06070204 CITY OF CUPERTINOa. s
BUILDINa;DIVISION PER CONTRA'' OR^ ,,,QRMATION`f"i
BUILDING ADDRESS: s BAY AREA REPIPES PERMIT No.06070204
924 PROVIDENCE CT
OWNER'S NAME: PERMIT ISSUE DATE
MCLEOD RICHARD 1861 ORANGE GROVE DR 07/28/2006
Rr NE:
SANITARY NO. CONTROL NO.
(408) 371-5763
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
ion LICENSED CONfRACIORT DECLARATION Job Description
w FF I hereby affirm NUI 1 am licensed under previsions Of Chapter 9(commencing
with Seedan1010)of Didion 3 afthe Bad.and Pofessioru Code.and my he..is
.3y inrallrare anderc`� Lie.« D 93(o REPIPE ENTIRE HOUSE AND WATER MAINLINE TO METER
`i"" "` 34 GALVANIZED TO COPPER
F p Dalt Lic.S for
CHTECTS DECIA re h
i I understand my plans shall W used as public mcorN
iyU
a� Licensed Profeedonal
OWNER-BUILDER DECLARATION
C C I hereby.(Sere then 11. mempl,rum the canuacmh License Any c Law for the
p O (allowing massa(Section 11D str t.aite. and Prareamol Code:Any city Of county
which its issa rt permit re enmuuct,alter,W forsu dtmlll it t or repair any structure
Z< Hadx slcenseepJkWnt to the lea beapplicanto forsuch Bance,Law(Clle A signed ennell
pter9
Had(commencing
witpurnum7")ofDivision3theComxesaLiante6w(Chapter9 Sq. FL Floor Area Valuat 6000
I F G the,he 4 tuoun with Sectionb.mf.7 and of Division of Callednwand Pr.Any ns Con.)or
$ Nat he'ts eumpt therefrom and Ne buffs far the alleged eumpuan.Any violation of
Section 7031-5 by airy applicant for a permit subjects the applicant en a civil penalty or ppN Npmber OCCU Type
nm ream than five hundred dolor (s50(). 3 5 6110 S 9 . 0 0 Occupancy YP
❑1,u owner of ate property.m my employees with wagesu Neo wk campensadon,
will do N,work.and the a.is non intended a' Mo ad r.sae(sac.11W.Buwmas ns Required Inspections
and Prose orma Cade:The Camacmes License Law does not apply m an owner of q P
progeny who Wilds.impoo.theman,andwim dcessmh work him.Wfortheough his
own employees,provided thatsmh improuments are mo inknded aronerW far ssk IL
however.the Wilding or improvement is sold within am year of completion.the Owner.
Wilder will Mve the bade.of Proving that x did ret Wild or improve far Paribas,of
sok.).
❑1.as owner of the property.am exclusively contracting with licensed contractors m
construct the project(Sec.10x4.Business and Pmfesslam Cade:)The Contravenes U.
a.law does not apply to an owner oI Property who Wires or improves therein,and.
whocontracts ontracts far such projects with a contractor(s)licensed pursuant n the Contracmh
caLicense Law.
❑lam,umpiubaer See ,B&PCfmdnumason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following attleruions:
1 ham and will maintain aCerdfom of Comcm in self-im.fm WorkersCampen-
ration,as provided far by Section 3700 or the Lab.Cade,fm an performance of the `/firms
work for which this permit is Wood.
1 have and will maintain WmIaces Compmaatian Insurance,as motored by Second
3100 of the Labor Code,for the performance of the work fw which this permit is issued. '
My Warxes ore w' n 1nsury�nce tori.and Poli number are:
Cartier. Zi Polity No.: ZVW,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu auction need not to completed if be permit is forane hundred dollar(LIIXO
nr less.)
1 unify that in the periomanec of the work for which this Permit is Wood.I shall an,
employ mypcmun in any manner m as to became subject in the Workers'Compensation
Laws of California Data
Applicant
NOTICE TO APPLICANT:If,after making this Cef iOcale of Eumption,you should
became subject le th,Wohees Compensation provisions of the Labor Code,you moat
.,O forthwith .Nu
with comply with such provispermit shall x accrued rooked.
z� CONMUC 1ON LENDING AGENCY
f•-' l xmby affirm Uw Nemo•ccnu acdm lending agency,for thcperfarmamc of
fin Ne work fur which this Permit u issued(Set.3077,Civ.C.)
Lenders Nauru
z Landers Address
U0 I certify Out 1 have mad this application and rum Nat theabove intimation is
U. F comem I agree m comply with all city and county on imntts and sum laws rtlaung to
�U Wilding construction.and hereby mabome rcPresemutims or this city to enter uponthe
FW show-mcmioncdpmpcny for,penes whichpurposes.
gL (W)agree n HYe.Indemnify and kGp herntleas the City of Cupertino agalmt
fib liabilides,judgmcn¢<osu and expenses which may in any way accrue agaimruia City
U Z in conregmne,of Ne ranting of this Permit. ^ ^
^ APPL No WILL COMPLY WITH ALL NON-POINT Issued by: Date /
SO ONS.
/ 2s 7�v6 Re-roofs
Si or p IicanoConuxenrI Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building.cupansatore.hsnale hanudous material
as defimd by the Cupertino Municipal Code.c uPmr 9.12.and the Health and Safety
Code,Semon 35312(.)?
❑Yea All roofs shall be inspected prior to any roofing material being installed.
,m No
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree[o remove it haaardaus air contaminants an defined by the Bay Ama Air Quality Managcm,nr all new materials for inspection.
District' 1'
❑Yu QrNu
I have mad Ne haradourmaterials req tharroma under Chapter 6.95 of the Califor. I
nu Health k Safety Can..Secvom 25505.25533 and 25534.I understood Nat if the building
does ter currently hoc a temn,Nat it Is my laspomibility an badly the acupam of Ne
mgaimS�pp y hlchp�x met prim issuance ora Cenifnsm yfOccupamy. Signature of Applicant Date
dokvt J 2 Sun l+a 1P Zit;L
Owner car amhmirad agent D=' g All roof coverings to be Class "B"or better
„�,, - Community Development
10300 Torre Avenue
ll�
i� �/'' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
`UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
066) 70-2-0 `1
OWNER'S NAME: i q.vi( c m PHONE # . 2S , 32-6 -1
GENERAL CONTRACTOR: �9J� FAX # I
I am not using any subcontractors: C� — v'
Signature bate
Please check applicable subcontractors and complete the followinginformation:
60 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
• dy�y 2 dz
Oi�ner/Contractor Signature Date
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35611059 . 00
DATE ISSUED. . . . . . . : 07/28/2006
RECEIPT # . . . . . . . . . : 35431
REFERENCE ID # . . . : 06070204
SITE ADDRESS . . . . . : 924 PROVIDENCE CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MCLEOD RICHARD
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : BAY AREA REPIPES
CONTRACTOR . . . . . . . : JOHN SWANSON LIC # 23773
COMPANY . . . . . . . . . . : BAY AREA REPIPES
ADDRESS . . . . . . . . . . : 1861 ORANGE GROVE DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 371-5763
•
FEE ID UNIT QUANTITYAMOUNT PD-TO-DT THIS REC NEW BAL
- - -- - - - --- --- ---------- ---------- - --------- -------- -- --- ------- ---- ------
BPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 47 . 37 0 . 00 47 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------- - - ---- --------- --- ------------------
CHECK 47 . 37 3530
TOTAL RECEIPT 47 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
CITY OF CUPERTINO (Xoi oqj�
REPIPE/SEWERS/MAIN SERVICE
•C ;v
UPEkTINO PERMIT APPLICATION FORM
APN# I I—D Dat
U
Building Address: q I
1Ly �a^Jv ; a�Pn�C L
Owner's Name: n/� n Phone#:
c�4r ] G Leo 2S — 32
Co ractor: Phone: License#:
I4r _571 -Y743 lq 3
Contc . Phone: Cupertino Business License #:
�o SutiSu Sok —oa 2
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description: n " A
Residential vCommercial ❑
Cost of Project:
S`O UJ.pp
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Pi in S stem Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Repipe of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
! BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING