(408) 365-2058
ARCHRECTRiNGiNEER: BUILPERMIT.INFO
BLDG ELECT PLUMS
OMEOCH
too LICENSED CONTRACTOR'S DECLARATION IOb Description
u 1 hereby affirm that 1 am licensed under provisions of Chepur 9(commencing
with Section 7")afOivision 3 fthe Businessad Profession.,Code.and my license is
romp--1 ad effect. ` 6 '66 y REPIPE HOUSE
2 License Clans Lk.if
iF p Dau Canuaaar r
7W ARCHITECTS DECLA TION
I understand my plans shall W used as public rtcards
)yU
so Licensed Pmfcsaional
`N OWNER-BUILDER DECLARATION
i I herehy slRm Net I am exempt from the Conuatofs License Law for the
p O fallowing moon.(Section 7031.5,Business and Pmfcuiona Calc:Any city or county
ISE which requires a permit m cons ruct,alar,Improve,demolish.at repair any structure $7250
prior u It issuance.&be requires tlaapplieant fmsech permit to Bk a signed statement
that he is licensed putwanI to the provisions of the Contractor's(iave law(Chapter 9 Sq.Ft.Floor Area that
�$ (commencing with Section 7080)of Division 3 of the Business and Prafesdens Com)or
�.•
that he k exempt themfferse and the huis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit objects the applicant m a civil penalty of a Occupancy Type
not mesa than five hundred dollars(5300).
I,uawner of Ne ptoPersy.amy wplayces with wagnu the4 sek eompemtion,
wllldo thework.and theawetusaumtmunded or aRemdfarsek(Sa.7041,Buslmsa Required Inspections
and Profession Code:The Conuuh
uLi m law does not apply an owner of q P
property who Wilds aimpmxes Nemon,and whodouauch work himselfarduough his
own employees,provided that such improvememu am nutinunded oraRemd foraah,It.
however,the Wilding or impe,wment Is veld within am year ofampletion,the owner.
builder will have W burden of proving that W did ser Wile or Improve for purpose of
sale.).
❑1,as manes of the properly,am exclusively contracting with licensed Contractors to
anstmct the Project(Sm 7044,Business and Profenslons Code:)The Conwetoh Li.
Cense law does not apply to an owner of property who builds or improves thaam,and.
who carman u for such projects with a conumcros(s)licensed pur mal to dire Contractor's
License law.
❑lson em-P,t ander�SJy., /} .B&P C for this moon
Owmr /A/LWYaL4<✓Ul/ /.GLaQf11 Data
WORKER'S COMPENSATIOR DECLARATION
I hereby alarm under inanity of perjury am of dim fallowing decuretram: an
Ihaw ordain mare by eCion 37 0 of Consentm selFkaurt a Wforma cempem
wise,r provided(pe mi Sutton 3700 of me Labor Code,for da performance of me
wade far which Nis penia is intact. s`
have sad will ode,for Workeh Compensation of the w Insurance,h his iredperm by Section
3700 of My k e Labor IJCpadea.,0y(an meumancmcaan�ra�o�fltNdepwoh for which this permit 6 Hsued
Censer. ��'L/ani m.fhl�f CX(W P!(�No nr2/9
CERTIFICATE OF MEMPTION FROM WORKERS'
COMPENSATION I
NSURANCE
(Thu section neetlrotWc.pkwdlithe
pcmit is faoro hundred dollars($100)
or lata.)
1 arsfy that In the performance of the work for which this permit is issued,I shell and D
employ any person in say an"mrso as to became subject to the Workers'Compensation Q
Laws of Califomie.Data
Applicant
NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should
become subjca to the Warkcr's Campcnsadon provisions of the labor Cade,you most
zOforthwith amply with such provisions or this Permit shall be damed reveked.
► CONSTRUCTION LENDING AGENCY
J••i 1 Wmby slam that there Is a construction lending agency for the perfummea of
a the work for which this Knnh Is iumd(Sec.3097.Civ.C.)
W� Q Lender's Name
Z) z Lender's Address
U C) 1 certify that I have mad this application and sate dot the&haw infomtlun in
IL P coma I agree to amply with all city and county ordinances and sum laws muting to
0U building convection.sad hereby aurhoin mpmsemaiiws of this city to enter upon the
ran ahovrmenticmd property far inspection purposes.
(We)agree to saw,indemnify and kap harmless the City of Cupcnim against
raw fA Imbilides,Judgments.ensu and upon•-•which may in any way aatuc against and City w /�
U z in consequence of the standing of this Permit. j
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR RE LAT10yyyy, �
Gl a�f u 4fio 7-o'aO; Re-roofs
Signature of AppuicantlCamrumr 10, Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will do appliantor future building occupammorc or handle lu aAous moa ial
as deamd by the Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety
Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
[3
❑Yes U0—
Wier the applicant of furore building Occupant um equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvarMu air Cmtamimana as de0md by Um Bay Area Air Quality Management allnew materials for inspection.
District?
Cl Yen
Ihave mad the hvardtesmaterials re33 andnuunderChapur&95 of the Califon
rias Own C&Sakry Cade,Seasons 911 i755lland25S34.1ility 0 notify
occup Wining
dao rot Currently have a anal this Ito my responsibility m notify dire occupant of dr
mquircummewhijorauSlIC 1.p/smFssmanccaaCcnifia.aoroampanay. Signature of Applicant Date
Q" eL 0�u 7 /3 d6 All roof coverings to be Class"B"or better
Owner or authorved Agent Data
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: quem
COPY # 3
Sec: Twp: Rug: Sub: Blk: Lot:
APN . . . . . . . . : 35617050.00
DATE ISSUED. . . . . . . : 07/13/2006
RECEIPT #. . . . . . . . . : 35236
REFERENCE ID # . . - : 06070075
SITE ADDRESS . . . . . : 21746 COLLINGSWORTH ST
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RONNIE FOX
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4709
RECEIVED FROM . . . . : DIJOSEPH'S PLUMBING
CONTRACTOR . . . . . . . : ANDREW DIGIUSEPPE LIC # 22796
COMPANY . . . . . . . . . . : DIJOSEPH-S PLUMBING
ADDRESS . . . . . . . . . . : 205 WYANDOTTE DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408)365-2058
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
______ _____________ __________ __________ __________ __________ __________
BPREPIPE NO OF FIXTURE 1.00 9.00 0.00 9.00 0.00
BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
__________ __________ __________ ----------
TOTAL PERMIT 152.37 0.00 152.37 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ ___________-______
CHECK 152.37 1648
TOTAL RECEIPT RECEIPT 152.37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
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r Community Development
g 10300 Torre Avenue
i ,� ' ✓' Cupertino CA 95014
Telephone(408) 777-3228
CI OF Fax(408)777-3333
.CUPER,TINO
Building Department
JOB ADDRESS: PERMIT #
7 COM 'N0& St 0-70015
OWNER'S NAME: VZWn PHONE #4C6)
GENERAL CONTRACTOR F*E#
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
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
• CUPI OF
EkTINO PERMIT APPLICATION FORM 4W,7�D�S
APN# 3C/ ^/ 7 � � S 0 Date. 7 — 7 3-�6
Building Address: l /O ^
X17 '16 0 ��i'h S war��l S � , `/ ,
Owner's Name: , Phone#:
�ahh � >° FaX zS3 - Yla3
Contract gr: / Phone: 3 6 S�n 0 License#:5 /g/G y
� I�US S �r/H'1/�ly k
Contact: /} �r , O S �� Phone: 3 6 S� 19(l Cupertino Busine s License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb [2f-
Job Description: 67G 4 -P
Residential ®, Commercial ❑
Cost of Project: 712
5 a, 0
•
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
•