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060702121 4 CITY OF CUPERTINO BUILDING DIVISION PERMIT v AMERICAN RESIDENTAIL SERV BUILDING ADDRESS: uTNo'06070212 21311 COLUMBUS AV OWNERS NAME: PERMIT LSUE DATE ROBERT PRANTIS 1479 BERGER DR 07/31/2006 NE: SANITARY NO, CONTROL NO. (408)287-2165 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t� t� LICENSED CONTRACTORS DECLARATION Job Description 1 hereby alRrm Ihet i am IlemvW under provisions of Chapter 9 (mmmeming p with Section 700" of Division J of Lie Butruss.md Prafceeioru, and my lhatm is in fall forward ,. ��' REPLACE SEWER LATERAL FROM CLEAN OUT TO NEW Lhanm cl + o. C Oae Can PROPERTY CLEANOUT DECI.a ATION 1ECL Ae 1 understand my plata M.II W umd es public rtcord mail be Licensed Professional OWNER -BUILDER DECLARATION , 1 herthy 4Mm that I em exempt from tie Conuacmr's License Law far the following mason. (Sawdust 7031.5, Business Sad Professions Code: Any city or county which requires s permit to emWrum, alma improve. demalah. or repair my maxum pdorm its issumm. elm acquiree the applicant forsuch penal, to Ole a signed Klement that is licensed personal to the provisions of the Caalocmra Licenm LAW (chapter 9 Sq. Ft. Floor Area Valuat fix365 (commencing with Secdw 70W) of 0ivhion J of the Businemud Pmfmiom Co@) m that he h emmpt therefrom and the bads for the alleged exemption. Any violation of e,k pw7vii 7v7 1,Occupancy VA,a.3 %IjlTj ' 1 ,� Section 7031.5 by any applicant far a permit mbkch the apPiwmt m a civil penalty of mm mom Nan Rve hundred dollars (5500). 3 oG VV jUU ,,1533 0 0•! Ol,uawmaaftiieproperty,amymployenswithwgauthebmlecmtpensadon, Required Inspections will do the "&. and the shumum Is was Trended ar offered ferule (Sec. 7044, Busimss and Prolamines Cade: The Communes License Law don rot apply in an owner of property who builds ar improves thereon, and who does such work himself or through his ownemploycea,providedthatsuchimpmvemmummtinmMd aro@redfasdolf, however. Ne Wilding orimprovemmt hold within am yea ofcompletion, the ownv- Wilde will aha the burden of proving thal W did and, Wile or Improve fur purpose of cons). 0 1, as most or the property am uclusively contracting with licensed amanmu ad construct the (Sec. 7044, Code:) The. Li. Business and professiproperty who Morel done So of property who Wilde or Improvns rod, cense Taw docs not apply m an Out - with a Comm, who tali, pmjeN MIN a eontrlelar(a) IfCC11Rd pamaenl m the rAnVCmt'e enseLoNfor License Law. ❑Ian uempt nada Set .BBPC far thio reason caner Due WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury oro of the following declaraiom: I have and will maintain a CeniRamaf Conserv m self-Inwm for Workers Compen• cation, u provided for by Section 3700 of Ilrc Labor Cade, for Ne performance of the � work for this permit Is Trued. 1 have and will maintain Worker's Compwatlan Insunna, u acquired by Section and ]700 of the Lata Code, for the perfamena of the work far which this permit h Isadd. My Warks aCampe ariv and Polity numbs.��a�ref: �)�a q Cartier. Polity No.:� s+138�T]`QJ CERTI CATEOFEKEMPrIONFROMWORKERS' COMPENSATION INSURANCE (This mNm Used not W completed! Bthe permit h foram hundredda0are ($100) or lest) I certify that In the performance of Ne work for which this permit is Wted.1 small Out employ any person in my munerm as to became Subject to the Workeri Compasulon Q Laws of Califan%W Dam D Appliam, NOTICE TO APPLICANT: If, afar making this Certificate of Exemption, you Nauta became, subject to the worwers Compensation provisions of the Labs Cade, you most forthwith comply with such provisions Or this permit dull W domed rewked. CONSTRUCTION LENDING AGENCY I hemby arum that Nero Is contraction lending agency for the perfamaam of Me work far which this permit Is wood (Sm. 3097, Civ. C.) ' Lmulces Namur , Undoes Addrw 1 ceNfy that 1 ban mW We application W sans Load the Shove information h coma. I agree U comply with all city and county on Immo, and SUM laws Miming to Wilding construction, and hereby mthame representatives of this city to enter Oran the ahon-menduned rropcny for inspection puryoses. (We) agree to save, indemnify and kmp humless the City of Cupertino against liabilities. Judgments. cash and expenses which may In my my accme again+,said City in couqua ce of the gmndng of this Permit. N•PAPPLICANT U ERST DS AND WILL COMPLY WITH ALL NOQ � Issued by: DateNRfe-roo SOU REO A �f.—. Type of Roof Silaware of HARDOUSMATERIAISDISCLOSUREan Will No applicant or future building ocaupwastom a bundle huallons mammal as deRmd by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety Code, Section 55533(.)T All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Wdl the Srplicmt llfaUm Wil Occupant um equipment or devices which mit Wurdnu aIr conumimnh Ind by tie Bay Ams Air Quality Management all new materials for inspection. DlslnctT ❑Yes Nu I have mad de haraNu annuumialsmquimmenu under Chaperd.95 of the Collar. mh Hmlth&Safuy Co,Swdm2550573533.WZ5534.1.Wcmu4LulilftbLdldi.g '. does rot molly It ownnaIqt. that it h my raponsihility m naify, a of Nc req a whi• u3hsBfetprior toissuance afacarer 6,t Signature of Applicant Date All roof coverings to be Class "B" or better owner or.aNan genl Dace • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department 1 SS ff Jzl.jp(( cis � t �RESSO U PERMIT # 6 T U 2--�-i OWNER'S NAME: PHONE # GENERAL CONTRACTOR Cv C d v FAX # I am not using any subcontractors: d �%6 ature Date Please check applicable 'subcontractors and complete the following information •�MprContractor 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile •�MprContractor Date 0m 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36205033.00 DATE ISSUED.......: 07/31/2006 RECEIPT #........1: 35447 REFERENCE ID # ... 06070212 SITE ADDRESS .....: 21311 COLUMBUS AV SUBDIVISION ...... CITY .............: CUPERTINO IMPACT AREA ...... OWNER ............: ROBERT PRANTIS ADDRESS ..........: CITY/STATE/ZIP ...: , OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: RESCUE ROOTER CONTRACTOR .......: BUREL, MARK T LIC # 21504 COMPANY AMERICAN RESIDENTAIL SERVICES ADDRESS ..........: 1479 BERGER DR CITY/STATE/ZIP ...: SAN JOSE, CA 95112-0845 TELEPHONE • (408)287-2165 *EE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ----------------------- BPSEWER SEWER SYSTEM ---------- 1.00 ---------- 21.58 ---------- 0.00 ---------- 21.58 ---------- 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 TOTAL PERMIT ---------- 59.95 ---------- 0.00 ---------- 59.95 ------ - --- 0.00 METHOD OF PAYMENT AMOUNT ----------------- ------------ CHECK 59.95 TOTAL RECEIPT 59.95 VOICE ID DESCRIPTION -------- ------------------- -------- ------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 46 NUMBER ------------------ 003903 VOICE ID DESCRIPTION -------- ------------------- -------- ------------------- 202 UNDERFLOOR PLUMBING 507 FINAL PLUMBING a�gzkva- 0 C CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE PERMIT APPLICATION FORM ��11C�0 APN # 3(02 .r 05 � Bldg. Permit Fees BUILDING Date:. I Bu' i ddret, PLUMBING PPERMITFEE U PLUMBING BPREPIPE Owner's Name!: PLUMBING BPFDCTURE Bhonet PLUMBING BPWSVCS Main Water Service PLUMBING Contr�- O PLUMBING BPSEWAGE Cont P one: LI�r^ 3 Cupertino Bu7ines7s License #: 2 0 r � -� Business License -41 Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: �k Cr D�? G� �i %%�G✓ G Residential Commercial ❑ Cost of Project: r 6 Is Qty. if ADDlicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repive of Fixtures PLUMBING BPFDCTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING •