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C DIVISION PERMIT
RESS:
PLUMBERS ON CALL
PERMITNO.06090118
RANBERR:
rARCHrrECTIE�WEER:
PERMIT SUE DATEHINAKA
KIYOSHI
520 MEGLIAC
SANITARY NO. CONTROL NO.
(408)879-9416
WEER:
BUILDING PERMIT INFO
BLDG EQ PLUMB MO
LICENSED CONTRACTOR'S DECLARATION
Job DBSCrlpt100
1 hereby affirm But 1 w licensed under providence of Chapter 9 (commencing
with Suction 700) of Division 3 ofthe Becomes wed Profession Code. and my licence is
mmO throe aneenea -7�p �[,��
G
REPIPE GALVANIZED TO COPPER
License Gln. Lm. «
Dam / / Contractor � +• �"
ARCH11ECrS DECLARATION
I undersand my plane 0111 he used as public Words
/ ^^/
V
1O
Licensed Professional -
DER DECLARATION
OWNEon attempt the Contractors taw for the
1 hereby affirm that 1 exempt
un Cade: Any city or county
1. ; an : Any
fallowing maven. (Section ED Badness and
065880
eine, improve, demnah my
str vs,, ski
which rtqultn a permit re cores
fie a sig wffmnuimmum
poor is its the for Cone pccmit m Om a algae(ateemcm
mC rtgoima Bre appin
Conuacare lJcense law
Sq. Ft. Floor Area
Value on
of (Chapuu9
Bothe ulioerwJ pursuam to Bm pmvisianafthe
licensed p
(commencing with Section 7000) Of Division 3 of rhe Business and Professions Coda) or
Ns he u exempt chemical and the basis for Bre alleged exemption. Any violadon of
NUNMifiberoUOccupancy
Type
Section 7031.5 by any apple=[ far a permit Objects the applicant to a Civil Penalty Of
not mom than five hundred dollars (5500).
❑ 1, as owner of this, property, or my employees with wajn u l ck Clecompeosedon,
Required Inspections
(I P
will do the work and theatructum i, maimmmded oraffered for,ele(Sec. 7041, Business
and Policeman Cade The occurrence, License law does ant appy man Meet of
property who builds mimprove s theroon, and who doessuch workhm eels, through his
awn emplayoae, provided thmaoeh improvements am not Invaded oscillated retrain. ll,
however, the Wilding or Improvement is within one year ofamp4does. the owner.
builder will breve the Widen or proving that he did naf Wim or improve for purpose of
si
❑ 1. as Owner of the property am exclusively contracting with licensed rnnmeton to
construct Ne project (Soo. TON. Business and Proeadon Cade:) The Contractor, U.
cense taw don not apply a as owner of property who Wild, or improved domme, and
who contracts for such pmJecu with a eontraaor(O licensed pursuant le the Contractors
Lunn¢ law.
❑ 1 sen uempt under Sec. , B & P C for this mean
owner Dam
WORKER'S COMPENSATION DECLARATION
I hemby af@m under penalty of perjury can of this folkswing declaeWau
I have and will mainWn a Cenifrca sof Convent to self -inure far WamoraComfort'
nation, as provided for by Section 3700 of de labor Cade, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker, Compensation resonance, as acquired by Section
3700 of the Lobar Cade• for tis performance arms work for which this permit is Issued.
My Workers Compensation IInnyurmce carrier and Polley number M:
Cartier: S�-rs�'� L`"e9( Pnik,Na.: 4G"L126
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mimsee Creed ter he camplemd ifine permit Is fnronc hundred dollars ($100)
or lase)
1 ceeiy that in the performance of the work for which this Permit is Iasoed, I shall not
employ any person in my mannerC u a became subject to the Workers' Compensation
'
Laws of California Data
APPli.1.
NOTICE TO APPLICAND If. after making this Certificate of Exemption, you should
become ,object to me Worsi Compcnation provisions of the labor Cada, you most
' forthwith comply with soh provinces or this permit shall be domed naked.
ON LENDING AGENCY
CONSTRUCTION
a construction agony far the performame of
1 homhy that dart u a
.30lending
ichthi
' e work for which the pemrit 4 wood (Sec. J097. Civ. C.)
Landers Name
L
lander, Address
j I certify that I love read this application W sate the the shove information u
' correct. I agree to comply with all city and county ordinances and sure laws minting to
Wilding construction, and hereby authorne representatives aides city to enter upon the
inormcdon
move-mentiond p npefty for purposed.
(We) agree to ave• indemnify and keep hismlee the City of Cupmiao against
j liabilities,judgments,cass and expenses which may in my wayse. against aid City
in consequence or the granting of this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by; Date
SOURCE REGULATIONS.
Re -roofs C7
Type of Roof
ale " /yi a4e- '1115 e
Sigmtum of ApplicanuConuemar Dam
HAZARDOUS MATERIALS DISCLOSURE
Will tho applicant or future Wilding oecuPans,rore Of handle harardave material
u defined by the Cupertino Municipal Cock. Chapter 9.12, and Bre Health ad Safety
cam.es 255320)?7
All roofs shall be inspected prior to any roofing material being installed.
❑ 89e
C]rs Y
If a roof is installed without first obtaining an inspection, I agree to remove
Will me applicant or fume Wilding omupm, use equipment or devices which
emh hawmmus air con maim us a defined by the Bay Arca Air Quality Management
all new materials for inspection.
Disuicl0Yes u
1 have mad the hazeduus materials mquimments unmrCMpmrb.95 of da Califon
nice HcalBr&Seely Cam. SOWM25505,27533 ani 1vademand thalifBc Wilding
does not currently have a iment, that it is my mspanibilify in notify the occupant of the
rcquirtuna which must be met pilar to Women of a CcrdOmm of oceo7 ..
Signature of Applicant Date
�'� A r � 9"r144
All roof coverings to be Class "B" or better
Owner car i otbmi m,1 agent Dom
It's �
It. a
CITY OF
4JUPERTINO
C`
11
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
3 �� c, -y
PERMIT #
D 6
OWNER'SNAME: w
PHONE#
GENERAL CONTRACTOR
FAX #
I am not using any subcontractors: Ani
Signature
Please check applicable subcontractors and complete the following information:
q1/S/o6
Date
-451;11 17 %,/.*—
Owner/Contractor Signature
�/// S/G G
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
vC
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
-451;11 17 %,/.*—
Owner/Contractor Signature
�/// S/G G
Date
wm 3 of 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36203015.00
DATE ISSUED.......: 09/15/2006
RECEIPT #.........: 36057
REFERENCE ID # ...: 06090116
SITE ADDRESS .....: 7938 CRANBERRY CL
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............:
ADDRESS ..........:
CITY/STATE/ZIP ...
YOSHINAKA KIYOSHI
A
OPERATOR: amyw
COPY # : 2
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
BPERMFEE VALUATION 5,880.00
BUSLIC FLAT RATE 1.00
PPERMITFEE FLAT RATE 1.00
TOTAL PERMIT :
METHOD OF PAYMENT AMOUNT
----------------- ------------
CHECK 620.79
TOTAL RECEIPT 620.79
VOICE ID DESCRIPTION
-------- ------------------------
-------- ------------------------
301 ROUGH PLUMBING
507 FINAL PLUMBING
•
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
126.36
----------
0.00
----------
126.36
----------
0.00
105.00
0.00
105.00
0.00
38.37
0.00
38.37
0.00
----------
269.73
----------
0.00
----------
269.73
----------
0.00
NUMBER
------------------
13033
VOICE ID DESCRIPTION
-------- ----------------------------
-------- ----------------------------
502 FINAL PLUMBING ENERGY
CUPEftTIN0
CITY OF CUPERTINO
REPIPE/SE`'VERS/MAIN SERVICE
PERMIT APPLICATION FORM
DUM115
APN #
Bldg. Permit Fees
BUILDING
BPGAS
Gas Piping System Fee
Date:
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Repipe of Fixtures
PLUMBING
Building Address:
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
7 C;
BPSEWER
Sewers
PLUMBING
Owner's Name:
Sewage Disposal
PLUMBING
Phone #:
ti C
Business License
BUILDING
c6—O
(`(O�) ZZ
Contractor:
Phone:
License #:
6."3r ew Cc. e
I M)
'9-? q Y5-3
712- V
Contact:
Phone:
Cupertino Business License #:
Z - a 4t
Building Permit Info:
_Bldg ❑
Elect ❑
Plumb B
Job Description:
P-eal" ga--
J,
Residential E�l
Commercial ❑
Cost of Project:
S SsFsO
•
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
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING
u