06090272 CITY OF CUPERTINO "r -
BUILDING DIVISION PERMIT VCQNTRAGTQRINFORMA.TION
BUILDING ADDRESS: SOUTH BAY PLUMBING . PERMIT NO.06090272
11180 SANTA TERESA DR
OWNER'S NAME: PERMIT ISSUE DATE
SINNOTT BEVERLY 441 N CENTRAL AVE 09/29/2006
NE; SANITARY NO. CONTROL NO.
(408) 370-3535
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
!ao LICENSED CONTRACTOR'S DECLARATION - IOh Df;SCil tlOn
I hereby affirm Nm I am licensed under provisions of Chaplcr 9(comae Ing P
? with Section7M0)of Division 3 of Ne Business and Profession Code.and my lie sets
± „ Nmnrme,nderr s r REPLACE 40 GALLON WATER HEATER
,191 Liamc CI lac.
t„o Date Camncmr
ARCHITECTS DECLARATION
ION
f 00U
W FF
1 understand my plans shall he used as puhlic mortis
Gy LIeCRted Pa(CSSlanil
3-off OWNER-BUILDER DECLARATION ContrON ��
i f 1 Masa .(Sere Nm 11. exempt from dm Coronal Ca :AnyC law for the
❑o following meson.(Sadun](131.5,Business and Professional Codc:Any oily rr county
m E! which myuires a permit tu construct,alar,imPmve,demolish.ar repair any met.. $935
-ZT priorol its issuance.amiaxdre the applicant forsuch perm,toftle,sigrmdsulemcm
Ei`e Ihakisliccruedpursuanttoteprovisions ofNCCawster'sLiecn¢law(Clupier9 Sq.Ft.Floor Area Valuation
yl-a (commencing with ScSWn7000)of Division 30fim Businessand Profesions Codc)ur
Nat M his exempt Nemfrom and She baso for are alleged exemption.Any violadan of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of r U U Occupancy Type
not mare Nan five hundred dollars($500).
❑1.as owner of the pmpany,or my employee with wages as their sole compensation,
will do thewark.and Nesmctureu naOnumed orofrertd rormle(Sec.]bd,Business Required Inspections
and Professions Codc:The Cmusime's Lice ace Law does Out apply n e an owner of q P
property who builds or ire prow thereon,ad who doe such.,it himsel f or through his
awn caplawss.provided that such improtemmus are not intended or onerralfi la.If. -
however,Ne building or bnpmvcmrm is sold within arc year of complcuon.Ne owner.
builder will have race burden of proving Nat he did not build or imp t.for purpose at
sale.).
❑1,as owner of the pmpenX am exclusively..resting with Ilccrucd mnmmix W
cons.,,he project(Sec.7014,Business and Professions Cade:)The Cmuxu a .U.
census,Law does not appy in an owner of property who builds at improm din man.and
who comms far such praises;with a conmctm(s)licensed pursuant to the Contractor.
Lima.law.
❑I am exempt under Sea. B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby.111.under penalty of perjury ore of the following deelarifiaa:
1 Ins and will maintain a Cenificare of Consent to self-insum for Workcr's Compcm
sadm,as provided(or by Section 3700 of the labor Cade,far dm perfotman s of Nc
wailic for which this Permit is issued.
1 have and will maintain Workefs Compensation loommucc,IS required by Section
37M of She labor Code.for Inc perrormanec of the work for which this permit is issued.
My Warkpq Compemadon Insunna carrier and Policy number are:
Cartier. OC.IJtY$� Co- Polity Na.:t MGa-w"
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not bccomple ed if the permit is intone hundred dollars($IM)
carless.)
I aruy ther in the performance of the work for which Nis permit is issued.I shall not
employ any Nixon in any hemmer so as m become Subject to the Worects Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,aper making this Ccaricam of Exemption.you should
become Subic"or the Waike's Compesvation pmvWom of the tabor Cwc you muss
.J O faMiwh comply with men provisions m Nu Te.it shall be damcd revoked.
z CONSTRUCTION LENDING AGENCY
.�. 1 hcmb al@m that Nene is a com mezion lending agency F Y { g my lar the performance of
lY the xxsh fur which Nis permit u issued($a.JM],CO.C.)
4 Q Lender.Name
LendeYs Address
V I cenify that 1 have read this applicazion and state that the above infosmatiun is
Iy f" correct.I agree in comply wit all city and county ordinances and state laws relating to
�O building construction,and hemby amponu representation of this city to enter upon the
alaarmentioned propc si for Infxnaon p gases.
F G (We)agree to save,indemnify and p harmless the City of Capenino against
res liebilnzgmdg at tiro ran and cxpcnsP rich may in any way same.gains aid City
Use in easrsequencc o¢Utc gond of Nis per it.
^ APPL ANTU ERST DS AND V ILL COMPLY WITH ALL NON-POINT Issued by: Date
s R U TfON : /P_
a I
Re-roofs
Sig mAPpllcsuHAUROOUS h ATERIALS DISCLOSURE Da Type of Roof
Will the applicant ar filum building acupantstoa a handle haar dmfs material
as defined by Nc Cupenlno Municipal Cade.CLaprer 9.12.and the Health aw Sardy
Code.OdYe an2ss32(a)7 rnonny���I�y�� All roofs shall be inspected prior to any roofing material being installed.
40
tits
Will ft applicant or future building oce pam use cquipacm or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove ,
emit harardaus air commimnu as defined by Ne Bay Asea Air Quality Management all new materials for inspection.
District? ,tet
❑Yes pJ'Nu
I hove mad Nc hvan]srus ma rialsm,ciem.underChapmr6.95ofNc CAhrar
macal &Safcyc :Safi 2YJ5.2553)aiul 374.lundcrsmndlhaiflh building
trot brronlly hut a¢ran it u my MjN ihility m troOr the u of Nc
mu' m tswh' mstbcmc I usece. cervIII, OfOccu ry. Signature of Applicant Date
araat n"d.gcon DI All roof coverings to be Class"B"or better
ISM
Community Development
�4 10300 Torre Avenue
fes/ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
o I o G o
OWNER'S NAME: 2 r `�i n.Ro—rr' I PHONE # yog
GENERAL CONTRACTOR: V,-YjkFAX , C(og a J(o
I am not using any subcontractors: / �2 9 (--)eo
Signature Date
Please check applicable subcontractors and complete the folio mg information:
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
Til
XIV -'712
h)�-
OwnefXor)&act4 Signature Date
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35617022 . 00
DATE ISSUED. . . . . . . : 09/29/2006
RECEIPT 4 . . . . . . . . . : 36254
REFERENCE ID # . . . : 06090272
SITE ADDRESS . . . . . : 11180 SANTA TERESA DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SINNOTT BEVERLY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : SOUTH BAY PLUMBING
CONTRACTOR . . . . . . . : RICK PERKINS LIC # 22605
COMPANY . . . . . . . . . . : SOUTH BAY PLUMBING
ADDRESS . . . . . . . . . . : 441 N CENTRAL AVE
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 370-3535
EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - ----- - - - - - --- ---------- -- -- ------ ---------- --------- - ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
------- -- - ---------- ---------- - - --------
TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- -- - - - - - - - -- - ---- ---------- -- ------- - - - - - - - ----
CHECK 84 . 02 19321
TOTAL RECEIPT 84 . 02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION-----------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
CITY OF CUPERTINO 0L
WATER HEATER
• CUPERTINO PERMIT APPLICATION FORM
APN# . .� Date:
Building Address:
Owner's Name- Phone#:
c1ca as a5y----,3
Contracto Phone: License#:
Coo ?J��S to 9-
Contact: Phone: Cupertino Business License#:
x3s
Building Permit Info:
Bldg ElElect 0— Plumb i Mech
Job Description:
Residential ommercial ❑
Cost of Project:
• Strapped ❑ On Platform ❑ Bonded ❑
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Ene y BUILDING
BUSLIC Business License BUILDING
•