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08050123.a,[[ ?Z4 _09 gyp? nt-u qy�qO� `ac ase Y�c L C C Z C a> yC UC UC OE �z CITY OF CUPERTINO 5 m r -� � �4s�a.-amt '� �a "P �* BUILDING DIVISION PERMIT CONTRACTORIN�'F,,,pQItMATION BUILD fr��'T`IkUCKER PERMIT08050123 OR CUPERTINO PLUMBING ER'5 NAME: PERMIT ISSUE DATE BARKER LOY L AND NANCIE L 1300 DELL AVE STE C 05/14/2008 HONLf."' SANITARY NO, CONTROL NO. (408)253-0618 ARCHf1ECflENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH 0 0 0 0 LICENSED CONnlACIOWS DECLARATION Chapter 9 Job Description oP 1 am under provisions of (commencing I hemby affirm that limm, with Section 7") ofDivision 3 ofthe Btsumaral Production, Code, ass my Breve u REPLACE WATER MAIN in son forte arsd ff 2 2 U b License w J L'e.g Da¢ Cmntmcmr'^ ARCHI'IF.CTS OECLARATIO 1 1 undemplanesshnd my plall be used u public roc rds Licensed Professional OWNER -BUILDER DECLARATION I heraby affirm that 1 am aacmpt from the Contnctots License Law for the relieving reason. (Section 7031.5. Business and Pmfossivas Code: My City or county ! which requires a permit to ---L altos. improv. demrlidL rr sopor any someone ! priorbits issuance. alto requires the applWantfossuch permiln tilt asigrN,uIntenr Nu islkcnscdpurmantWft mvis mofNeConunemriL.icenselaw(Chaptor9 Sq. Ft. Floor Area Valuation (commencing with Section 7") of Division 3 of the Busineaand Pmfesions Code) or $1000 than M is exempt Imminent and Ne basis for the alleged estmptiae. Any violation of 35614 Aff Number Occupancy P Y Type Section 7031.5 by army applicant for a permit subjects the appl'tcanl W a civil per,Ity of not mart Nn five hundred dollar ISM 023 ❑ I. A oweer of 0. property. or my employees with wages A their sole comper,adon, Required Inspections will do the, work.4 the announce, is out Wendell oronered for MW(Sec. 7014. Business and Professions Code: The Contacmh License Law don not apply to an owner of progeny who bas LIN or improv thereon, and who does ouch work himsel! m Nmugh his ovn emplaym, moWded Nar such impmvemaus ase not in¢mWd oroQertd forsale. a. hawesv, Ne Wilding or Impmvemem'u sold Whin arc Lear of completion. Ne owwar- builder will love the Wrden of proving that he did net WW or imprwc for purpose of sale.). ❑ 1. u owner of the Property sec exclusively contracting with lammed conuacsort W construct the Project (Sec. 7014, Bahamas and Profession Code:) The Contactors U- . mem Law does not apply W an ovwar or property who Wilds or Wpmm dmmon, sod. who contacts for such pmjects with amm murr(s) ficened Ptrtman, to Ne ConuactsN License law. ❑ lamexemp,mcco5 ,B&PCfatbsmamn Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury man, of the: following declarations: ❑ I have ass w01 milnuin •CutifieaW of Conserv n self-iasurt for worker, Compan- Milan, u provided for by Section 3700 of the Labor Code. for d, Performance of the weal, for which this permit is inced. ❑ 1 An and will mainWn Workers Compensation Insurance, u required by Section 3700 of den Lobo Code. for the peRmmance of Ne work for which this permit, issued. My WaM1s.r�s aC�mm�P`e.'.danlasu carter and PolWy number Cartier.-- ll"�Tc G.stAoiiry No.: CERTIFlCATE OF EXEMFMON FROM WORKERS' COMPENSATION INSURANCE (ihu section ward not W completed if the Permit Isfeamnehundmd dollars (Sind) or WM) 1 mrudy that in the perdormmcc of the work for which this permit is issued. I Hill not employ any pec mr in my maoncrus as W become mbjeet to then Workers Compenuuu laws of Califomia. Dao Applicant NOTICE TO APPLICANT: IC after making Nu Cerficam of Exemption. you should become subject to the Workers Conpenadon provision of the Labor Coda you mus foMwith comply witb such pmAsimus or this permit shall W deemed mmked. CONST ucnON LENDING AGENCY I hereby affirm this ft. 4. conmuclinn lending •,eery for the performance of den work for whim Nis Permit is ih,wad (Sec. 3097, Civ. C.) Lemice, Name lessers Address I certify that 1 haw mad this applic Iden and sure that Ne salve infinum tie. u cormeL I sgme W complY with all city and county ordinances and state laws rtladng us Wilding comebction, ass hereby arnhodse mpresutatim of this city W enter upon den ahove-menumnedcry for impaction purpmea (We) agree to Ave, indemnify and knrmthe p haless City of Cupertino against Iiebiliue;judgmenis.LLcots and expenses which mel, is any way amwa againleid City in corlsequcrosce mf the gMnun6 of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE _ Issued by: Date GULA710N J� Re -roofs `f ,EImrE cam- S ADa o� Swum of ApplicanVCon res Date OUS MATERIALS DISCLOSURE Type of Roof Win the Wildinge. auntie and CucantnofMuni Seely ChaptRoeor Remits dc0wad by the Cupertino Municipal GON. Chapter 9.11 and doe HMIN and Safely . Scctiea 2ss32pn ❑ v M1fo All roofs shall be inspected prior to an roofing material being installed. P P Y W11 tW applicant or future Wilding occupant one equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit hmudnw air commitment u defined by the Bay Am Air Quality Management all new materials for inspection. Disulctt Oyes ZNu 1 have read Ne hvaNraumauMils mquimocw under ChaPmr6.95 of Ne Cilifor- nuHMIN&Safcty Cada S.-6 ts25505,25533a 25534.1mldermand Naliftlen Wilding does sot curmndy have a tmanl than it u my rnponsibility W reify lar occupant of the requirements bichmustWmelpno masanmmr,CcnirmaWmrOcmPanry. `J Signature of Applicant Date �`%Z Z % �' All roof coverings to be Class " " S 'W'or better - Owner er amW�rcd agent Date 0 4 ITEMS OF 4 • • CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN .:......: 35614023.00 DATE ISSUED.......: 05/14/2008 RECEIPT #.........: BS0.0.0004775 REFERENCE ID # ...: 08050123 SITE ADDRESS .....: 21920 RUCKER DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 102.48 --------------- 102.48 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 507 FINAL PLUMBING .REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING OWNER ............: BARKER LOY L AND NANCIE L TRUS ADDRESS ..........: 21920 RUCKER DR CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4760 RECEIVED FROM ....: FRANK CARDIA CONTRACTOR .......: CARDIA, FRANK L LIC # 612 COMPANY ..........: CUPERTINO PLUMBING ADDRESS ..........: 1300 DELL AVE STE C CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: (408)253-0618 FEE ID ---------- UNIT QUANTITY =---------------------- AMOUNT PD -TO -DT THIS REC NEW BAL 1BPWSVCS WATER SERVICE 1.00 -------------------- 20.40 ---------- 0.00 20.40 ---------- 0.00 1BSEISMICR VALUATION 1,000.00 0.50 0.00 0.50 0.00 IPPERMITFE FLAT RATE 1.00 .. 40.79 0.00 40.79 0.00 1TRAVDOC FLAT RATE 1.00 40:79 0.00 40.79 0.00 TOTAL PERMIT ------'---- ---------- 102.48 ---------- 0.00 102.48 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 102.48 --------------- 102.48 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 507 FINAL PLUMBING .REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING CITY .7 CUPEI�TINO 0905 oia3 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE PERMIT APPLICATION FORM APN # 3-t—) (o I q O ^ 3 0 13 Fee ID Date: c�, !q-0-3 Building Address: � � C� /�U RV Q( �r• `` // r- -'1/\o ter CJ50 l y CUT 0— Owner's Name:Lne/�o�JNC- 1PCSEWER Phone #:�i�p�jlccJIZ Contractor: 1CPSS Fax #: p `3 Contact: �� j(�A ��1^o \." \0' f Commercial re -pipe per fixture Phone #' Fax #: 0 Contractor License #: (Q/�l l GjQ S Cupertino Business License #: (� Job Description: D n � r M 0\ A Commercial Gas Piping System 1-4 Outlets Residential Commercial Valuation: 1ij 116 00 Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Quantity Fee ID Fee Description Fee Grou Permit Type 1PCSEWER Commercial building sewer/sanitary sewer P 1CPSS IBPREPIPE Commercial re -pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System 1-4 Outlets P 1BSEISMICOM Seismic Commercial P / IBSEISMICR Seismic Residential P 1PRSEWER Residential building j sewer/sanitary sewer P j IRPSS Cfff OF CUPEkTINO CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE FEESCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1 PRREPIPE Residential re -pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P IBPFIXTURE Plumbing Fixture P IPGASRES Residential Gas Piping System 1-4 Outlets P 1 BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P / 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B 4 CITY OF UPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building De artment JOB ADDRESS:�Lj q -)-p Q _IC« �T. BUSINESS NAME PERMIT # o CD 5 V Q- OWNER'S NAME: PHONE # Cement Finishing GENERAL CONTRACTO . no kAmWAcN FAX # S3– b � IB - c I am not using any subcontractors: S– 1 l.(–orb ature Date Please check applicable subcontractors and complete the following information: -1��/��- 5-14-0� —wner/Contractor Signature Date 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 -1��/��- 5-14-0� —wner/Contractor Signature Date