05020021 CITY OF CUPERTINO
BUILDING DIVISION PERMIT s CONTTtACTOR3INFORMATION '
BUILDING ADDRESS: BELL PLUMBING INC PERMR1905020021
OWNER'S NAME: PERMIT SUE DATE
('HAT'j2420 PRI R. AVE n2 /n2 /20oc;
)HNNY
ONE: SANITARY NO. CONTROL NO.
(510) 438-9000
I
CHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I� l�
LICENSED CONfRd under S DECLARATION
1 ion 70 affirm Nat 1 am licensed under previsions of;Code, 9(ammense is Job Description
sh Sanson]IXU)of Division l of the Businwand Professions Code,and my licusm isfAllmrteand , REPLACE SEWER
qLicence Class t7 Lic.g
le1-es Date Z—z—n Conuacbr G U v
e 1J' ARCHITECTS DECLARATION
y U I undemiand my plans shall be used As public records
6
L O Licensed PNfCV1nMI
3 OWNER-BUILDER DECLARATION
Si 1 hereby affirm that I am exempt from dm Contractors License Law for the
i O o following mason.(Seed on 7131.5,Business and Professions Code:Any city or county
v�$ which require a permit to consumer.alter,improve,demolish.or mpair any structure
prior to its iuuancc,alw requires theapplieni for such permit to file a signed sntemem
€�
that he is licensed purmanun the provision of the:Contractors L ecom Law(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7")of Division 3 of N[Business and Profrasions Cade)or
that he is exempt th aefrotm and Ne basis for the alleged exmnp0on.My violation of
Secfion 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of
not more than fiw hundred dollars(M). 3 7,Vb8'Q1A87e10 0 Occupancy Type
❑L as owark.Ne prop[ry,w Is misteraa vio wage as them sole compewness
will dothework ands: o Comunots License elod
nota(Sec.7044.Business
and property who
Code:The Convectors ndwho law does not apply lf an Owner is Required Inspections
poperywho s.pmor(mprolsu th Improve who am not inworkhimselfedWaugh his
meso.,OR Wiping Or i Nat such Improvements are not c..ft woRemd for sale,-
Wilder,the building ar improvement u mid within ono year of completion,Ne ower-
builder will bare the burden of preying that M did nm Wild or improve for purpose of
sale.).
❑1,as ower of the property,am eaclummly Cour acing vist licensed anmeerors to
constmct the project(Sec 7(s1x,Business and Professloru Code:)M Contractors U.
ave law does not o
in
As to apply ly owner of property who builds or
impmprotherton,and
who contracts for such p0 vinecontractor(scontractor(s)licensed Furman,toves the Contractors
Licence law.
❑lam exempt under Sec ,B&PC fm Nis meson
Owner Data
WORKER'S COMPENSATION DECLARATION
1 homily ARum under penalty,of perjury arc of the following declarations:
1 haw and will maintain aComil atc Af Consent to sel6insum far WonkerSCompen-
cation,As Provided for by Section 37M of use labor Code,for that,performance of th[
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Inswma,u required by Section
37W of Ne labor Code,for dm perform.of the were for which Nu permit is Wood.
My Workers Con pensauon Insuaxe On and Policy nuorbo,A: q
Cari<r.�_�OPoliN O
CERT FICATEOF COMPENSATION INSURANCE WORKERS'
COMPENSATION INSURANCE
CITU section wed not W completed if the permit is for Alto hundred&I]=(S 100)
or las)
1 cAm y Nat in Ne performer,of the work for which this permit Is issued.I shadl caw
employ anypermn in any mannerm u to become subject to the Workers'Compensaimn
Laws of California Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject no the Wmker's Compensation previsions of the Lehm Code.you must
Jz forthwith comply with men provisions or this Permit shall W deemed revoked.
'Z'O CONSTRUCTION LENDING AGENCY
(+ l hereby affirm Our them is a construction lending agency for the performance of
a the work for which this permit is issued(Sa.3097.Civ.C.)
Q Isndcr1 Namc
z Icndeh Mdreu
V p 1 certify Nat 1 have read this application and sum Net the shoe[information u
0 F Wilda l Agree te comply with all city and repro oNirtanes and curt cza t.porng m
0 W abow-menumscrionatd hereby authoriaertPrnsenutircv of Nis city tocntu upon dm
r 4 ,haven junin[d proms.eny for inspection putlionwhich ms ( , O
(Wc)agree ro save,indemnify and keep harmless the City of Cupertino against s
0,F.rq in COnSN=dgme hograuand[xpeiva which may in any way accrue against said City
3 z inconscgwrtce ND granANOf DSUu permit
t—' APPLICANT UNDE$$$$$$tttttt7jj7��''''ANDS WILL COMPLY WITH ALL NON-POINT Issued b
SOURCE REGUL'ATIgN3 y9 Date
/ Z -e Re-roofs
Stgnuurt of ApplicanVCantramw Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant sore or hardly hacandous material
az definyd by Um Cupertino Municipal Code.Chapter 9.12,and the Health and Salary
Code,Sation 25532(,)?
pea N. All roofs shall be inspected prior to.any roofing material being installed.
Will thy applicant or fretum building Aare ant mm If a roof is installed without first obtaining an inspection,I agree to remove
Pp B s e.Ail Qm or device which g p
Air by Anus air contamivnu az defined by Nc Bay Arta Air Quality Management
District? all new materials for inspection.
❑Yes ,>6o
I have read the hvu brusmaterials mquiremence un lerCharmerd.95 of Ne Califor- a
nicelicaln&SafcIYCodc,S[Nons 75505,25533 and 2553x.1 understood Nu if dm Wilding
drys not curry dy rent,Nau apomibility to Amity shy acupam of Nc
mquimmcn ch m me or vancc of a Cmtifmate of Occupancy.
n t ,- `°��- � �3 Signature of Applicant Date
Owner m c edagent D,m All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
�'' Cupertino CA 95014
"fi Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
Jos ADDRESS: l`� o {7 rel v PERMIT #�S as baa
OWNER'S NAME: N,1 C- -j PHONE #
CONTRACTOR c�( U
I am not using any subcontractors: Z - Z-QS
Signature Date
Please check applicable subcontractors and complete the following information:
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/Contractor Signature Date
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICECITY OF
CUPERTINO PERMIT APPLICATION FORM
APN # S /SO OS Date: 2
2- QS
Building Address: JJ rr
b3 �0 / 2v,�� 1Tr U
Owner's Name: �O r N1 Ch ` Phone
Contractor 11 Phn License#:
Contact: Phone: Cupertino Business License#:
(0 - c-(H -7 bbo M Z.o( �1 0
Building Permit Info:
Bldg ❑ Elect' ❑ Plumb Q-- -
Job Description: 1 N LF,-,Z / / y
� L�/6)c�_n O VS � [Z� - 20 6�1— l/✓V�
Residential Commercial ❑
Cost of Project:
2 foo
Qty. if
A licable Fee ID Fee Descril2tion Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE i -_ Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
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