04060015CITY OF CUPERTINO
777777777;777
' BUILDING DIVISION PERMIT
�aysh.�
BUILDING ADDRESS:
LARRY WV
S & D GINGERELLI PLUMBING
PERMITN004060015
_Q-712
OWNER'S NAME:
PERMIT ISSUE DATE
BUSH PHILIP
NE:
SANITARY NO. CONTROL NO.
(408)243-4223
ARCHOMC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
1 hcteby.from that I me licensed under prost itons of Chapter 9 (commencing
Job Description
with Section 70110) of Dividon Sof Ne Businessland PmwudW.Code, end my license is
I. fall
Linsoc nnndeHee`'
Licenu Clan Lic.p
REPLACE WATERHEATER . F6'hWIA M
Dow Contractor
ARCHITECTS DECLARATION
- i
1 understand my plans shall be used as public records
1 '`.�,,
J U L N 2004
Licensed professional
OWNER -BUILDER DECLARATION
1 Waso .(Sinn Nal 11. exempt from the Canlnctor's Licenu Law for the
BUILDING
following reeson. IIDstr B, altmss and o haat: My city orcounty
which requires a permit li
ermit t w, de
construct, be alrec, improsu, demolish, at repmr any tWGure
cture
re
Priormiucensed pursuant to
lW applicant for Contront ractor's
NeofDiviomofsite innoule a , ned Law (Chapter9
tha(comma
Sq. F[. Floor Area Valuation
ccenscdpSectio 7
(commencing with Section nand of Division 3 the Rosiness and Professions or
eBusinessaLicenseationCodc)
the
Nat he is exempt therefrom and due buil for tW alleged exemption. Any violation of
laden
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of
'6er0 0 -
T1
Occupancy
not more Nen five hundred dollen (5500).
-
• ' Pe
D 1. as; owner of the property. M my employees with wages as theirsaw compenntlon,
willdothework,.ndth sa Clumisn^linkndedoroneredforsde(SCc.7W.Busines.
and Profession. Code: Thu Contractor's License Law does WI apply to .n owner of
Required Inspections
property who builds orimproves Ounces, and whodoeasuch work himself orthrough his
awn employns, provided thalsuch improvemenu ate not Intended oroRered fmaale. If.
howsysq the building or improvement is sold within one year orcomplelion, the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
Q 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's U.
come law docs not apply to an owner of property who Wilda or improves Neon, ad ,
who concocts for such projects with a comountor(s) licensed pursuant to the Carmelm's
License taw.
❑Iannow, tun deo Sec. ,B&PC for this mnon
s -L Date 1 d t
r �iCO
O CO ENS f
fNduToNDFAI
1 Wrcby Nitre under penalty of perjury ane of the I ng dedvulana:
1 hove and will maintains Certircato of Cmuenl to self -Insure for WorkeiaC'ompen-
sa0on, a provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Tsuursnce, es required by Section
371 of the labor Coda. for the performance of due work for which this permit is issued.
. .
My Worker's Compemauon Insurance cortin and Policy number are:
Cantee Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisonsion need not W completed ifthe Permit s forms hundreddollars (SIM)
or less.)
I certify 0.1 in Ne perfmmenee of the work for which this Permit is island, I shall not
,.playmyPa.. in any msnrmr m as to became subject to the Wmkers'Corepensauon
'
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: IL after making Nis Certificate: of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Cade, you must
forthwith comply with such Provisions or Nis permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby ellirm that desert is a construction lending agency for the Performance of
the wails for which this permit is mood (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
I ceNfy Nat 1 have mad this application end sues that the shots inform W un is
COMM I agree to comply with all city and county ordinances and auto laws totaling to
building consuunion, and hereby authorin reprrsenutives of this city to cnur upon the
ahove-menudgro property for inspection Purposes.
(We) agree to save, indemnify and keep harmle d sere City of Cupertino against
ueSono ntl Cxpenes which may in any way accme egainstsdd City
in
in consequence of the
of Starting or this permit.
PLICAL T RSTN
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by; Date
S URCE^G( L.AATIIONS.
J5/')
j
Re -roofs
SiB^ PpliEanU nlnc Dees
N ZARDOUS MATERIALS DISCLOSU
Type of Roof
Will the applicant or rutore building occupamoftne ar ndleh ousmatorial
as defined by the Cupertino Municipal Code, Chapter 9.12, an ealth and Safety
ode. Section 25532(a)I
❑YCs f��,w\,�
All roofs shall be inspected prior to any roofing material being installed.
/ �
If a roof is installed without first obtaining an inspection, I
Will the applicant or future building occupant use equipment or devices which
agree to remove
u havardnus air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
isodcs7
❑YCs yP)yY.
I have read NShe anbunnommiala requirements under Chmm,6.95 of the Calif.,
nia HcalN&S ode,Sections25505,25533 and 25534.1 understand Natifthe building
dans not mly hast a lonan4 that it is my responsibility m really the occupant of dw
mgwnme s whim must be met poor m inuancc are Ccrtircan, of Qw.ruucy.
Signature Of Applicant Date
1,
7L
All roof coverings to be Class "B" or better
Owner ter s n ag t '
.
a 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Elk: Lot:
APN 31602037.00
DATE ISSUED.......: 06/01/2004
RECEIPT #.........: 25692
REFERENCE ID # ...: 04060015
SITE ADDRESS .....: 10712 LARRY WY
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OPERATOR: suem
COPY # : 3
OWNER BUSH PHILIP C AND FRANCES A TR
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2057
RECEIVED FROM ....: PHILIP BUSH
CONTRACTOR GINGERELLI, JERRY A LIC # 21906
COMPANY J & D GINGERELLI PLUMBING
ADDRESS 3533 CONSTANCE DR
CITY/STATE/ZIP ...: SAN JOSE, CA 95117
TELEPHONE (408)243-4223
'*E ID UNIT
__________ _____________
BENERGY PERMIT FEE
BPWHEATER PER HEATER
PPERMITFEE FLAT RATE
TOTAL PERMIT :
QUANTITY
__________
AMOUNT
__________
PD -TO -DT
__________
THIS REC
NEW BAL
1.00
23.10
0.00
__________
23.10
----------
0.00
1.00
9.99
0.00
9.99
.. 0.00
1.00
35.52
__________
0.00
__________
35.52
0.00
68.61
0.00
__________ ----------
68.61
0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ -__-_-___-_-__-_-_
CASH 68.61
TOTAL RECEIPT 68.61
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
i
4
Ir OF
CUPERTINO
CITY OF CUPERTINO
WATER HEATER
PERMIT APPLICATION FORM
APN #Z
/(� n Q
`7
Date: �t
1(/ to e, t) ;Oro
Building Addre
PLUMBING
_
Owner's Na•
�%
BUSLIC
Phone #:
Contractor:
Phone:
License #:
G f, (4 G,9,ZELt- r
Contact:
Phone:
Cupertino Business License #:
Building Permit
Info:
Bldg ❑
-Y Elect ❑ Plumb
Mech ❑
Job Descripti
E �, PGF' 0 D 009 8 t`z-"
Residential 19
Commercial ❑
Cost of Project:
Strapped ❑
On Platform El Bonded ❑
New Location
❑ Replacement
Qty. if
Annlicable Fee ID
Fee Descrintion
Fee Groun
BPWHEATER
Water Heater / Vent
BUILDING
PPERMITFEE
Plumbin Permit Issuance
PLUMBING
BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING