05080010300
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CITY OF CUPERTINO
CUN'TACTQRf IN`U,'�tMATTN,
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
MIKE COUNCIL PLUMBING INC
PERMITND'05080010
110828 SYCAMORE rT
OWNER'S NAME:
PERMIT ISSUE DATE
PANOS KOUGIOURIS
1977 O'TOOL AVE
08/02/2005
NE:
SANITARY NO. CONTROL NO.
(408)272-4900
ARCHIIEC (ENGINEER:
BUILDING PERMIT INFO
BLDGELECr PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
hereby affirm dist I am licensed under provisions of Chaptar 9 (commencing
p
with Section 7001) of Division J of Me Buanesa arM Profeloions Cade, aM my licence in
U�enforce
cl end effect. Lic.a'e Z C-3
GAS LINE (TO EXTER..HEATER)
Dau ContractorLl MIA -X-
t43
ARCHITECTS DECLARATION
I undsaand my plans shall he used a public record
'
Licensed professional
OWNER -BUILDER DECLARATION
I hereby afford that I am exempt form Me Contractor's Liccom Law for Me
/7
following maxan. (Section 7(01.5, Business and Professions Code: My city or county
({(t ®.ti
which requira permit to construct. altar, improve. demolish, or mpar any structure
es
�I �� $1900
Prior to its lauana, also requires the applicant for such permit to rile a signed statement
dad,ha la licensed pursuant to do pmvisioNuf the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area I
�'a Valuation
m`'
(commencing with Section 7000)of Division J of the Bounty and ProfNsions Code) or
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Yy
that he is exempt therefrom and the basis for the alleged exemption. My violation of
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!/
nn
'" Occupancy Type
Section 7071.5 by any applic con for a permit subjects the appliance to a civil penalty of
W, mart than five hundred dollen ($SW).
❑ I. u owner of Mae property. or my employees with wages as their sok compensation,
i ed.echons
Q, 4 n p�
will do the work, and thesuactu eIs not intended unffcmd formic (Sec. 70th. BusinwI&
and ProteatloN Cade: The con serves License Law don net apply to an owner of
property who build orimprovea the com. and who doasuch work himselforthrough his
own employees, provided Must such improvements are notinundW coffered for M e. If,
4
however, Ne building or improvement is sold within am Sear of completion. the owner.
Wilder will have the louden of proving dust he did rot build or improve far purpose of
see..
L as owner of doe properly. sm exclusively contracting with licensed emVaetors to
construct the pmjm (See. 7014, Business and Pmfesaiov Code:) TW Contractors Li-
cense law does not apply to an owner of property who build or improves thereon. and,
who conscious for such pmjem with aconuecroas) licensed pursuant to the Con metes
Licence Law.
❑ I am exempt under See ,B&P C far this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affrrm under penalty of perjury am of the following daluuionv.
I ".am will Malcolm. Certificates of covens to elf-(nsum for WorkeYsCompen-
satinn, a provided for by Section 3701 of the Labor Code, for M performance of the
wok for which this permit is issued.,
I have atk will maintain Worker's CompensationWunntt. u reyuired by Section
7700 of Me Labor Cade, for the performance of dist work for which this permit is wood.
My Worker's Compensation Insurance artier and Policy number art:
Caller. 2�A Polity Na.: S �O
IC/%'EMPTIONFROMWORKERS'
COMPENSATION INSURANCE
(7TH section need not Me compicud If die permit a for one hundred dollars ($10))
or kis)
1 adfy Met In the performance of tlm work for which this permit is issued, I "I nal
employ any person In any owner an u to became W bjece lathe War$=& Compensation
Laws of CaliforaM. Dau
Applicam
NOTICE TO APPLICANT: If, after making this Catalina, of Exemption, you should
become Subject u the Workers Compensation ptoviuons of Ne lahor Cad, you mus
forthwith comply with such provisions or this permit shall N deemed reveled.
CONSTRUCTION LENDING AGENCY
I hereby of irce that Nene is. mvumdon lending agency for Me performance of
the work for which this permit Is issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
1 certify that 1 have mad this application and su c that the above Information Is
'
correct. 1 agree to comply with all city and county ordinances ask slow laws misting to
building construction, ask hereby authotim representatives of this city u cola upon the
above-mentioned property for Impaction purposes.
(We) agree to uve, indemnify and kacp harmeas tie City of Cupertino against
liabllWa,Judgmenu.cosu and expenses which may in any way we= against and City
In consequence of the {ratan{ of this Perot.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO% -P0�1
/h ^
Issued by: Date F .4 o
soap7al�tlL�uoNs.
Re -roofs
�_ _ & 12/ S
Signsaust orAMBIcantrComrswor ata
HAZARDOUS MATERIALS DISCLOSURE
Type Of Roof
Will Me applicant or future building occupant am or handle havudous material
at dOned by the Cupertino Municipal Cod, Chapter 9.12, and the Health and Safety
ue. Soman 25532(a)7
❑Yen `p No
All roofs shall be inspected prior to any roofing material being installed,
If a roof is installed without first obtaining an inspection, I agree to remove
Will M e applicant or future Wilding occupant use equipment or devices which
It hazardous air contaminants at derined by the Bay Area Air Quality Management
all new materials for inspection.
lDimicO
❑Yes �o
I haw mW the hvaknus maurials requircnens under Chapter 6.95 of the Califor.
Health&StfctyCode. Samosa 23505,25573 mal 25534.1 undersuM this ifthc Inildin
o rot cumnLI haw ssowndwitismyrespon ibllitymnotify thoort toful
c stbome1pdortoisaanccafaCenifiamofOccupancy
Signature of Applicant Date
1am
All roof coverings to be Class "B" or better
owner m ata
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
p Fax (408) 777-3333
�UPEf�TINO
Building Department
JOB ADDRESS:
/D 9 zB S An4409'e 027
PERMIT #
O S-Oeoo (o
OWNER'S NAME: )24AjL)S
PHONE #
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Dat
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
OA u >v g t L,
3 O 33
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Dat
IN
CUPEkTINO
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN # S�
J z b �
Bld . Permit Fees
Date:
$ z os
Building Address:
/Ooze
-
PLUMBING
Owner's Name:
Plumbing Permit Issuance
Phon #:
BPREPIPE
S
-.rd4 -
Contractor:
Phone:
®�=27
License #:
BPWSVCS
c
e--51.
Contact:
Phone:
Cupertino Business License #:
BPSEWAGE
—? 3- O 6 5-
z3 0 -S3
Building Permit Info:
Energy
BUILDING
Bldg ❑ Elect ❑
Plumb
BUILDING
Job Description:
Residential Commercial ❑
Cost of Project:
•
Qty. if
Anolicable Fee ID
Fee Descrintion
Fee Groun
BPERMFEE
Bld . Permit Fees
BUILDING
BPGAS
Gas Piping System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Repipe of Fixtures
PLUMBING
BPFD{TURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Dis�osal
PLUMBING
/ BENERGY
Energy
BUILDING
BUSLIC
Business License
BUILDING
.y