06070142 CITY OF CUPERTINOf. ? , a"z?�a'n y 'a
'U,LDING D IVISI ON PERMIT 'C�1\?llltiv'�TQR
.a ;
BUILDING ADDRESS: ABLE SEPTIC PERMrrND'06070142
7560 TIPTOE LA
OWNER'S NAME: PE M1717 ISSUE DATE
QUIGLEY ROBERT 520 REED ST. 07/21/2006
NE:
SANITARY NO. CONTROL NO.
(408) 377-9990
ARCNRECrfENGINEEA:
BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
0 0
Op LICENSED CONTRACTOR'S DECLARATION IOb Description
FF I hereby affirm Nat 1 am li¢vN under pmo.vixiof Chapter 9(mm
mmming
SW with Sccuon70f,U)o(Division 3af the Businw inti Profcssiun� andmyliccnxis
!�H in full force and efrwc r{{]]uu INSTALLING PROPERTY LINE CLEAN-OUT
t'dj? License Class Lic.is
s„ Dan: Contractor
ARCHrrELTS DECLARA ION
i 1 understand my plain shall leaned.public records
iyU
o
Licensed Pm@ssirnal
i OWNER-BUILDER DECLARATION
:a 8 1 herehy alum that 1 am exempt from the ColliCode:
A.,C Law for We
:O O following massa Permit
t 703 LA Business and Professions.dali Cale:Any city or Countyre
m which xqulins a pwmio re erw.cL alcor.W for such
aarmit t,of mash any el.[mrt $2000
rite pnorus its issuance.Palso inquires theeisks O for smhract."Licensrile ae ned aw(Ch mem
ZEi Nat he is licensed pur.mtw We previsions of Jin Canlmcturi License law(enaprer9 Sq.Ft.Floor Area Valuation
e i`� (commencing with Section 70(1 of Division 3 of We Busirtmma Professor.Code).
Nat he in exempt therefrom and We basis for the alleged exemption.Any violation of
Section 7031.5 by sh,applicant(w a Permit subjew We applicant W a Civil penalty,of
not mom Nave hundred dollars(S500). r Occupancy Type
Went fin
❑Las We work.
die Wimuct cis cmPbyws wiNwagexasthk,(Sec.comPwaness
will do thewons andJ The Conuwes License Law
n ntapply 7W.Business
of Required Inspections
J
aro property
whobu era:The nett ancon, nd who law ares not apply lf rt rand is q p C/Y'XI
propertywhobuilds i improvex thereon,andwho doesauchworkhimxlfed fin
his
Own cmPbyeWiprovided thmach imPtosemenu are not inmMed wrRemd for sale If.
however,the Wilding or improvement issuld within can year of mmpn,for the owner.
Wilder will hese Ne WNcn of proving Nal he did not Wild or improve for Ourynx of
cans).
0 1.as owrcr of We PropcnY•am exclusively.moaning with licensed cemxuns in
construct the project(pl,in aJ.Businessfand P,who
ds a,i the Conaacw's U.n
cense law dors not apply m an owner of property cepa Wilds rs Wprows Committees and.
whocontractsLacu for such projects with a conudwr(s)IicenxO pursuant m We eantrxtofs
License law.
❑Tofu exempt undo See .B&PC(or this reason
Owner Dam
WORKERS COMPENSATION DECLARATION
1 hcmby arm under w.lty of perjury one of the following declarations:
1ham andwill maintainaitten 37M of Co.cmmtalc-smarte performance
of We
cation,r pmviai for mi Sttvan 3700 or the Labor Code.fm We pedormana of tic
work for which this permit is soma.
O 1 have and will maintain Worker's Compensation Insurance,as required by section
370(1 of We Labor Code,for We pcdo.,.of Ne work for which this permit is issued '
My Wor Commoma.I nnce carrier and Policy number
Cartier. %La'1l L-�Tv+a'sL Policy No.: � 'w' �
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisxctim wed not W completed lithe Permit is forme hundred dollm($100)
nr Icss.) t
I certify Nat in the Performance of We work for which this permit is issued.1 shall not
employ any percent in any mmnerx u to became subject in the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you Would
become subject to to Workces Compensation Previsions of We Lab.Code you moa D
0 Z forthwith comply with such provisions or this permit hall W accrued mmkcd. Q
Z`0 CONMUCTION LENDING AGENCY
F I Wmby aamn this Jinx is s construction(So.3 ,Cre. agency for We performance of 4 O
Uj
We work fur which Nis permit u issued(Sec.309'y,Civ.CJ
00. Q Lender's Name
=Z Lanaefs Address
U 0 1 certify Nat 1 have mad Nis application and scam Jw the above information is -
U, P come[,I agree in comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authonm rtpmsentxrins of this city to crier upon the
rex move-mentioned pmpenyfor im,ecrionpurpoess-
(We)agree to can.indemnify and keep hvrmleas to City of Cupcnino against
r'/1 limiliuea judgmenu,c.0 and expmxs which may in any way...&:.L=it City
(„)z in consequence of the granting of th' permit.
" APPL UN ST pS WI L COMPLY WITH ALL NON-POINT Issued by: Dale 2�'�L
SO _ R U in,
/..a
6/G Re-roofs
SIgnaurt of Appltan en car Da¢
OUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding occupmumrt or handle hrraaw material
at alined by We Cupertino Municipal Code.Chapter 9.12,and Ne Health and Safety
Core.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
40 Oven ON.
Will We applicant or future Wilding Occupant un equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hurallonin air cmtamirtants u refused by the Bay Area Air Quality Management all new materials for inspection.
District]
OYex ONO
I have read the hvallousmaleri5alsreyj cru under Chapter 6.95afthc Ctlifor
oialikalNfthW
va.255I,255 an 25531.1undcrsasnd NuifNC Wilding
J an l @car u m3 resp min' e-ll6tify the w upanr of the
q x metinr a02 TNamrro-,>,p '( Signature of Applicant Date
ownwwaaNrnvcd,gcrd L Date� All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35932047 . 00
DATE ISSUED. . . . . . . : 07/21/2006
RECEIPT # . . . . . . . . . : 35333
REFERENCE ID # . . . : 06070142
SITE ADDRESS . . . . . : 7560 TIPTOE LA
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : QUIGLEY ROBERT
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
EE ID UNIT QUANTITY AMOUNTPD-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 59 . 95 4233
TOTAL RECEIPT 59 . 95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION 106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
•
SfTYF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408) 777-3333
*UPERTINO
Building Department
JOB ADDRESS: PERMIT #
ZS�o - 'I `l�bL. �� `tSD14 06 G ?d < -f OWNER'SNAME: 0 PHONE # 377-
GENERAL CONTRACTOR: lJ ftGi(L -�-FAAXX # ,?Z— f[o7
I am not using any subcontractors: 100 \ 2l
Signature Date
Please check applicable subcontractors and complete the followmi 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 Tjl� -ITL
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contra for Si Date
ouMo14-
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
�CUPEkTINO PERMIT APPLICATION FORM
APN# 3rDq—�Z_,y"r1 Date?zl O {o
Buildin Address: _ V
-Tip1- , r Lh l jvv
O er's Name: Phone#:
'�'o�>�- Qvi ( Z3- L
Contractor: Phone: License#:
! � 3-17-x( �`I L� 7 s
Co�#act: Phone: Cupertino Business License#:
14��1e} l 8- Z I ` ?)
Building Permit Info: qlN I Kw p
Bldg I' Elect ❑ Plumb
Job Description:
Residential Q/ Commercial ❑
Cost of Proje
• �v
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•