06070022 CITY OF CUPERTINO +^� e
Bi:ILDING DIVISION PERMIT a CONTRA PTOR INFORMATION
r t
BUILDING ADDRESS: SO BAY PLUMING P�hd�NO06070022
733 STENDHAL LA
OWNER'S NAME: PERMIT MUEDATE
ERIC DONDE 441 N CENTRAL AVE 2006
E:
SANITARY NO. CONTROL NO.
(408) 370-3535
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG EIF.Cf PLUMB MECH
Too LICENSED CONTRACT'OR'S DECLARATION Job Description
%wp 1 hereby affirm door 1 am licensed under proifamis of Chapter 9(commencing
eiW with Scmion7IX1U)rf Diviaion]r(the Busineu and Profcuions Code,and ylicens is
m solifm c and efts�(-7 T R & R WATER HEATER
j�? Liccnu CI�s hk.N
Contractor
ARCHITECTS DECLARATION
f w U 1 understand my plans shall W used u Public records
°O1n LiCcucd Profcssional
S OWNER-BUILDER DECLARATION
to
X 1 hereby affirm that 1 am exempt from the Contractors License Law for the
c O following mason.(Section 7031.5.Business and Professions Conk:Any city or county
5:6� which mquires a permit in cnnsWCL altar,improve,demolish.or repair any structure, $385
prior In its issuance.arm requires the applicant for such Permit o file a signed statement
that k is licensed pursuant to arc pmvialoos of the Contractor's U..La.(Chip.9 Sq.Ft. Floor Area Valuation
e�'D (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the Was for One alleged exemption.Any violation of
Section 703M by arty applicam(m a peora t subjecu the applkant to a civil penalty of a Occupancy Type
not mole than five hundred dollars(5500).
0 1,u rwner of the pmlaeny,or my wploycu wird wage u theb miecompuuauon,
will drlhewmk,and the he Ccmumti Lics Law
does no,Apply owner
of P q fired ns eedo
and property
wh ou Code The Conmcmr's and
wha Law data not Wass lf a^owner is P
r.
propenywyees,pdsmimprut such Improvements
.a,imendkhimulfarthraugh his
y.Gg� y
ownc .theu,ping or iNatauch imis sold nuartne your omoRered forsake,li �/ fll@a
however.the building or improvement is sold within one year of completion,thepose of
builder will have the burden of that k did rot build m improv[[m purpose of
sale,. V'`U2/ 1006
0 1,as owner of the property,am exclusively contracting with limmed antrssmre to
cense La it not apply
to n meBusr of aM Pmfuoou Cade:)The Convertors V- 1'f- p res rg u
[cue law dao not applyje an with
a of property who kills or improves thereon,and Ir�t�j..NJ)LvFflltla4rgalfl tlWgg77i11'3/1q�DIN
gl �aEw„
who conttacu for such pmjecu withaeonuacmr(s)li¢nzdpurwam in Canuacwrs � � Jap]t�tiV6,luV{p171,t7(�/`.'��3C_1J
Licenses aw.
0 1 ma exempt under Sec. B&P C for this..an
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury no of dee following drelaratimu:
1 have and will maintain a CertiBcau of Co..,In self-insure for WorkersCwnpen-
smort,as provided for by Seedon 3700 of the labor Code.fm the arfmmarra of tlm
work for which this craft is iuued.
0 1 have and will maintain Workers Compensation Iruurstea,as required by Section
3700 of the labor Code,for Ne performance of the work for which this permit Is issued. '
My Workers Compensation Insurance Cartier and Policy number are:
Grtier:SV{� ln�f.vi—i Policy No.:Z✓SQIFL O O 1 601
CERTIF EMMON FROM WORKERS'
COMPENSATION INSURANCE
(This aeNon mod notbecomplcted lithe permit Is farone hundred dollars(5100)
or less.)
I aril).that in the performance of the work for which Nis permit is issued,I shall am
employ any person in any manner an as to become subject in the Workon'Comporumon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you Nauta
become subject an the WarkeYs Compensation provisions of the labor Codc,you in=
.J O forthwith comply with such Provisions or this permit shall k dcemcd vimkcd.
.Z 5 CONSTRUCTION LENDING AGENCY
(, I hembyalBfm that them isacoutructinn leadingforthe fortnma of
ag my pr
Cli the work for which this permit is issued(Sec.NN],Civ.C.7
W� Q Landers Name
� z 1<neera Adam::
(„)Q 1 arify that I have read W s application and sues that the aWw,information Is
(y correct.I agree to comply with all city and county ordinances and ante laws misting to
C.F.) building construction.and hereby audionic representatives of this city to enter upon the
r W akvoms.jud,cdproperst land.. Non purowhich may
a (We)agree to save,indemnify and Map harmless the City Of Cupertino against
liabilities.jnce of the gran and expenses which may in any wayacemc against said City
V z in crmegmnce of the gronun u permit
APPLI UNDERSTAND ND 1L1:COMPLY WITH ALL NON-POTr,1'r Issued by: 6i Date
SO CE GU A S. (ji
6r Re-roofs
mum qLAVpjpCOouC.mrmC%a, Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ik applicant Or fuwm building oce up natnorc Or handle hazardous material
as defined by the Cupeniou Municipal Code.Chapter 9.12.and the Health and Safety
[tole.Sectionzss3z(a)7
❑Tes All roofs shall be inspected prior to any roofing material being installed.
41 Will the,applicant or future building ma ant uK If a roof is installed without first obtainingan inspection,I agree to remove
pP g P ea Air
arta which P
[mit kzardnus air conumimnu u defined by the Bay Area Air Quality Management allnew materials for inspection.
District' _•
❑Yes gftart
I have mad the bxra dous ma eriab mquirtmenn undcrCkpter A.95 of Ne Gli(op
nu Health&Safer).Goac.SaUan 25 SJl am12353a.I undcrsavb deer lithe Wilding
dors not currently M1aa a¢ran r it' my rupomihili acupsm of the
mquircme f,hm the IF
r greficacofOcapancy. Signature of Applicant Date
G rr au ho.. cert D,te All roof coverings to be Class "B"or better
Community Development
Tl 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: 73 3 S7r-4J— 11J�`� 4+ v' PERMIT # O b C) 70 0 .4
Z
OWNER'S NAME: AdDo PHONE #
C �CONTRACTOR: .I'N!S (Jv» AX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
•
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: B1k:,. Lot :
APN . . . . . . . . : 37542033 . 00
DATE ISSUED. . . . . . . : 07/10/2006
RECEIPT # . . . . . . . . . : 35158
REFERENCE ID # . . . : 06070022
SITE ADDRESS . . . . . : 733 STENDHAL LA
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : SHIN JONG M
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4658
RECEIVED FROM . . . . : PERRY ROBERTSON
CONTRACTOR . . . . . . . : RICK PERKINS LIC # 22605
COMPANY . . . . . . . . . . : SOUTH BAY PLUMBING
ADDRESS . . . . . . . . . . : 441 N CENTRAL AVE
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 370-3535
•FEE 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
----------------- ------------ ------------------
CASH 84 . 02
TOTAL RECEIPT 84 . 02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION-------- ---------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
i
CITY OF CUPERTINO O(OO1CO2�.
GGA WATER NEATER
• CUPERTINO PERMIT APPLICATION FORM
APN # 3-TS-A,2 - Q3'2-5- Date: —7--7 - O
Building Address:
7 + vk1 1 6 L
Owner's Name: Phone#: �h4 6� g7S
i 6n E
Contractor: Phone: License#: G
S�v � 4ots 370 3 5 3 5 � SO G7
Contact: Phone: ass s 9So Cupertino Business License#:
ear Uo� 2Z b
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Job Description: V
Residential 0-- Commercial ❑
Cost of Project: 51
Strapped 8— On Platform Bonded El
New Location ❑ Replacement
1
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/ Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING