06070201 CITY OF CUPERTINOT 7'sw^
BUILDING DIVISIONPERMIT CONTRAG`�TOR INFORMATION
BUILDING ADDRESS: , KOPELS DAVID PERMff"0.06070201
958 WESTLYNN WY
OWNER'S NAME: PERMIT ISSUE DATE
KOPELS DAVID 07/28/2006
E:
SA ARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
op
LICENSED CONrRACIOWSDECLARATION - SObDI:SCrI son
mC I hereby affirm WE I am liaised orale,provisions.1 Chapter 9(commencing p
�ZW with ScorceaOIXBof Division3 o(thc Business and Profeviam Code.and my licenau
m 'ocClarsderfa REPIPE COPPER
Llccmc Clazs com
�k•� Dote TSDECr
ARCHITECTS DECLARATION
i e� 1 undersand my plans shall be used u public records /
�yU
.0.t' Licensed Prefessioml
5 Oat I a. mm,t from
DECLARATION
CrATION ,(,+
C 1 herthy athero that 1 I.J.eacmp from We Camranoo Any c law for than o
.o O fallowing uses a (tutu i ]031. Bu,inus and Pm2Nun Code Any city a, tc my
%$ which requires a pcnnil m ones the
alter,hn(xeve,h pamiit t Or ereod,a sig any strunuro $6000
priormia issueeuo.also requites theapplkam for such pmmi',Lkam Levisulcmcm
x
'hot he is licensed purreantb We pmvisiom of We Conuecmh Licntu law(Chapter Sq.Ft. Floor Area V nation
2�,G (commencing with Section]000)of Division Jof the Busineaand Profession Code)or
that he Is exempt themfmm and the buffs for the alleged asereptims Any violation of
Section 7031.5 by any applicant for a permit sublimes the applicant m a civil penalty of e2' Occupancy Type
not more Wan Bw hundred dollars(SSW).
❑I,se owner of the Property or my croployces with sages as Weir solo campewdon,
will do We work and the suucum,is net intended or attired fonahe(Soe.1014,Basimu Required Inspections
and Pmfeamns Cade The Comm Utes License law does,sol appy m an owner e of q P
property,who builds or improwa Ws,eon,and who data such work himself err through his
own employeau.provided that such hmpmwmeaes art not i^oMed oroRered for sale.If.
however.the building or unprowmrat is old within aro year of wmpletion.the awner-
milder will have We burden of proving that he did Out build or impeose far pugpu of
sate.)
1.ss..of the property am comm wily contr m ing with limned mmusicians in
construct the perm(Sec.7014,Business and Profusion Cade)The Conlracmes Li-
cone law does not apply in an owner of property who builds or Improves;thomom.and
who Wroomm forsuch projeces wild a conaanara)lianad puruant un the Carnia mes
Liana law. /1
❑lamer -Doper ,lid PC( our n
Owmrj Dam .
WORKER S COMPENSATION DECLARATION
1 hereby affirm under peas of perjury arc of the(allowing decleratiau:
I have am will maintain a CeruOuo ofConsem in self insure for Worker'sCompcn-
sation,u provided for by Section 31W of the Labor Cade,for the peAormamx of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as;required by Section
37W or We labor Code,for the pertormanee of the work fa which this permit a issued
My Workcfa Coopenuuan Insurances carrier and Policy number art:
Cartier: Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu octan moil not be completou if the permit is thrum hundrtddollan(SIM)
or 1.)
I CamfY that in tan performance of the work fa5.wIt h Wis Permit u homed.I,hall not
ompluyanypersoninany maovGr 6 a-0eTnfims�ecl to the Workers'Campenuuon
laws of Calif�'^�}Dram ( J! !�, II// C
Applicant�(�(l/ l G
NOTICE TO ctfjeANT:IL atom mabn0 Wu CenhOcate of Labor adyou ushould
in=
.J ,� become n comp y the Wortr oCampcwuon provisions an the tabor Code,you muv
forthwitheomply with such provision or this .I,shall Mdamcd revoked.
Z O CONSTAUCTIONLENDINGAGENCY
E" Ihereby affirm that Wert u a eonuuclina lending agency for the performance,of
CS Iia work(ser which this permit Is issued(Sec.3097,Civ.C.)
G0 Lender's Name
z Lender'.Address
U Q 1 certify that I haw mud this application and sero that the above information is
FCaereeL 1 agree in comply with ill city Nd county aolosee S and sum laws relating in
pU building construction,and hereby aathome representatives of this City to enter upon the
pur,m
Lt7
above-mentioned pu.cos for dexpe ses which s.
H gy (Wes)agru to saw.Indemnify and keep harmless the City of Cupcmn'agamal
ten inermuu,iudgmenes,cnesand osteitis which may in any way accrue against aid City
l;)z in canuquencc of We granting of this permit.
SOUR/CANT �REGA/�E/�RpSpf$AND AND WILL COMPLY WIITTTHH Al�l/.pN OIM Issued by: Date
50//
Re-roofs
Si ore ofA 1 UC ARDO Dao
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thesuppliant or fMuni buildinge.Copier
.and fes Health anmaterial
U defined by the Cupertino Municipal Cade.Claper 9.12.and the Health and Safety
Code,section 2ss3z(gl
❑Y" 0>d� All roofs shall be inspected prior to any roofing material being installed.
41 Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Emit havardnw air conaminam as defined by the Bay Area Air Quality Management all new materials for inspection.
Davin? OM___
❑Yes 4cV9'M_
1 have real We hmommis matedalsmquimnena under Clupter6.95 of the Glifory
nu Health h SafctyCodse.Seed.25505.25577 and 25534.1 unhrsand tutifthc building
does not w e onanL that it u m pan.1.1.y m noul'y to occupant of N
myulrt taw - mate, poor ,mymancwrm oroccu ,� Signa[ureofApplicant Date
�� — " All roof coverings to be Class"B"or better
Owner ser suuthom d ageto Date g
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
.T�, �s l ah UH / ? 3 060 -20 -2-01
OWNER'S NAME: PHONE # a 6 dGtF
GENERAL CONTRACTOR: a FAX # fod f!
I am not using any subcontractors: % 7-2r-45'
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 p�vyc v ole r er'��
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature bate
CITY OF CUPERTINO
M 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot : '
APN . . . . . . . . : 35927016 . 00
DATE ISSUED. . . . . . . : 07/28/2006
RECEIPT 4 . . . . . . . . . : 35426
REFERENCE ID # . . . : 06070201
SITE ADDRESS . . . . . : 958 WESTLYNN WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KOPELS DAVID
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : DAVID KOPELS
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : KOPELS DAVID
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- --------- -- ----------- ---------- ---------- ---------- ---------- ----- -----
BPREPIPE NO OF FIXTURE 20 . 00 180 . 00 0 . 00 180 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- - -- - - ----- ---------- -------- --
TOTAL PERMIT 218 . 37 0 . 00 218 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----- - - - -- ------- ----- - ------ - --------------- --
CHECK 218 . 37 3827
TOTAL RECEIPT 218 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION-------- ------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
c�oao�
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
�CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Addres
-41
vW23 �
O�yRer's Name: Phone#:
v qvy 6-
Contractor: Phone: License#:
6 G r, w
Contact: Phone: Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb 2-
Job Description:
re lzoe--
Residerftial 0 Commercial ❑
Cost of Project
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
a BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING