06070085CITY OF CUPERTIIYO
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BUILDINO DIVISION PERMIT
n,CONTRp.CTCU,R INk'ORMaA.TION
BUILDING ADDRESS:
ALERT PLUMBING,
PERMIT N0.06070085
19261 PHIL LN
OWNER'S NAME:
PERMIT LSUE DATE
JEFF WHITED
2530 BERRYSSA RD.
07/1!1/2006
NE:
SANITARY NO. CONTROL NO.
(4 08) 272 - 14 23
ARCHTECr/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
LICENSED CONTRACTOR'S DECLARATION
Job DCSCiIpCtOn
I hereby affirm met I am liciued under provisions of Chapter 9 (commmacing
with
Division ]afthe Business arW Pra(cssium Code, and myliccnse isin
ulllfame adAffect.
REPLACE AND INSTALL SEWER LATERAL AND TWO CLEAN
License Class, Lt'"Dam.Contr
OUTS FROM HOUSE TO SIDEWALK
ARCHITECTS DECLARATION
1 undersand my plans dull w used u public records
Licensed Precessional
fr DECLARATION
Oat
exempt from the Contractor's License Law county
I wmby. that I I am exempt
o
(Sat I.S. and Protections Code: Any city or county
following ¢tion.(Saito 103
strBasin..s
which requires improve. de fie sig any aaranom
premia re emslru0. alms improve, h=ermit
n t A
for such Contractor's
poor to its �ensed eaburequites swvision ontra toitmmmonLad summem
b)
Sq. FL Floor Area
Vanua 900
of
pursuant
ofDiviomofaenBusbtohLianselaw(Chapter9
(commencing wish Section Division of Nafon, AnyAS Ction ter
and the f r the Al eged exemption,
Nat he u exempt therefrom and a bull for the reneged exemption. Any violation of
ext
Jp IdTber0
Occupancy Type
Section 7031.5 by arty applicator for a permit subjects on applicant to a civil penalty of
not more Nan five hundred dollars ($5001
3 7 5 4 0 0 0
0 I, u ower of a property, army employees wish wagessa their sole comAmatian,
Re ired Inspections
will do the wad. and the manual Bear intended or offered formals, (Sec. ]094, Business
and Pmfessiasu Code: The Conaracurs Liarese Law does not apply u an owner of
property who builds or improm themon, and whodassuch work himaelfar through his
own employees, provided thea such improvements tie not intended Mofpmad for sale. If.
however. the building or improvement Is sold within toe year of completion, the owner-
buildcr will have the burden of proving that be did Me build or improve for purpose or
cone.).
0 1, as owner of the property, am exclusively contracting with li=med contractors a s
^J a(
the probes (See 7044, Busmer of and Rofesoom Cade:) TheLid
mase La was theot.
acme law dam not apply man owner of property who builds or improves Norton. and
v
V
who r
contracts for such projects wish a eontracmrts) licenced pursuant m the Contractor's
ew
0 1me law.
❑lam(e"""ac���mps under See ,B&PC for Nis mason
Owner Dau t y
RKFR'S COMPENSATON DECLARATION
I hemby affirm under penahy of perjury not of the following dnclan ions:
of Consent soCodenswe for Worker's Compen-
1 hon: and will for by. a Section
sation, for by Ss Non 3700 of the labor Cade. (m the Performance of Ns,
r which this
wort for whim thio permit u LvuN.
-
0 I ruse mod will maintain Winkcrs compensation Insurance, u required by S=Nw
3700 of a Labor Code, for Ne performana of Ne wmria for which thin poem, B issued.
'
My Workee, Compeuatian Insese a carie and Policy, number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
from section need As w completed if the permit is far art hundred dollars IS IM)
O( lean)
Q
I certify that in to performance of a work fa which this permit B issued. 1 shall not
moployany' Fallen in anymanncrsp clap gape subjenma Worker'Compemation
- 1
Iawsaf CaO'Gynia a `��,,/F.
Applicant
NOTCE ro P If, after m�ting this Ccninca c of Exemption, you should
baome sublM 'he Warets Campenudan previsions of Ne labor Code, you mum
forthwith comply wit such Provisions or Nis Permit shall be dmancd mwk=d.
CONSTRUCTION LENDING AGENCY
I WrabY that mom is a construction(So.3lending agency for the performance of
which
theLe work fur which this permit is ivad (Sec. 3099, Civ. C.)
!.enders Nam=
Le.eers AaaM..
I certify that 1 have mad Nis application and main Nu Ne above information is
toren. 1 agree m comply with all city and county ordinances and sum laws relating to
building construction and hereby amhorin, represenuaives of this city to enter upnn ahc
ahovcros.judg d c for
purpo
(We) agree m save, indemnify and keep harmless the City of Cupertino against
judgments. costs expertiA which ms.
costing cxpcnsesmit. may in any way acctA against mid City
in f the of this
APPLICANT=UNDERSTAng
Q WILL COMPLY WITH ALL NON -POINT
Issued by: Date
URCE U T7
Re -roofs
s m p1UAAWCmurm m m
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will lie applicant or fuum building occupeam sum or handle himmodous material
u dcrsned by the Cupertino Municipal Code. Chapter 9.12. and Ne Health and Safety
25532(x)9
Code, Section �19e
❑Yes
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 ase (.,am wilding Amapa., sex cyuipm=nt or devices which
agree to remove
emir haiardnus air conuminams As derimed by the Bay Arta Air Quality Management
all new materials for inspection.
District?
❑Ye A"-
1 have mal the hanrd. mmcrima.Wimmenu under Chap n,,tai ofd, Cnifar-
M.Heal"Smesy Cede, Seetiom 25505.25533 and 25534.1undemund destitute wilding
dos A, Mo only have a Imam at it B my mi,a mihility m notify din Acupam of an,
myuimmenu whkhm w Bmaanc=ora ceNrtate ora
Signature of Applicant Date
All roof coverings to be Class "B" or better
2`L22!2 amtftitil agent
15m,..
07/07/2006 21:58 4082876302
01TYF
OUPI,INO
THUY WHITED PAGE 01
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Dep a.rtment
JOB ADDRESS: F PERMIT #
OWNER'S N �: �;
AME:., �, : �'`t'i ='F� PHONE # 4i`a�'
GENERAL CONTRACTOR: A � r t '� k t .. l..i -A' I FSC #
I am not using any subcontractors: / y Cv
Signature ate
Please check annlirahla c„1-v-�,,.k�.•f....� ,..,.] ,. _.,.,..,..,_ ter-_ c_n__._• _ _
Owner/ Contractor Signature
7 I �" j..
Date
SUBCONTRACTOR
-- --
BUSINESS NAME
uVa.LLl0.uVll:
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
Ar,
Tile n
r t, ,i
Owner/ Contractor Signature
7 I �" j..
Date
•em 1 of 1
CITY OF CUPERTINO
121,7 uMMli�xil�Fi�1 Y
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37540050.00
DATE ISSUED.......: 07/14/2006
RECEIPT 4.........: 35254
REFERENCE ID # ...: 06070085
SITE ADDRESS .....: 19261 PHIL LN
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER JEFF WHITED
ADDRESS ..........:
CITY/STATE/ZIP .... ,
OPERATOR: amyw
COPY # : 2
0
RECEIVED FROM ....:
JEFFREY WHITED
CONTRACTOR .......:
RUBEN OCHOA LIC # 27275
COMPANY ..........:
ALERT PLUMBING
ADDRESS ..........:
2530 BERRYSSA RD. #323
CITY/STATE/ZIP ...:
SAN JOSE, CA 95127
TELEPHONE ........:
(408)272-1423
*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 AMOUNTNUMBER
CHECK
------------
59.95
------------------
4380
TOTAL
RECEIPT 59.95
VOICE
ID DESCRIPTION
VOICE ID DESCRIPTION
106
SEWER & WATER
202 UNDERFLOOR PLUMBING
301
ROUGH PLUMBING
507 FINAL PLUMBING
0
1S-all-
CITY
OF
CUPEkTINO
oCo0-W35
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN # 3-1dr2—
Bld . Permit Fees
BUILDING
Date: -7/19 p (,
Building Address: IQ 26 I
Lqh�
PPERMITFEE
Owner's Name:je�C
, ` II �e
(,,J cA
BPREPIPE
Phone #:
yc'48-8 5-(2-0Z
Contractor:
BPFIXTURE
Phone:
License #:
/
Ric Ochoa
0)—Z - 1 2-3
F35306L
Contact:
PLUMBING
Phone:
Cupertino Business License #:
PLUMBING
o8- 8 — IzoZ
2� 6
Building Permit Info:
Business License
BUILDING
Bldg ❑
Elect ❑
Plumb 2
Job Description:
f \Qct
/�
/1 C,fo,
S
Residenti 1,:P�"
Commercial ❑
Cost of Project:
•
Qty. if
Applicable Fee ID
Fee Description
Fee Groun
BPERMFEE
Bld . Permit Fees
BUILDING
BPGAS
Gas Pi ing System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i e of Fixtures
PLUMBING
BPFIXTURE
Pblg. Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC .
Business License
BUILDING
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