04120137CITY OF CUPERTINO
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BUILDING DIVISION
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BUILDING ADDRESS:. '
MIKE COUNCIL PLUMBING INC
PERMIT Ncb4120137
10383 TORRE AVE BLD 1
OWNER'S NAME:
PffWrr ISSUE DATE
TORRE PROFESSIONAL CENTER
1977 O'TOOL AVE
04
ONE: -
SANITARY NO. CONTROL NO.
(408)272-4900
ARCHITECTIENGINEER: _ -
BUILDING PERMIT INFO
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BLDGELECT PLUMB MECH
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' LICENSED COM7U, L'IDR' DECLARATION . •,...:.. ..
-1 reb rm Wt 1 em I=ndC virion or Clupter 9 (wmmening
withsectio )of Dlvialon 3o fee Burin Pmfe cions Co o,odmyliceno is
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i Job Description
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mmnrn ffect
Licen lav
Date ^ ' Contrtetm
UNDERGR.•-GAS LINE/REPAI-Re,(,E) LEAKS
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p�
- AR NfIECned ON N16.
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I de Y PWo I M1e area Ile, olio
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owER
for
orDECLARATION
rem the 11, eumpl from the Conlnctora e: A nye law the
e,I am can
1 mems 703 1,5, atn.Improve. edam Code: Any city .r county
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which rtgW... • permit ne ennwuc6 alw. demolW. ri repair structure
whichfollowingreoosa permit
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j( 7) // {! // 11 ... C/✓85200
its issuance, nt for w ed
tprior hat he extent qui ma tic applivnlraramh permit so file.signed atemmem
t tJwvelaw(Chapmr9
_ _ Sq. PI. FIOOrArea „- U��
'/�l ( Valuation
ohecowsiness and Parusian Code) or
7M)Division
cingwidpurction7
(cammc. exemptM1Seclion1
(commencing
the Any of
Sectio b b therefrom and the fa tie
soup da h Iceman
i e _
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� 't�Occu arc sl a -� •- -
i p y Type
t to l Penal'.
by any applicant for a permit rvhjecu Ne applkanuo a null penalty of
Section 31,5 per subjects
a thrun
nt more Nus Rm hundred dolbn (g.500}
Q I,ssownerofdepmpmy."mrwlploywwithwaguvlhei,mlewmpewdon..
..
- Required Inspections
will do the wart; and the avunurt is not intended"offered forade (Sec. 7044, Business
The Located Law dam
and Profession Cade: Contrenors a¢ ret apply m an care, of
proMnywho builds orimlaoms therwn, andwhoaoessuchwork himulforthroogh his-
manemployee. provided that such improvements are oat intended Motcrtd (mv4. If.
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hewevu, the Wilding or improvement is veld wlthinon year ofcompledon. Ne owner-
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builder willham Ile burden of proving dw hadid not build "improve fm purp"e o!
vie.). .. -
❑ 1. u coma of the property. am exclusively contracting with iicenvd conuanma in
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construct the project (sec. 7044, easiness and Profusion Code:) TTe Corma on'S U.
.. ,
arta Law don not apply an an owner of pmpeny who builds or improve Nem'., and....
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who contracts forsuch projects with a comiscmr(O incensed punent so the Condutoes
,
Liccne law. - . -... a
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❑'Iomexempt under Set .' ` .B&PCIor wareason
Owner Date
_
WORKERS COMPENSATION DECLARATION -.-,_t,
1 hereby affin under penally of perjury, one of tie following declaroioac
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Ihaveandwillmtered.aCeNOvte of Concert asalf-tnurtf" WorkersCadpen.
.. . ..... .... -__.. '"
canon, as pmvided for by Seedon 3100 of the labor Code, for the performance of the
wart for which this permit is issued.
❑ 1 have and will maintain Worker! Compensation Inure cc. v required by Section
3700 the labor Cede, for the performanecolthe work Tor which this permit ie named.
... . -
Wrise,C•om need'. Insurance Carrier M:}a1�oJv��yrmber are C. u: ol(cy.No.:
CBfa ON PRO W 0 I FAS
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COMPENSATION INSURANCE
(IDb auction wed net Wcomplemd lithe Permit is furore hundred dollua(5100)
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orI )
1 certify that in de performance of the work Am which this permit b issued. I Nall me,
employ anyperron in my menmrm as m become object to de Workers' Compensation
---
Laws of California. Date
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Applicant -
NOTICE TO APPLICANT. If, afar making Nh Cenifinte of Eacmptien. you Nomle
become subjev m Ilse Worker's Compensation provisions of the labor Code, you must
forthwith comply with such provision or this permit shall he deemed mooted.
CONSTRUCTION LENDING AGENCY
- I hereby alaron that them is a convection lendingegeney lot dm performance of
she w"k for which Nb permit b house (Sec. 3191. Ci, C.)
Lenam's Name,
Lender's Address
1 certify that I here with thirtyapplicationand sue that Ne, above information is
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correct I agree ct comply with all ells and countsumul mcof and vete hoe elating
and un
e
buildingconstruction,proand hereby oNon uw of this city menerupon Ne,
ahorc-mentioned progeny for an purpova
prpose&
(WC) ogre In arm, indemnilY Nd kap hermlus tie CITY or Cupertino agent
indemnify
liabilities, judgmenW costs and ea,., which meY in any way accrue egernt add City
I. this
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APPLICANT UNDERSTAND( AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGU ONS.
Re -roofs
Type of Roof
Sin o I AtyConuem"
r HA2ARDOU MATERIALS DISCLOSURE
Il the applicant or future building occupant more or hand a ons materia
.
,
M defend by the Cupenino Municipal Code. Chapter 9.13. and HnIN and Safety
ode, seed.. ssvz(a)T. /
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 the applicant or future Wading occupant ure equipment at device which
mit haimerrus air wnteminants o red by the Bay Arca Air Quality Management
all new materials for inspection.
DinrictT
❑Yes u
1 have mW the Weardnnmetedab requiements under Chapter6.95 of the Califor.
nhHealth@Safely Codc,ScL' o=25X15,35533u 25534.1uhcnuhdwifde Wilding
dms not cunanlly ham a anent than It is my mspomlhilily m nodly thC occupant of the
rtqulrtmcnts whichm Wmel pnarm maerme cite, 'race ar OcculwmY.
Signature of Applicant Date
All roof coverings to be Class "B" or better
0 �2 new
uthmiae rel
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acloF
�UPEI�TINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building De artMent
.:ADDRESS:
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I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
RI
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
UOwner/Cont5lctor Signature
_O
Date
CITY OF CUPERTINO v (�� Z f37
REPIPE/SEWERSIMAIN SERVICE
CUPEI�TINO PERMIT APPLICATION FORM
APN # 3/ 4ob 2 ;'
b
Date: ,
-av-off
Building Address:
• BPREPIPE
3 CCC, C
PLUMBING
Owner's Name:
Phone #:
or re- 55,' pm
BPFIXTURE
Contractor:
PLUMBING
Phone:
License #:
PLUMBING
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Contact: P ne
Cupertino Business License #:
Vl p-
BUSL
Building Permit Info:
BUILDING
/
BldgEl Elect El Plumb &T
Job Description: I
Z
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(A
Residential Commercial
Cost of Projec •
Qty. \
Aon 'cable 1 Fee M
Fra Tlrcnrintinn
Fir. Rrnnn
PPERMITFEE
Plumbingua
Permit Issnce
PLUMBING
• BPREPIPE
Re i e of Fixtures
PLUMBING
BPERMFEE
Bldg. Permit Fees
BUILDING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSL
' ess Lice n
BUILDING
My ILI"