06060032CITY OF CUPERTINO
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BUILnINGDrvMIon PERMIT
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BUILDING ADDRESS:
CUPERTINO PLUMBING
PEBMrrnD.06060032
11236 LA JOLLA CT
OWNER'S NAME:
PERMIT LSUE DATE
LEONARD PHYLLIS
1300 DELL AVE STE C
06/05/2006
NE:
SANITARY NO. CONTROL NO.
(408)253-0618
ARCHI'IEC (ENGINEER:
BUILDING PERMIT INFO
'
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
1 hereby stand Net I am licensed under of chapter 9 (commencing
Job DeSAN
provision,
Wim Seance cll1 DlWtlon Sofmo BuainessWPra(dsium Code.aM mylkensea/fYY
ilC mea dee
ys•y 5
REPLACE WATER MAIN
LED
es g (Q2
Ii/�Y�I{:I�
Dau Conlracmr •'--✓�
RCHITECI'SDECLARA�
I understand my pla is,hall be used u public records
I I L t) 2006
Liceed Professional
ns
OWNER -BUILDER DECLARATION
I hereby affirm that I em damp, from the Contractor', License Law far the
following mason. (Section 703 1.3, Business and Pmkssiom Code: My city or cous y
UNN/0
which nquiroa a permit to construct, alar. improv, demollsh, or repair my structure
- D Q
prior to its issuance. reject requiM' BM apPllcml for such permit to rile a signed statement
Ft. Floor Area
Valuation
Nat he k licensed pursuant to the provisions of the Conudctar's License law(Chapur9
Sq.
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is dempt therefrom and Use basis far the WWFA acemptima My viohllan of
i
Occupancy Type
Session 7031.5 by my applicant for a permit subjects the applicant u • civil penally or
sot mon than five hmd,d dollarsmll (SSOOL
❑ L u.wtur of tlu property. ser .,played with wags u udehmc. corn.ueNaa,
Required IHsI)eC[IODS
is as, Budrm
Co the stenontkrotmundess"offend
andPr lework.
set apply to rt owner of
AW do sa,au(Sec.to
and obu ld.d.: The Conuec,I, uame law
uch
propenywho bulla, or Improves thercon,md whadasaech wok himulrortlmugh his
enywh
own m,meh Imp,wmmtt in rot or far B,
latind
ver. di buiprovided
yearof c num
however, the building a improvement ta hatd within oro yw W mmpkdoa• me awm-
builder MB hive the buNm of proWng that he did oat build Or improv fa purpose of
,
uk.).
❑ 1. u ..ser me property am exclusively contracting with Behind contractors to
co.vuct the project (Sec. 701.4. Business and Profession, Code:) The Contractors u•
even law dao cot apply, in owner of property who build. or improve memn. and,
who contracts for such projects with a conlracur(s) licensed punuanl to the Contractor's
'
License Law.
❑ I m dempt under Sae .B At PC for sets reaven
Owner Data
' WORKER'S COMPENSATION DECLARATION
Ihercbyafnmu rpeeltyofpedMmorthe(olb ngdaluadad:
0.ation,
1 ham and will cadmium aCenill m.f Co.ent to ulf-inere fa Woddd`s Compco-
an provided ran by Section 3700 or the Lader Code. for on performance of the
work for which this permit is usual
,
❑ 1 have and will maintain Worker's Compensation l,urma, u acquired by Section
3700 of the labor Chad. for the performance of the work for which thin Permit i, lased.
My Workdes ompmantioa buaana drtia and Policy number am:
carrier. - /f`a/5. Polity NO., -P 2
CERTIFICATE OF EXEIAP 1ON FROM WORKERS
COMPENSA71ON INSURANCE
_
Crus section Used ambe completed Ifine Permit ts roraUs hunmrddo rms(5100)
or lea)
1 anify that In the performance of the work for which this Permit is (mud, I shall not
employ anyper,.n in my manor, at In become subject to the Workcr3 GomperafadM
laws of California. Dau
Applicant
NOTICE TO APPLICANT: IL net making this CeNndu of Exemption. you th U
become subject in the Worker', Compensation provision of Lha Lahr Code, you muss
forthwith comply with such provide. Or Its Permit shall ad damW rev eked.
ON LFNDlNG AGENCY
CONSem
1 hereby m Wt men ts io agency for me perform.rtce of
is a conservation
which 7. Cing
the was for which this permit ts iisUsd (Sec. 309'1, CW. CJ
'
Lander'. Name
lundets Address
1 I certify that 1 hive read this applicadon and,uu mu the above information k
' comet I agree to comply with all city and county odinanns and suss laws railing to
building concoction, and hereby aumorim mpresenuaivea of this city to cnur upon me
abovcmcnuened property for inspection Purposes.
(We) agree to an, indemnify and keep humleas me City of Cupertino against
i liabilkla.judgments,cons and upend which may in my way accrue againtssid City
I. consequence of the hooting of this Permit. -
r
' APPLICANT UNDERSTANDS AND WILL CO LY WITH ALL NON -POINT
�^ J
Issued by: Date
OURCE RErrUL K11
G
C
Re -roofs
Type of Roof
Sagnatu can 5 MATERIALS DISCLOSURE Data
Will the appllcent Or future building eceuPmt sun or handle hamdou, maurial
as defined by the Cupertino Municipal Code. Chapter 9.11• and the Health and Safety
Code. Schen 23m$a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yd v�Nd'---
If a roof is installed without first obtaining an inspection, I agree to remove
Wtll the applicant or mtutc building occupant use equipment or devices which
hanrdeu air conuminanu u defamed by the Bay Ana Air Quality Management
all new materials for inspection.
17
QYd QNe•
undorC'hapurh9y.rmeGlifor-
�I hove read the hasadnus mau11,111
,
1 Ml 21134* ding
<omkSaTcty Cade, is 33305, 2myresp1273N.1 undersand a .'spd. d,or the
fere set currently have a unm II u my responsibility ratify the aecupmt of the
Rqr &&rem. r.c,dfkaaroeen
mana�pynnar'
Signature of Applicant Date
�s
All roof coverings to be Class "B" or better
ower a rind r D,a ..
Community Development
10300 Torre Avenue
Spoof
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
�UPEkTINO
Building Department
ASS:
J1/23�
PERMIT
TT
Oa 3z -
OWNER'S NAME:r< �
PHONE # clog - 253-ocig
GENERAL CONTRACTQR:
FAX #
I am not using any subcontractors: _ G 5 - o (P
ign vre Date
Please check applicable subcontrac ors and complete the following information
Date
60
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
lurnbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date
am 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35621051.00
DATE ISSUED.......: 06/05/2006
RECEIPT #.........: 34687
REFERENCE ID # ...: 06060032
SITE ADDRESS .....: 11236 LA JOLLA CT
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: LEONARD PHYLLIS
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: FRANK CARDIA
CONTRACTOR .......: CARDIA, FRANK L LIC # 612
COMPANY ..........: CUPERTINO PLUMBING
ADDRESS ..........: 1300 DELL AVE, STE C
CITY/STATE/ZIP ...: CAMPBELL, CA 95008
TELEPHONE ........: (408)253-0618
•FEE ID UNIT QUANTITY AMOUNT
-------------------------------------------
BPWSVCS WATER SERVICE 1.00 9.00
PPERMITFEE FLAT RATE 1.00 38.37
TOTAL PERMIT : 47.37
PD -TO -DT THIS REC NEW BAL
------------------------------
0.00 9.00 0.00
0.00 38.37 0.00
---------- ---------- ----------
0.00 47.37 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 47.37 VISA
TOTAL RECEIPT 47.37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------------------------------------------- ----------------------------
103 UFER 106 SEWER & WATER
507 FINAL PLUMBING
•
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hllvfi
CI OF
CUPEkTINO
OcCD (00013�)-
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN # 35Lo-- ?-I —
Date:
Building Address:
BPGAS
l23 ' Jolles
PLUMBING
Owner's Nate:
5 �5.S
Phone #:
e/4l(, "yZ95
Contractor: Phone:
License #:
L Plk,b 2s3 -o40/8
C.ay(7v5
Contact: Phone:
Cupertino Business License #:
Ff-C,
BPWSVCS
Building Permit Info: f2o �0
PLUMBING
Bldg ❑ Elect ❑ Plumb 2-'
Sewers
Job Description:
BPSEWAGE
Residential Commercial ❑
PLUMBING
Cost of Project: _
BUSLIC
Qty. if
Annlicable 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