06090072 CITY OF CUPERTINO
BUILDING DIVISION CO Tliwe,
PERMIT 10RANFO ATR
BUILDING ADDRESS: DIJOSEPH' S PLUMBING INC PERMIT NO.06090072
22164 VIA CAMINO CT
OWNER'S NAME: PERMIT ISSUE DAM
JOANNE KOERING 2867 KILO AVE 09/19 /2009
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: (408) 365-2058
BLDG BUILDING PERMIT.INFO MECH
ELECT
PLUMB
LICENSED CONTRACTOR'S DECLARATION Job Description
.5 1 barcloy affirm that I am Licensed under provisions of Chapter 9(commencing
I U
with Saclkm7(XaY)ofDivWofl 3.1fdar Busincessand isorpassibriesCode,ander,license 4
a raill f..mr1.ffaSLe 5(
Lie REPIPE HOUSE FROM GALVANIZED TO COPPER
c'mcclass Lie.. /g `/
9 ,
Dam 11 ",17
PP __7�4�A C1,7ECC11DECURATION
I undinstand my plans shall the used as public records
'ou
,U
Licensed Professional
I exictry ,.beat
DECLARATION
at I ma asomp,from the Contractors Lice.."w for ther
4QC following reason.(Section 7031.5.Business and Professions Code:Any city or county 87900
ie which requires.Pamir.ciat,after.brorrove.&..[Lh,or sciati, by Someone
prior to its issuance,also requires;the applicant forsuch N111111 to flee aligned Statement
q. Ft. Floor Valuation
2 that the is licensed purembram thic proviknotif dre Ccummisam',LiceiserLaw(Chapter 9 S
i
(cearmicamns with Sscdom?fSK)of Division 3 ofure Business small Prourcusmas Coale)or
that he is exempt therefrom and the basis for that alleged exemption.Any violation of
section 7031.5 by any applicant for a permit Subjects the applicant to a civil Penalty of APRq1;�Or � Occupancy Type
.at..rc than five hundred dollars(35001
0 1,as..a,of the p.,n,,a,my play.with wages as their Suto exansponsid.r. �c
,vii1d.ftworl, and the sconscre is anit Initiated craffemal forsele(S.C.70".Business
and Pruassioms Case:The Commistair's License Law it.Suit apply W as owner of Required Inspections
property who Wilds orimprives tharcon,and whodeassurch anarklounnotfor through his
inmeacepi.yees,provided shut Such junprommocals are mairmadead aroffened far saic.If.
however,the building or improvement,is Said within am year of completion.the comer-
builder will have this Istandes of proving that IS,did not Wild or improve far purpium of
sale.).
0 1,as owner of the property,am exclusively contained,with licensed contractors or
sonsionx the project(Sec.7044.Business and ftfoadorms Code:)The Countracter's Li-
Cases Law does no,apply in an owner of proptny who Wilds or haternmS;human.Start,
who Contracts for such Projects with a contractor(s)licensed puramal US she Cruirectior's
Licarom Law.
0 1.m exempt an&,Stc. _.B&P C for this...a
Owner Dam
WORKERS COMPENSATIONDECORATION
I thereby affirm under peratty of perjury one of ft following dalmatians:
bu�and will mountain a Carfilluctur of Consent to silf-iname par Wari Comper-
an n,as provided far by Section 3�of the LSW,Code far the perfmomme of ithe
war,
"&for which this Permit is issued.
I have Said will maintain Worker's Compensation hicauxurce,as required by section
37 of Ne labor Cotle for Ne per(.rtnanee of the work for which thv permit is issued '
MyWm�1cdzPxmi Insurance...c...Said Policy number are:
Cann W-1 3—
citink.., 7tir 1r(40,fKiicNo.:91f5
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
mals.,Io need an,as S..,Icwd it the permit is far...hundred dollars($IW)
...to.)
I tmidfy Not is to peffmarrurec of 0e work for which this permit is issued,I abseli not
employ any person in any maturacran as in become subject to me WoftraCompintrailon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If.al making this Ceftiricrum of Exception,you Should
became Subject.the Worker's Compensation provisions of me LSWr C.dc,you must
z fornawiter comply with Such novirrims.this permit Shaul hcontend revoked.
z "
C7 CONSTRUCTION LENDING AGENCY
I hereby affirm that done is a construction lending agency for that performance,of
the work far which this permit is issued(Sim.3W7,Che.C.)
Learkr's Nam,
ZD Z Landers Address
U 0 1 certify that I have mad this application and sum that dic above information is
I, conch.I.,me to comply with all city and county onfinance,and State laws ral.firrg 1.
oU building construction.and hemby authori7a representatives of this city to cnicr upon the
Wvc montuound properly for inx,,nnim purposes.
(We).,mm 1.Save inifinartify and keep hatless do,City of Cup,ninniagainst
g,, linithiintmajudgments,cosis and expenses which may in any way accrom against Said City
U Z in coneopeence of dic ipauding of this monsit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-poirrr Issued by: Date
SOUR
f 1 47
- 40 Re-roofs (�;7
Signature of ApplicanuCommenclor /11" Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will as defined by me Cummins Municipal Codc,Chamser faun pter 9,12.and tha Health and Safety
Case,Secdcar 255324? All roofs shall be inspected prior to any roofing material being installed.
Oy. ON.
Will the applicant or future building occupant mor equipment in devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit har,unhour,air commumarms a&limit by the Bay Area Air Quality Management all new materials for inspection.
District?
Oy. ONu
I have read the Inexamma Cubic,
.is Hhh&SaficYCOake,Secummi 25533 Sout 15534.1 wormusid ansairder,building
duce not currently haw,a annual met it is My reSaireschility an Mary use WCaparl of me
.quirethe I f C ficateoroccuporcy. Signature of Applicant Date
Ml=a ;,-12-,�w
Owner or autharir<d no 7 ;� uSw . All roof coverings to be Class "B"or better
0-1100
Community Development
v` 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
4JUPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
,2216 (( (11 a roAf kel' (,i'/` C56 0 ?0 0 -'—
OWNER'S NAME: )aOni7toL(G v/'G PHONE #
GENERAL CONTRACTOR: N.p FAX #
I am not using any subcontractors:
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
-
12 -A5
Owner/Contractor tignature Date
CITY OF CUPERTINO
6m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32646010 . 00
DATE ISSUED. . . . . . . : 09/12/2006
RECEIPT # . . . . . . . . . : 35994
REFERENCE ID # . . . : 06090072
SITE ADDRESS . . . . . : 22164 VIA CAMINO CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JOANNE KOERING
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : DIJOSEPH ' S PLUMBING
CONTRACTOR . . . . . . . : ANDREW DIGIUSEPPE LIC # 22796
COMPANY . . . . . . . . . . : DIJOSEPH' S PLUMBING INC
ADDRESS . . . . . . . . . . : 2867 KILO AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 365-2058
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------ - ------ -------- - - ---------- - - - --- - --- ---------- ----------
BPERMFEE VALUATION 7, 900 . 00 147 . 96 0 . 00 147 . 96 0 . 00
BPREPIPE NO OF FIXTURE 2 . 00 18 . 00 0 . 00 18 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
-------- -- - -- -- - --- - - --------- -- --------
TOTAL PERMIT 309 . 33 0 . 00 309 . 33 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-------------- - -- ------------ ----- -- - ----------
CHECK 309 . 33 1713
TOTAL RECEIPT 309 . 33
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
CITY OF CUPERTINO O'NODU
d' REPIPE/SEWERS/MAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
APN # 2( _ 10—aG Date: C /2" Q'.c
Building Address:
22 /6y L 1' 67 ��� /�����yC/
Owner's Name: Phone#:
)Oapmr l'a�v�
Contractor: Phone: 3G 205 V License#: - g/G
b�JasPpti s pl�w,���9 Tic
Contact: /ny /; j 0 S rr4i Phone: 3 GS� -,QC/ Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb 0,
Job Description:
-17rNP �t��, s r aGl. to co0PCU-
Residential [ Commercial ❑
Cost of Project: 7 ?d a Ci
•
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 Repipe of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•