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06080221CITY OF CUPERTINO't.r�*^ 1tMATi BUILDING DIVISION PERMIT',C1lH't'Re.1.CTOILINI+'O rr > 7. , a d . BUILDING ADDRESS: CUPERTINO PLUMBING PERMIT No.06080221 20092 JOHN DR OWNER'S NAME: PERMIT ISSUE DATE GARCIA GEORGE 1300 DELL AVE ST 2006 NE: SANITARY NO. CONTROL NO. (408)253-0618 ARCHITECT/ENGINEER: BUILDING PERMIT INFO PLUMB MElCH BLDG ELECT It� 1= IC I= LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm Nu 1 am limned under provauans of Chapter 9 (commencing Business Profusions Code, and my license is �' JOr,{hTvA DCS , Y pt tt '.� si b' with Section 7000) of Division 3 ofdw and in And 490 R COPPER RE-PIP 20"OR2-De TER MAIN COPPER Lle.g� Dale ARCHTIECTST`DECECLAR ON J ('`al �43 understand my plshall Qe used upublic records IuntleMmans '•itJ h ry� A. Licensed onel OWNER-BUILDER DECLARATION 1 hereby effinn that I em exempt from the Cantranara License Law for Ile hereby f// `''' ttti7�.'IY'(I PLOW fallowing Masan. (Section 703 1.5, Business and Profcsunm Cade: Any city or manly FFFIIf {{{iii \\„// 5 0 0 0 which ¢guards a permit to construct. alter. Imptow, demolish, or Mpair any structure Sq. Ft. Floor Area Valuation prior m its issue=. Alan requires the applicant for such permit as file Asigned$W Mint Contractors Literate Law (Chapter 9 Net he is licensed penuant M Ne provisions of Ne (cummume ry with Section 7000) of Division 3 of the Business and PMical ans Code) or that W it exempt therefrom and the halt for fe alleged exempdon. Any Nolauon of MdiSbr u u Occupancy Type Sued. 7031.5 by Say applicant for a permit subjects the applicant to A civil penalty of not mom than JIM hundred di llus (S50E. ❑ I, u owner of the property, M my employ= with wards u Nab mk mmpedsadm, Required Inspections p wad Budrcv Newark. ale NeaMmumbnces Lidedarawdo an,Anrt router And Pr Cade: The Law doe! ml apply q andwhodoesetchwork f is property h bu a ver he=,, And W propertywho buildsored mortared such aM not Intended moQaed for own employees, pmvldrd fataum imps dam unarm old Ami the awner- old within ate year of mproam builder, the Wilding a.I. for builder MB law Ure burden of proving fat k did tet build m improv for purpose of of pmmsil ukJ. ❑ 1, As owner of the property, Am e.dus vely contracting with fic seed cm"m`Wra k mrxam ct the project (Sec. 7044, Business and Prafnslads Code:) The Contruers Ll- ,ane Law does rot apply M An owner of property who builds or immowa thereon. ted. went canmcu fat aneb pmjm Awitha"wracer(s) licensed ptesamt nathe Comrutars Lk-ac Iso. ❑ I am exempt now Sea . B k P C far Nis matin . mer Dae WORKER'S COMPENSATION DECLARATION I hereby Lft o. under petWry of Perjury sae of the following declaaimse 1 hew And will mortal.. Cenafimm o(Co du m An Sel6lmum forwarkeYs Compen- on,, provided far by Section 3701 of the Labor Cade, fm ftperformanm of de u iu work for which this permit is issmd. 0 1 Mw and wi0 undmam Warkera Compenu0on I., u required by Scotian - 37110 of de tabor Code, for In, performance of the work (=which Nis permit in lanced. My Wmkera ca�mnsalon Insurance carrier and Policy number are: Carrier, a%cfJ Policy Na.: - tTr -2 CERTI— Fl ATE OF FRO WORKERS' COMPENSATION INSURANCE - (TMa Model need not he complemd if the permit is fmane hundred do0att (5100) or less.) I certify Not in the performance of the work fan which Nil Permit is issued, I till at employ my person in try manner so u M WCOMC subject to ft Warkuf Compedsadam Laws of California. Date Applicant NOTICE TO APPLICANT: If. Aller making this Cenificam of Exemption, you should became ubjmt a the Workers Campentedan provisions of Nc labor Code, you mus forthwith comply with such Provisions or this permit atoll he deemed mated. ' CONSTRUCTION crdswc. 30 lending Agency far the Perfurtname of seer mart ie ad.. leading Agency I ho, chum the week fm which Nd permit b issued (Sec. J09'r, Civ. C.) which s Lenders tartish Add Address i I certify Net 1 Mw reed thin application and Mute Na the W. information is ' Carta. l Agree to comply with all city and county maknocaa and Aum laws Mlsong to building construction, and hereby ambodxe mpmacn aiws of this city to enter upon the shave-.enured prapcny (ant lnapecdan purposes. (We) agree 1r sew. Indemnity and loss, camluna a e City of Cupcnino agaiml i liabilidds,judgmcmts,cdsts and cap..=whi,h may in my way Acttua agues said City in consequence of the goanfing of this permlt. ' APPLICANT UNDERSTANDS ABID WILL COMPL ALL NON-POINT q Issued by: Date �/lo Re-roofs Type of Roof D Dame Signature HA RDOUS MATERIALS DISCLOSURE Will Ne applicmt or future building accupanlaare or handle hrrudous materia as defined by the Calandra ra Municipal Code. Chapter 9.13. and the Health and Safety Section 255320)7 All roofs shall be inspected to any roofing material being installed. ❑Yea B7ls— prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or Name building =upon[ use equipment of devices which amts hvaMnm urcmtaminma u dcRned by the Bay AMA Air Quality Management all new materials for inspection. District? ❑Yds 8lhf I have real the Imemim nctcrlab requirements under Chapter6.95ofNeCalifor- .atHeal"SuctyC mods 27505,25533 and 21534.1 understand Natl(Ihe Wilding d tcu am. dm It i yMaton notify ft amupmt or de = w .ervre,tercryMy.�� Si re of punt Date /eamy �Y��j / All roof coverings to be Class "B" or better e- ' ' Owner nuNanzO Agent a Cl OF @UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS:/ PERMIT # t�� `) f)( -),'i a _ f V� r� Y)r. (c) K 0 cr-6 I OWNER'S NAME: r—r„=-V _ I PHONE # 2 S"3 - oCe ) A I GENERAL CONTRACTOR 40, � r wpft,� 016c, 1 FAX # I I am not using any subcontractors: Please check applicable subcontractors' and complete the followine information t - off Date Owner/Co n6actor'gnatur" e� 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 Owner/Co n6actor'gnatur" e� Date am 2 of 2 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ......1.: 36934025.00 DATE ISSUED.......: 08/28/2006 RECEIPT #......... 35786 REFERENCE ID # ...: 06080221 SITE ADDRESS .....: 20092 JOHN DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: GARCIA GEORGE ADDRESS ..........: CITY/STATE/ZIP ...: , RECEIVED FROM .... CONTRACTOR .......: COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ... TELEPHONE ........ •EE ID UNIT ----------------------- BPREPIPE NO OF FIXTURE BPWSVCS WATER SERVICE PPERMITFEE FLAT RATE TOTAL PERMIT OPERATOR: amyw COPY # : 2 FRANK CARDIA CARDIA, FRANK L LIC # 612 CUPERTINO PLUMBING 1300 DELL AVE, STE C CAMPBELL, CA 95008 (408)253-0618 QUANTITY AMOUNT PD -TO -DT 2.00 18.00 0.00 1.00 9.00 0.00 1.00 38.37 0.00 ---------- ---------- 65.37 0.00 THIS REC NEW BAL 18.00 0.00 9.00 0.00 38.37 0.00 ---------- ---------- 65.37 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 112.74 VISA TOTAL RECEIPT 112.74 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------------------------------------------- ---------------------------- -------------------------------------------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING ff�Q UPEkTINO CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE PERMIT APPLICATION FORM APN #V Q— 2 1 � � J7 Bldg. Permit Fees BUILDING Date: 8 Building A_dd9 ss: J-7kn �� Dt PLUMBING PPERMITFEE Owne 's Name: C, PLUMBING BPREPIPE Phone #- 5 X93/ f c Ci 4—• BPFD{TURE Pbl . Fixture PLUMBING Co tractor: Phone: Main Water Service PLUMBING License #: �Cw P6 50S-3v,J BPSEWAGE G11;4990S ContacA vPhone: Cupertino Business License #: FrcL, L CO- (-Ckta 3(7,s9-31411 BUILDING Building Permit Info: Bldg ❑ Elect ❑ Plumb R' Job Description: Q Q Residential Commercial ❑ Cost of Project: S U UCS 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 BPFD{TURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING