06080193CITY OF CUPERTINO
C®NTRACTCIR INFUR ATION,,, ;
BOILrwNG DIVISION PERMIT
BUILDING ADDRESS:
CONSOLIDATED PLUMBING INC
PE"""06080193
20875 VALLEY GREEN DR
OWNER'S NAME:
PERMIT LSUEDATE
WOODMONT PROPERTIES
3732 D CHARTER PAR
08/23/2006
E:
SANITARY NO. CONTROL NO.
(408)978-3093
ARCHITEC IENGtNEER:
BUILDING PERMIT INFO
BLDG ELECT PUMB MECH
0 0 I0
LICENSED CONTRACTOR'S DECLARATION
Job Description
Job
vnse Of Cbaplc+9 (commencing
I hereby affirm Nal l am licensed under Pmi se
with Secuon 7") of Division 3 of the Business and Profeuiuns Code, and my license u
in toll fmcemd affect
�- 3 L- 6 2.
INSTALL SEWER LINE CLEAN OUT - BLDG: 18-23
Li<enm aara Lk. x
Dau Centsacur
ARCHnECfS ATICN
1 un rsmnJ my plans shall h u 'public m'ad'
' �w ✓
Liuensed Professional
OWNER-BUILDER DECLARATION
I hcmhy .lion I am cxcmpt from Nc License Law for the
j
f ..I. Cad :
followingmoon. on 703 Cade: Any city or county
ig
v
Permit tmearr,Businessand nofckmoli any fuuttum
t ere a signed
which requires n permit re co ss the alar, impmsu h Permit
poor LLl its iIIuiM
the CmararIm's Oiecroc gaw(ChLL'mml
Nowisho Law lChapmr9
Sy. FL Floor Area
'Valuation
of
that heisliccnudpursuantmNcpmvisionsofNCCOntrmmr'aLicense
to
Panama, olam
i
(commencing with Section 7000) at Division 3 of the Business and Profeseiev CeEc).1
$5000
that he u exempt Ncmfrom and dee basis for the alleged emmptiws Any violation of
APN Number
Occupancy Type
Section 7031.5 by arty applicant fm a Permit subjcas the applicant to a civil penally of
not mom Nan five hundred dollars (SSW).
❑ 1, u owner of the property, w my wployaa with wags u Nen sole competuation,
32699064.ee
e
Required Inspections
willdo Newark.md Neswnumismlinundedworzemdtorsale(Sec.7044.Businus
and Professions Code: The Contractor's License Law dwa not apply m an owner of
9 P
Property who builds orimproves themon, and who doeaswhwwk himself or thmugh has
own employees, provided Out such improvements are dot inteMrd wolrered for ole B,
however. the building or improvement is mid within am year of eompletion. the owner-
builder will have the burden of proving Nan h did not build or improve for purpose of
sale I.
❑ I. as owner of Ne propeny. am ajobadvely... m wing with licensed contractors u
.
construct the pmlcm (Sec. 7064, Business and Professions Cade:) The Conuacuh Li.
case law does not apply m an owner of property who builds or improv thereon, and
who contracts for such projects with a canuactor(s) licensed purmant to th Contractors
License law.
❑ I am uempt under Sec. ,B B P C for this moron
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one of Ne following declarations:
P3
I him and will maintain a CeruGeauof Covent toelf-insum forWorkers Counin-
lar Code, for Ne pe fmmsrenof the
sauon, u provided for by Section 3700 Of dobo
were for which Nis permit is issued.
I have and will maintain Worker's Compensation Insurance. u axpinad by Section
u
3700 of the lather Cade, far the performance of the wok for which this permit is issued.
I .SANITARY-
My Workers Rmpensitien lnmrame catsicr and Polity number a m:
Carrier: Policy No.: ����QQQQ�/�/gqqq������^^^^�/�/ -33
60
C RT- .ATE OF EXEMPTION FROM WW RW
COMPENSATION INSURANCE
-
Mas section mtecd nm be completed if Ih permit is Waste hundred dollars (SIM)
or Icss)
1 candy Nm in Nc performance of the work Ter which this Permit u issued. I shall not
a t"�
employ any' person in any manner so u w subject become subjeco the Wormns Compensation
.
Laws of California. Dau
,I'Vl`{
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption. you abou d
become subject M the Worker's Compensation previsions of Na labor Coda you must
tenhwith comply with men provisions or this P rail shall be deemed mwked.
j CONSTRUCTION LENDING AGENCY
affirm Nal is construction lending agency for Nc perfurmancc of
1 ha,
' hmh it I d (See
work fur which Nis permit is issued (Sec. 309], Civ. C.1
s
Le s Namc
M
Loe
lenders Address
1 rectify ths, 1 have read this application and sou Nm Ih above information is
' correct I agree to comply with all city and county ordinances and sou laws relating to
s
building <ommuclion, and hereby authome mprmnmtiws of Nis city to enter uMn the
aWYC'ummiuncd properly for inspection purlwsce
(We) agree to save, indcmoify and keep harmless the City of Cupertino against
I Inbililiu.judgments, casts and expenses which may in my way mama against said City
in consequence of the granting of Ina permit.
' APPLICANT UNDE STANDS AND WILL COMPLY WITH ALL NON-POINT
^
Issued by:
Date
SOURCE REGU N
Re-roofs
Type of Roof
2
Pp6<aratrcemlrm
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupmtnom w handle m ardour material
as dcfincd by the Cupertino Municipal Code. Chapter 9.12, and the, Health and Safety
'
Cale. Secno. 255320)]
❑ res
All roofs shall be inspected prior to any roofing material being installed.
`a"ir
If a roof is installed without first obtainingan inspection, I agree to
Will the applicmt or Imam building occupant nu equipment Or devices which
remove
P g '
mit haaardn o air contaminants as dcfiacd M1-NC Bay Am. Air Quality Mavgemcm
all new materials for inspection.
District]
❑ Yu
I have mad the hararduus materials tequimmcrs under Chapter6.95 of the Califor-
nia Health & Safmy Code, Sections 25505.25533 and 25534.1 undcrstmd thmif Na Wilding
does hot currently have a tenant Our it u my responsibility in notify the asupam or Nc
reyuimmen It to prier of aferufetne of acconcy.
Signature of Applicant Date
2
All roof coverings to be Class "B" or better
cr or sulhoriud agent
2 of 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32609064.00
DATE ISSUED.......: 08/23/2006
RECEIPT #.........: 35745
REFERENCE ID # ...: 06080193
SITE ADDRESS ......
SUBDIVISION .......
CITY .............:
IMPACT AREA ......
OWNER ............:
ADDRESS ..........:
CITY/STATE/ZIP ...
20875 VALLEY GREEN DR
CUPERTINO
WOODMONT PROPERTIES
9
OPERATOR: amyw
COPY # : 2
•
RECEIVED FROM ....:
CONSOLIDATED
PLUMB
CONTRACTOR .......:
D DOUGLASS
LIC # 22941
COMPANY ..........:
CONSOLIDATED
PLUMBING INC
ADDRESS ..........:
3732 D CHARTER PARK DR
CITY/STATE/ZIP
...:
SAN JOSE, CA
95136
TELEPHONE ........:
(408)978-3093
qEE
----------
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
------------
224.90
------------------
9313
TOTAL
RECEIPT 224.90
.
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
Fax (408) 777-3333
Building Department
JOB ADDRESS:
2-092S-
PERMIT #
O
OWNER'S NAME: od p
PHONE # 6-10 " 5-i 2 31'60
GENERAL CONTRACTOR or roles T c
FAX # cK8 176 3C79,C
I am not using any
Please check applicable
and complete the following information:
•
Owner/Contractor Signature
Date
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
(, SgQ��,
CIN of
�UPEkTINO
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
ococtOP►3
APN #�-u_ m— n, I
Bldg. Permit Fees
BUILDING
Date:
Gas Piping System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
Building Address:
BPREPIPE
Re i e of Fixtures
PLUMBING
2 0 i37S-
Pbl . Fixture
g 2
Owner's Name:
Main Water Service
PLUMBING
Phone #:cj I'Z 3-960
Oc' ca� CD.
PLUMBING
BPSEWAGE
'f6 2,f'�D2Go
Contractor:
Phone:
License #:
BUSLIC
cee
�� 36ai3
SUS 6 2 - G 76
Contact:
Phone:
q 2 2 3 / f,
Cupertino Business License #:
ct/e e��a2c
362-7
td 22.9w
Building Permit Info:
Bldg ❑ Elect ❑
Plumb
Job Description:
Residential ❑ Commercial ❑
Cost of Project:
c
•
Qty. if
Applicable Fee ID
Fee Description
Fee Grout)
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
DEC -13-2006 13:10 MARK THOMAS CUP
0
4082535173 P.01i02
DISTRICT MANAGER-ENGINEER`�'�0 gA�tTgrel
Q0o �/� ,PAp BOARD OF DIRECTORS
MARK THOMAS & COMPANY, INC. m 1 J STEPHEN C. ANDREWS
DAVID E. ROSS WILLIAM A. BOSWORTH
DISTRICT COUNSEL YEAR$ Of JOHN M. OATTO
Si. iVl.c
ATKINSON 0 FARASYN, LLP. �I't6[tS KEQ 4400 CURTIS B. HARRISON
HAROLD S. TOPPEL
WENDELL H. KERR, JR.
20833 STEVENS CREEK BOULEVARD, SUITE 104
CUPERTINO. CALIFORNIA 9501421 S4
(408) 2337071 PHONE • (408) 2535173 FAX
www.cupertinosanitarydistrict.com
Pile: CuSD –MOP
Building Dept. – Cupertino
City of Cupertino
Attn.: Building Department
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: Tenant Improvement—Install Sewer Cleanout
Name: Recreation Center
Address: 20875 Valley Green Drive, Bldg: 18-23
APN: 326-09-064
Pennit No. 06080193
■ Videotape and Property Line Cleanout inspected.
No additional conditions/requirements by the MAT *
Inspector: George Santos/ Tony Soares ...............................'..
Date: ... 12-13-2006 ................... Sanitary Sewer Location:
SUPPLYING SANITARY SEWERAGE SERVICES FOR: CITY OF CUPERTINO, PORTIONS OF THE CITIES OF SARATOGA, SUNNYVALE, LOS ALTOS AND
SURROUNOING UNINCORPORATED AREAS