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06090075 CITY OF CUPERTINO �.yaxpssurs�'xs# ,f .,td.2' h�'^'a°�•r BUILDING DIVOIOfN PERMIT �X�&.'T"* C,T00RAN RMATIQN,� BUILDINGADDRESS: TOM' S PLUMBING PF71MITNO'06090075 10092 MOSSY OAK CT �. OWNER'S NAME: PERMIT ISSUE DATE WUNDERLICH MARGARET 12246SYVAT"A "TTNNARATOG NE: SANITARY N0. CONTROL NO. (408) 867-6010 ARCHnEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT l� l� PLUMB MECH O O LICENSED CONTRACTOR'S DECLARATION Job Description tui I hereby+from then 1 am Ibsnud under pmwiom of Chapter 9 mcommeMng with Section 700,0)or Di isum3afJte Business and Profeasiuv Cade,led my license is Lm 0 inrullfa eWandcna (o � � REPIPE FROM GALVANIZED TO COPPER TYPE L rqz Lmensa�C 1µsi'—E(�y—� COS Wheat p Dam t 4007 ARCHIIECI-S DEC 1 N I untleraunJ my plana shall k used a publ c rtcartla s ' Lkemcd Professional OWNER-BUILDER DECLARATION i Q0 I hereby affirm Sec o that 11. exempt from tie Communes :Any c Law far tk Q O following meson.(Section 713 Id.Business and Rofveiov Calc:Any city or county f$jL which rtqulma a permit reconstruct alcor.Improve,demolish,nr repair any strneum $6143 -ie prior mits iencedp nedaequiresdue rroA oicamthe her Conch pcnoitrofilcaeLaw(ned utemeer • a Natkulittvedpuawnite kpo alouafNcConwcmr'sLmen¢ aw(Chepm9 Sq. Ft. Floor Area Valuation $ (commencing with Section 7000)of Division 3 of Ne Business and Pmfnsons Crum)or .. that he Is exempt tkrtfrom and the basis for the alleged exemption.Any violation of Section 7031.5 by aro'applicant for a permit subject the applicant to a civil penalty of r U U Occupancy 1pe not mom arm,Bw hundred dollars(2300). ❑1,u owner of the property,or my employees with"to an Nair sale compensation, will Pr thework,ands: heumureiaeot's License offered do rmatl apply In aq Business Required Inspections and Projections Cade:The C sere I, at Intended Littve law dao not apply man owner of q P property wbobuada«improves memos,andwhodausuchwork himselforthrough his own employees,provided that such improwmenn art not intended oronered fmaale If. however,the building orimprovement is said withinone year of completion.the owner. j builder will have Ne burden of proving that he did not Wild or improve for purpose of neteJ. ❑1.u owner of the property,con exclusively conaeming with licensed contractors te consortia one pmkct(See.7014.Business and Profusions Cade:)The Commences LI- fp cave Law deco not apply je in owner or property who Wilde or improve Carmelites and. O whocommentsLace for such pajems with a convamor(0liccnsed punvnt m tk Cantracmr's 0 lase Law. ❑lam uemptunder Sec. .B&PC far Nis reason . Owner Data WORKERS COMPENSATION DECLARATION I hereby rdBou under penally of perjury one of the following declam0av: 1 haw:and will maintain a CeNftcate of Conant to salf-Insure for Worker's Compen- uden,as provided for by Section 3700 of the labor Code.for the performance of can, work for which this permit is issued. ❑T have and will maintain Worker's Compevation Insurance,as required by Section 3700 of Ne LaWr Code,for Ne performance of the work far which Nu permit h Issued. My Worker's Compensation Innermost caner and Policy number w: _-a Cartier.1 rv' �9461 I Is" Poliry No.: C.106 I� f•�y CERTIFICATE OF EXEMFIION FROM WORKERS' COMPENSATION INSURANCE C17N raedm uW rot k completed If Ne permit Is forone hundred dounce(5100) or Ice.) I ttnify that In the Performance of the work for which this permit Is issued.l shall not employ any person in say summer an as to become subject is he Workers'Compennedan ' laws of California Date Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you Nwld become subject m the Worker's Compensation provisions of Ne Labor Code you most .JO forthwith comply with such proWsiov cordis Permit shall be deemed mwked. z CONSTRUCTION LENDING AGENCY [ti Iherehyarom Out Nem ieaconnruninn lending agency far Ne perfmmemc of GL> the work for which this permit is issued(Sm.3M7,Ci,C.) QLentices Name z Lenders Address U Q I ronify that I have read Nis application W state the,the above information is U. F corracL 1 agree m comply with all city and county ordinances and sum laws relating to O V building convection,and hereby authorim mp=nuriws of Nis City to comr upon the r W ahove-memiuned pmpeny for inspection purposes. C (We)agree to new.indemnify and keep hamAcu the City of Cupeniou against tirA Iiabili0u,judgmenu.cosu and expenses which may in any way accrue agaivuaid City U Z in consequence of the Bunting of this permit /� 7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date _ e SOURCEREG LATIONS. `3iqdlPA1h 0,614 I-/?- 4a Re-roofs Spartan aApplicvVConuacror Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will dm applicent ar forum Wilding amspNt amen crhandle haallous material v defined by the Cupenim Municipal Code.Chapter 9.12.and the Health and Safety Cook,Section 25532(q' All roofs shall be inspected prior to any roofing material being installed. C)Y. Pa Will dte applicem or future building accupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hourdnv air contaminants as defend by the Bay Ama Air Quality Management all new materials for inspection. District' ❑Yes gossem� . I hue read the tandems materials requirements under Chapter 6.95 of the Califon nla Hculth&Safety Cadc,Secdm25505,25533um25534.Tundcmand Nmiflhc building does not currently how a onam diet It's my responsibility he notify he cecupmt or the requlremenu which must tae ' iuuavc ofa Cerdfxa¢oroccupmy. Signature Of Applicant Date 9—/a-r- All roof coverings to be Class"B"or better 0 er or Noriud agcm Dam' Community Development 10300 Torre Avenue s Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT# oDR 0 S S Y d Com 04067 OWNER'S NAME: t(/ PHONE # I-W(o—,$go f Z_ GENERAL CONTRACTOk FAX # I am not using any subcontractors: -` Signature Date Please check applicable subcontractors and complete the following information:. 63 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 em 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 34232113 . 00 DATE ISSUED. . . . . . . : 09/12/2006 RECEIPT # . . . . . . . . . : 35996 REFERENCE ID # . . . 06090075 SITE ADDRESS . . . . . : 10092 MOSSY OAK CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WUNDERLICH MARGARET ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : JOSEPH CLARKE CONTRACTOR . . . . . . . : CLARKE, JOSEPH M. LIC # 10044 COMPANY . . . . . . . . . . : TOM' S PLUMBING ADDRESS . . . . . . . . . . : 12246 SARATOGA SUNNYVAL RD CITY/STATE/ZIP . . . : SARATOGA, CA 95070 TELEPHONE . . . . . . . . : (408) 867-6010 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 6, 143 . 00 137 . 16 0 . 00 137 . 16 0 . 00 BPREPIPE NO OF FIXTURE 2 . 00 18 . 00 0 . 00 18 . 00 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 193 . 53 0 . 00 193 . 53 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - - -------------- ------------ ------------------ OTHER 193 . 53 VISA TOTAL RECEIPT 193 . 53 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING • CITY OF CUPERTINO a REPIPE/SEWERS/MAIN SERVICE �� CUPERTINO PERMIT APPLICATION FORM APN# Date: 3�I�Z z- 13 -la-e Building Address: IDD r�t, 0OSSY c7�rlc �o� Owner's Name: Phon #: �� Contractor: Phone: License#: d I? S, V7 G 0/0 5 a' Contact: Phone: Cupertino Business License#: zlre y o 8 0,J `f a ` O a y Building Permit Info: Bldg ❑ Elect ❑ Plumb Ea Job Description: Residential Commercial ❑ Cost of Project: o_ ' r 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 Re i e of Fixtures PLUMBING BPFIXTURE Pb] . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING •