06050199 CITY OF CUPERTINO
BUILDING DIVISION PERMIT aCONTRACUTORjNFORMATION
BUILDING ADDRESS: ABLE SEPTIC PERMIT NO.06050199
10190 STONYDALE D
OWNER'S NAME: FERMI17I5SUEDATE
CUPERTINO KITCHENS DON 520 REED ST.
NE:
SANITARY NO. CONTROL NO.
(408) 377-9990
ARCHRECT/ENGINEER: BUILDING PERMMNFO
BLDGO � MECHO
+og LICENSED CONTRACTOR'S DECLARATION
m JOb Description
% I hereby affirm Nat I ton lisemd under Provisions of Chiller 9(commencing
�< niuSf�t`Isoen'IXalfr fDividon 3.fma Business read Prafcssiom Code.and my license is t
; i ueenazeas �-42 L.-as 6-77475 PUTTING IN A PROPERTY LINE CLEAN OUT ABOUT 10
=mac oam _ contranor�bTc 3'c/oh-c OF TRENCH
ARCHITECTS DECLARATION
I¢ I understand my plans shall he used as public records
)iu
e
'Gt; Licensed Professional
OWNER-BUILDER DECLARATION
N I thereby affirm that I am exempt from the Contractors License law for lie
❑O following mason.(Section 70315 Business and limitations Codc:My city or county
5= which requires a Permit to construct,alms improve,demolish,or repair any stmctue
_zY priorm its issuance.alsorequires thcapplicant farsuch permit refile asignedsummcm
<
that he is licensed pursuant to she provisions of me Contractor's Liasx Law(Chapter 9 Sq.Ft.Floor Area Valuati 3800
a- (commencing with Section 7000)of Division 3 of lbo Business and Professions Code)or
i thou he u exempt daelrom and the basis fm the ellegd exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicam to a civil penally of ,�N umber OccU anC T e
Imt mart man five hurled dollars($50y. 3263 023 . 00 P Y YP
Lo flue
vout the pmpmy,amy wirewagesas meiWe(See
7ompensiiess R
andll Fruitlessness
dework andtheswctumunosintendedmawdoes 0.1 apply 70 u.owner
Re dInsecuons
and Prty who
Code:71m CantmcmYs License law Oates not apply lf an owar of q p
property eny lobo builds provided
div Wthereon,andwlm aussan work hirtuUfor Wougn his
own employes,provided mat sato improvements arc net ear of completion.
aro@red for Worser.
however.de building orImprovement umid withinamyearofimprovfortheower-
builder will have Ik bbNen of proving that he did Ids build or improve for puryaa of
al.). J
❑has,wner thepofshe ctproperty.am e.71)4 .Bsin.analely contracting wire )Theedconuacmra . /^ 1
comma La the not
(Sec.7044,Business rod property
wh ions Cade:)pr Conuarcon.U.
came law data not apply je an owner of property who builds or nal In n tenon and,
who contracts for such projects with a conmacros(s)Gutued pursusm m dm Conuamors
L[ccns taw. O�
[-]1 am eacmpt under Sec
B&P C for rob rtaam
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby Num unsatder penilty of perjury aim of the following declardos:
Lha ve aria will maintains Cmtifieam of ConantrCode.farte Workersceofth-
woricf r which
provided thi for ni Section 3'/00 a(tiro Lamm Code,fm dm Performance o[de
work for which this pcnnit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3700.f dm Labor Coda.fix the perfarmanae aide work forwnich this permit is issued. '
My Workers Comps mrlion lnsumiue carrier and Policy number am:
Croner. policy Nu: 4WItIl I
.� CERTIFICATE OF EXEMFR
PTION OM WORKERS
��/a7ll`y`w{{/)If/ COMPENSATION INSURANCE
(Ibis satfm sed Imt bo compiemd if de perms is faam hummed dpllas(Slml
or mss.)
I certify that in thc performane,of de wall for which this Permit or issued.l shall rant
employ any person in any manarso its as become subject in the Workers'Compcsation
Laws of Cilifomia.Dam
Applicant
NOTICE TO APPLICANT.If,after making this Cenifiate of Exemption,you should
become subject in she Worier's Compenauon provisions of de Labor Code,you must
.,z forthwith comply with such provisions or this permit shall he deemed evoked.
zO CONSTRUCTION LENDING AGENCY
Thereby af0ms mat dace[..construction loading agency far the Part..of
ai Nc work fur which this permit Is Wood(Sec.MG.Civ,C.)
ALeaders Name
z Lenders Address
U Q 1 eerify that I have rad this application and sum dos the above oformadon Is
LI. toren.I agree to comply with all city and county ordinances and sum laws elating in
0U building construction.and hereby authorize rtprsentiones of this city to enter upon the
r W ¢hove-onerawril property for inspection pugwas.
gy (We)agree mase,indemnify and kap harmless dm City a(Cupemno against
h Inabilities.judgments.costs and expenses which may in any way accrue against said City
f
U Z APPLLICANT UNDERSTANDS AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z�
SOU EREGULATIpNS.
_ice--v S-14106 Re-roofs
Signature of i enVCommcmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fume building aeeupateom orhandle haraNaus immoral
as de0ad by tbo Cupertino Municipal Code.Chapter 9.13,and de Health and Safety
41 Code,Section 35531(.)? All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or future Wilding occupant sea equipment or dcvius which If a roof is installed without first obtaining an inspection,I agree to remove
..it hvallous air comumimmis as de0ned by the Bay Area Air Quality Management all new materials for inspection.
District? ��` ///���
0Yes �cJNo .
[have read the harardous mouoria inspinemenu umtr CW,w6.95 of de Califor-
nia Health&Safcty Code,Sectiones 35505.15533 and 75534.1 understand thatifdc building
does not cunendy have.myna that it is my reapamibility to of,de aaupam of de
mquiemcnuwhicIt mus be met prior to issumsec of a Certificate of Occupancy. Signature of Applicant Date
r z bt
Owner unm irmd agent g
All roof coverings to be Class 'B"or better
Dam' �
CITY OF CUPERTINO
om 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32637023 . 00
DATE ISSUED. . . . . . . : 05/23/2006
RECEIPT # . . . . . . . . . : 34526
REFERENCE ID # . . . : 06050199
SITE ADDRESS . . . . . : 10190 STONYDALE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CUPERTINO KITCHENS/DON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ABLE SEPTIC
CONTRACTOR . . . . . . . : GILBERT, GLEN LIC # 21407
COMPANY . . . . . . . . . . : ABLE SEPTIC
ADDRESS . . . . . . . . . . : 520 REED ST.
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95050
TELEPHONE . . . . . . . . : (408) 377-9990
•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 AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 119 . 90 3859
TOTAL RECEIPT 119 . 90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
•
Community Development
'+ 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT## 6� Sd/ Q q
/0/90 /t cLr. Ko
OWNER'S N : C�,x.�vw ke,4c<v 75 &bn PHONE # C3ry _ S
GENERAL CONTRACTOR sl bk S G FAX #
I am not using any subcontractors: Cion,_a,,,.
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
REPIPE/SEW.ERS/MAIN SERVICE
•CUPEkTINO PERMIT APPLICATION FORM
APN# �� n ^ 2Date:
mak' �✓ L S '13 ab
Building Address:
lome a ✓hho
Owner's Name: Phone#:
�vv�i/r+o Y�'dri.e,�7S Do./ 63`1 - -7
Contractor: Phone: License#:
e- .477--7-7-72? ( 7-7"-75-
Contact:
77"75Contact: Phone: Cupertino Business License #:
Y'vbGh '
377 aIHLv "7
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
"vIAh /h cL
Residen ral l ( Commercial ❑
Cost of Project:
. T4 ?�^+t+c. Lin. N.s�.h-d^c./1 r3f,Y.,.�..k.L �g-� /8'W ou
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bld . Permit Fees BUILDING
BPGAS Gas Piping 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
•