06050124 CITY OF CUPERTINO wv
BUILDING DIVISION PERMIT ;CCSNT�'tA, TQ�IY1 '1iRMATTO
BUILDING ADDRESS: DRAIN DOCTOR PERMITNO.06050124
18860 NEWSOM AVE
OWNER'S NAME: PERMIT ISSUE DATE
JANET COWAN 1775 WINCHESTER BLVD insli F;/?.nne
WN E: SANITARY NO. CONTROL NO.
(408) 370-3082
ARCHITECT/ENGINEER: BUT DING PERMIT INFO
BLDGO ELECTO PLUMB
MECHO
;op LICENSED CONTRACTORSDECLARATION Job DCSCT1pUOn
I V I Wrehy arli.that 1 am lhanaed under provision of Chaper 9(commencing
with Section 700)of Division 3afthe Business and Nofess ons Cade.mad my Iketm ls
i ars a veer a g�,= 3 L 5 8 INSTALL SEWER CITY C ALE®
� p san
Dau COmtruSar pc
e 7W7WARCHITECTS DECLARATION
La 1 undersand my plans shall le used an,public meet&
ltCC' Licensed Professional
MAY22- 2006
< OWNER-BUILDER DECLARATION
1J
2 I hereby a(Iim Into 1 em exempt from the Cantraxa's license Law for Ue
OC following mason.(Section 7101.5.Business and Profession Cats:My city Or county Ino ill MON, a c:
5$t which requires a permit to canRrle4 alter.Improve,demolish,or repair any structureKM 16W
Li sm $2200
_ztA prior in its issuance.also requires one,applicant forsuch permit to Ru a signed comment
< that W is licensed puahant to use,provision or the,Conwcufs Ukence Law(Charles 9 Sq.Ft. Floor Area Valuation
Y�C (conncocing with Section 7000)of Division 3 of Ne Buseem; ad Professor Code)-1
$ that W is exempt therefrom and the hula fa Ne alleged exemption.My violadun of
Section 7001.5 by any applicut for a permit subjects the applicat On•dvii Penalty or AP14 NVMger U U Occupancy Type
on,moa dun live hundred dolls(SSW).
❑1.u eater Or the property,or my emplaycn with wages as dteb ale campm rod...
will do doewaak.and thestauaua lst�tfntendedro
naffemdhossia(Bee.7lla,Bu6mon Required Inspections
and ProOssion Cade The Comrades a Meso-Iaw dom t apply m e an owner of q P
Property oho Wildaoimprow•s doereoaand who dossech umkhimmelfar lough his
own employees,provided that such improvements art not Intended uraResed forsale ff.
however,the building or improwmai isald within one year a(compledoo IW owner.
builder will law the burden of proving Wt W did rot Wild or improve for puspo a of
ale.).
1,as owner of the properly,not exclusively contracting with licensed conuanass in '
controa tte project(Sec.7Uaa,Business rad Profession Code:)The Comusc nes U•
cc=Law don not apply man Owner of propeoy who Wilds or wprows Wesson•and,
who convects for such projects with scontramoRa)licensed pursoul in the Conwctaa's
Lin.law.
❑1 as exempt under Sec .B h P C for this moon Alm
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane Of the fallowing declarations:
1 ham and will maintain a CeNOau ofConemt to alf-lasum for WOraets Conpm a.
sawn,as provided for by Section 3700 of the labor Code•for the pesformarae of the A.f�9r
work for which this permit is issued.
❑1 have end will maintain Worker's Compensation Ineunna,as acquired by Section '
3700 of the Labw Codc,for the performance of We wok for which this permit is sound.
My Workee,Compensation laamunnm artier ad Policy numberwat�t,S, Y ✓
Carrie rA-fl 0—f5` n�Iy U/�'y Polley No.:C�// •&3�3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu action need Out W completed If Has permit Is furan,hundred dnlurs(SIM)
or Ina.)
1 ceniry,that In the performance of the work for which thin remit is Issued.I mha0 or
employ any person In any manor a as to become subject in the Workers'Comperoadan
Lawn of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Wohefs Comptr ation previsions of the Labor Code,you meet
.J O forthwith comply with such provision domed
or this permit shall W rewked.
Z y CONSTRUCTION LENDING AGENCY
{-t I hereby affirm that them u a construction lending agency far doe performance of
LLv the work for which this permit u issued(Sec.3191,Civ.C.)
GQ landcr's Name
.7 z Lee aees Address
U O 1 certify that 1 have mad this applicaion and sum done the show information le
I2. F comet.I aa=in comply with all city red county aNinteo and rote lave relating In
0 building construction,and hereby authorim mpnescm,ni s of this city to enter upon the
[27 shave-mcmmucd property for inspection p.,pm&
py (We)agree to sow,indemnify red kap bomless the City of Cupertino against
W liabilitn,judgarkma eats and expenses which may in my way aecrvo gatnt said City
U z in consequence or the granting of this Permit. /
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO EREGULATIONS. /2z,59� elf s /�___0 Re-roofs �-
ZillaatureorApphcsuu ..W Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will doe applicant or future Wilding aavpsetmoa or Nndle havudau material
as detnea by the Cupenina Municipal Code.Chapter 9.12.ad the Health and Safety
Cole.Section n532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya Jallo
Will the applicant or future Wilding Occupant use equipment or tkWoa which If a roof is installed without first obtaining an inspection,I agree to remove
.mit huaNmn air onuminnu as dcfited by ted Bay Amo Air Quality Mangan rot all new materials for inspection.
District?
❑Yes RNo
I haw mal IM hvardousmaterials requirements under Chap c0635 or the Catiror-
ma,Health&Safety Cod,•Sariau 25505.25533 and U534.l understood this if the Wilding
don not comotly how a unset,that it is my uspoulhili y in ratify,the=upas of do,
requirements which most be I rrm�lsmaana a f.c,adfalcorcccupeacy. Signature of Applicant Date
ai��f�i7// S' %f-o(n All roof coverings to be Class"B"or better
mer or authorized agent Dau'
aClOF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephoae(408)777-3228
Fax(408)777-3333
#UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
/8;P01o O r�- y
OWNER'S NAME: T .ve r o w ti PHONE # -90 S�
GENERAL CONTRACTOR.- lql_ c-root FAX #
I am not using any subcontractors:C:/ % S
Slgr'gnature 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
�i S -Zeo, - oln
Owner/Confractor Signature Date
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 375300211. 00
DATE ISSUED. . . . . . . : 05/16/2006
RECEIPT # . . . . . . . . . : 34412
REFERENCE ID # . . . : 06050124
SITE ADDRESS . . . . . : 18860 NEWSOM AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : JANET COWAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : DRAIN DOCTOR
CONTRACTOR . . . . . . . : JOHN H. LIM LIC # 24784
COMPANY . . . . . . . . . . : DRAIN DOCTOR
ADDRESS . . . . . . . . . . : 1775 WINCHESTER BLVD
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 370-3082
*EE ID UNIT QUANTITY' AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPSEWER SEWER SYSTEM 1 . 00 21 . 58 0 . 00 21 . 58 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 59 . 95 0 . 00 59 . 95 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 59 . 95 10299
TOTAL RECEIPT 59 . 95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
•
r�-I-
CITY OF CUPERTINO
• SunREPIPE/SEWERS/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN# 3i5-3o. of Date: 06
Buildingg Address:
F/�o ,veL�_zSo v
O er's Name: Phone #:
Co wAN %mom- ) 57,- 90 S
Contractor: Phone: L' ense#:
/ IToa-�V/- �j �%3 �/5&
Contact: Phone: Cupertino Business License#:
Y6 -7-0/e7
Building Permit Info: 5E'L,4/E'/cam C/7'r CCS (/p q/7-
Bldg ❑ Elect ❑ Plumb;El
Job Description:
Residential Er Commercial ❑
Cost of Project:
00• '°
•
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 c of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•