06060058 CITY OF CUPERTINO ciawx« ' '� '
B]JILDINC:JIVISION PERMIT C0NTRACTC1RINF0RMATI0N�
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BUILDING ADDRESS: GREAT AMERICAN, PLUMBING C PEINtO06060058
20985 PEPPER TREE LA
OWNER'S NAME: PERMIT ISSUE DATE
OBILL PECK 166 GRAHAM AVE 06
NE: SANI'T'ARY NO. CONTROL NO.
(408) 995-6400
ARCHIIECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
Tao LICENSED CONTRACTOR'S DECLARATION
g 1 hereby a(Rmt that I am becosma other provisions of Chapter 9(mmmeneing Job Descrip
jZ� with Section 70110)of Division 3 of the Business and PmfmmnLCud.,vrd my lice.is ONALED
<o imm�fnmeaneme OCy� L PROPERTY LINE CLEANOUT
L' Ua Clara
I~S� ARCHr1ECTS DECLARATION •��lNr 2006
i C I understand my plans shall he used as public records NNNNppppyyyy
avV � ��g�� qty
G Liccvcd Professional g] u M'g1aA
OWNER-BUILDER DECLARATION gftl11T/'ry/Opp lyt�N�tftt
I roan .(Sera on I em cumut ns farm the Contractors,:Any c Law for de
.p O following moon.(section 703 L5,Business and Profeuiom Cade:Any city or county
29 which requires a Permit to con amc4 alter.Winnow.demolish.or minor any structure
$1 6
;iy prior.itscarancc.alsudito provisions
the Contractor's
Lives,Law(summmt
2�0< Natheulicenxtl Sectiouo00)o(Disionso(the eBusinessalicctnelawdsCouln9 Sq.Ft.Floor Area Valuation
(common osemp, Section]000)o(Division of the Business prion.Any vi Coae)of
�
that he u eumpt therefrom and the buts for the Jlcgcd exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of XPR r U 0 Occupancy Type
not mart titan five hundred dallan($54)0). '
❑I.uownerof the pmpemy,remyotimaneh ded orNwaghu Nev ec.c ,Business
will do the si.mwtokands:no Commodes
omm rades License Law
dos act apply t oan owner
of Required Inspections
and Profwiobu Cade:The Wm t ereards dd wue Law doh aria apply b an owner of q p
Property who buildsorimpmw demon,and who does andead khinuelf ulthrough his
awn employees,provided that such Improvement semmu art mt ear ole or oRemA fasale.owner.
however.Ne Wild as or en of pmmt amid within ane year of c parew f r Ne eo
bailors will have the burden of proving that h did not build or impmvc far purpose of
fab.).
1,as owner of th pmpcny,am exclusively contracting with Garued conamench in
Construct the project(Sec.7044.Business and Prof sumac Code:)Th Contra ores U.
centra law doh not apply m an owner of property who builds or impmws thetmn,and,
who contracts far such projects with a eomeactor(s)lieeadead pursuant to the Cantmcmr's
Licuen law.
❑lamexemptunder See .B&PCforthumuon
Owner Dau
qpWORKER'S COMPENSATION DECLARATION
1 bemby affirm under pemlty of perjury all of the following declarations:
I have and will maintain a Certificate of Conant to ulf-insum fa WorlaCes Compcn�
satian,an provided for by Section 3700 of the Labor Cade,for to,performance of the
work for Which this Permit is issued.
I love and will maintain Workers Compensation Insurancon.as aspered by section
3700 of Ne Labor Code,far the pefformaare of the were fa which this permit is issmd. '
My Workers ommmauon Warartc caricr and Poli c
Caricr. icy No.,nu
CERfIFlUTE OF EKEI ON FROM WORKERS'
COMPENSA INSURANCE
(ITU sn tion amino t,,cmnpleoJ if dm permit h loran Itundrtd dollars($100)
orlha)
1 coup,dart in the performafee of th wart for which this Permit Is issued,I shall ret
employ any person in any manner m u m become subject to the Wmkcre'Compewfian
Laws of California.Data
Applicant
NOTICE TO APPLICANT:Ir,after making this Cenifiate of Eaemption,you should
become subject ro the Workers Compcmation pmrisionf of the law Code,you mew
.,O foMwith comply with each provisions W this XMIL shall h deemed revoked.
Zy CONSTRUCTION LENDING AGENCY
(+ Thereby UT,.that Nem isaeotutrtno.lendingageay(a,the perform.of
fZ> the work fa which this permit u Wood(Sec.3097,Civ,C.)
fz1 0. Q lender's Nva
0. z Leaders Add.
U Q 1 certify that I have rod this application W sum that the aIso. information In
IT, f'" comm.l agree to comply with all city and county ordinances and state laws minding in
U building construction,and hereby authorim representatives of Nis city to enter upon the
0. abovemenduncd Property for inspection pugeses.
(We)agree to save.indemnify and kecp hafmlhs the City of Cupertino agilnst
incoitih.Judgmethn"mouandupemhwhieh may in any way acme gainstadd Coq
V z inco.
race of Nc tranting of Nis permit.
'—' APPLI UNDER WILL COMPLY WITH ALL NON-POINT Issued by: Date
s0U RE
tgmturt of Ap m Re-roofs
HAZARDOUS MATERIALS DISCLOSUREType of Roof
Will the applicant or future building occupant more or handle hanrdom nowrial
u defined by the Cupertino Municipal Code.Chapter 9.12,and the Hea1N and Safety
Code.Seeded 15532(+)7 All roofs shall be inspected prior to any roofing material being installed.
Orex lgfio
Will Ne applicant or r tum building occupant mcyvipmcnt or dc whichIf a roof is installed without first obtaining an inspection,I agree to remove
omit bassoon.air conumimnu u defined by the Bay Ama Air Quality Mamgcment all new mat Is for inspection.
Dista ct]
❑Yes
i
I have mad Nehvarda.materials mquirtmcnu under CTapmr693ofNe Glifor.
nu H.INhS tyCode,Sectiam]SSo525531 vW25334.IuMersuM thmifNe Wiliin
dors art eta t it a my prrmlulily m artify the aeupaal o e
nnNirc r eco
corpeam of mpanry. attire o pplicarl - Date
wrier of as ,m roof coverings to be Class"B"or better
e Community Development
r 10300 Torre Avenue
J Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS- PERMIT #
2La"12— 6O0 .�
OWNER'S NAME: PHO -7 _/—
GENERAL CONTRACTOR: IMMAFAX #
I am not using any subcontr ors:
Date
Please check applicable subcontractors and complete the following ' ormation:
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
T'
n r Signature Date
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35912018 . 00
DATE ISSUED. . . . . . . : 06/07/2006
RECEIPT # . . . . . . . . . : 34732
REFERENCE ID # . . . : 06060058
SITE ADDRESS . . . . . : 20985 PEPPER TREE LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BILL PECK
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : GREAT AMERICAN PLUMB
CONTRACTOR . . . . . . . : CORPORATION LIC # 18061
COMPANY . . . . . . . . . . : GREAT AMERICAN PLUMBING CO INC
ADDRESS . . . . . . . . . . : 166 GRAHAM AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
TELEPHONE . . . . . . . . : (408) 995-6400
•FEE 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 95894
TOTAL RECEIPT 59 . 95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
CITY OF CUPERTINO
REPIPE/SEVERS/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # 3 r q ,L SDI f� Date: I
Buildin Addres .
0— Phone Phone#:
L -7
trac or: Pho License#:
�— c
C to Phon _ Cup 'no Business License #:
� -- /�
guildi4 PermitInfo:
Bldg ❑ Elect ❑ Plumb 'fes
Job Descripti
Residential Commercial ❑
Cost of Project: 60
• I �
1
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 Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Dis osal PLUMBING
BUSLIC Business License BUILDING
•