06050027CITY OF CUPERTINO
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"• BUILDING DIVISION PERMIT
RCONTRACTO,R,M,.ORMATION ._
BUILDING ADDRESS:
ALL VALLEY PLUMBING
PERMIT N0.06050027
11112 WILKINSON AV
OWNER'S NAME:
PERMIT ISSUE DATE
TATIANA TATARKO
3345 SELDON CT
NE:
SANITARY NO. CONTROL N0.
(510)376-4816
ARCHMICT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
DECLARATION
LICENSEDCONIAd DELLA ATION
ON`[Rd
___aee::�zz��iiieeogf
Job Descrlp
under provisions cr Y (commencing
I hereby affirm that 1 am underS
LEU
wish Section 7")af Division 3 ofthe Business vW Professions Cods. and my liecnmu
���
L",,hrameanaerca - /'
License Claz, Lu. N i %V
WATER HEATER REPLACEMENT
1
MAY
Dale Conlranor
ARCHTTCrS DECLARATION
I undersand my plans shall be used az public records
Licensed oral
OWNER -BUILDER DECLARATION
■k■■
�`��
I hereby alum ,License Law for It
hereby I am acmpt from Ns Cosions
C
following ICYIOM1 ($Cc4an )831.5. BLLa111Lta and PIOfG4VYm GOde: My Clly or LOYnIy
on
which require a permit to c..,, eller, inn mve, dM oR h, nr repair any structure
8 0
prior at its issuance. also requires the applicant for such permit to file a signed surement
Canuaz..U.. aw(Chapter 9
Sq. Ft. Floor Area
Valuation
that hculicensed InsomemtoOepmvisionsofthe
(commencing with Section 7")of Division 3 of the Bussusa and Professions Com) or
that he u exempt therefrom and the baso fo It allcgrA exemption. My violation of
r
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant a civil penalty of
nos more Nan five hundred dollars (5610}
❑ 1, as owner of the property or my employees with wages a dmir Hole compensation,
Required Inspections
will do the mark, Md theswcmrt is not intended or offered far sold sa.?014, Business
and prafessiom Code: Too Comm�ofs License Law awn ret apply to an owner of
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property who builds mimproves therem,and whadoessuchwork himself car through his
own employees, provided ant such improvements ase wtinleMrd oaffmcl fussale IL
however, she building or improvement is sold within one year of completion, the owner
builder will have On burden of proving Ina t didnot build Or improve for patpme of
-
ak.).
Q 1, as awwr of the property, am exclusively contracting with Beenea contractors a
construct the project (Sec. 7014. Business and professions Code:) The Contactors U-
ccme Law alma not apply m an owner of property who Wilds or improm Nemon, and ,
who comment far such projects with a comano(s) Hummed pursuant m the COnuachofs
License law.
Q lamacmptunder See .B@PCfurthismaan
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury am: of the fallowing dalaratiaes:
❑ 1 baveand will mainuin aCertificateof Comem w nelf-insurc for Workers Cumpcn-
,an.. az Provided for by Stenon 3700 Of the Lair Cone, far dte performance of the
work for which this permit is issued.
❑ I have and will mamatn Woukcf, Compensation Insur . az required by senior
3700 of the Mbar Cade. far Ne performance of the work far which this permit u issued.
My Worker', Comer a6on Insunnn carria and Policy number ase:
Canner. %-e z.»%�� Policy No.: ��16 s�3034/n�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu suction wed not W compked if Om permit is foram: hundred dollars ($100)
a ,
or less)
1 anify Out in the perfermawe a It work far which this permit u Wood. l "I not
employ any peran len awy mannerso az a became abject to ft Warkeri Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, aper making this Certificate of Exemption, you should
became subject an the Warker', Compensation provisions of the talar Cade, you must
'
comply with such provisiwm or this permit shall W named umked.
CONSTRUCTION LENDING AGENCY
hrabyaffrm Na Nene iso commuctinn lending agency Por the p n6ansamn.f
Om work fur which this permit u uswd (Sec. 3097. Civ. C.)
Lende's Name
Lander's Md.
I certify Nat 1 have read Iris application and sic¢ that Om above information lea
'
I agree to comply with all city and county ordinances and sae laws minting m
building construction, and hereby authome mpracmtim of this city to enmrupon the
for purposes
(We) agree to ave, indemnify and kap bannlca Ute City of Cupertino against
epamen
agmc cxpcmeswhich may in any way eccmc agaiwaim City
incohmqua thecosmand
of the granting of this permit.
A APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Dale � G
3_O
SOURCE REGULA ONS, �
Re -roofs Z--
j� a�� ` / -E-3-615.
Stgtaurc of ApplicaHAZARDO Data
HAZARDOUS MATg CLOSURE
Type of Roof
Will the or future building occ sem Or handle
a Coram
Healloanmatsrid
az denwd by It Cupertino Municipal Cade. Chapter 9.13, aW It HnIN and Safety
e. Chaps
Code, Section 25532(a)? w(
[:3 Y. �L lq.
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
Will the applicant or future building occupant use equipment or devices which
remove
emit lumardnm air ronuminants a deface by On Bay Ara Air Quality Mangcment
all new materials for inspection.
District?
QYn �Nu
I have mad the haardts m
materials requirements undcrCh nnW6.95ofthe Califon-
ria Health a SafelYCode, Section 25505,25533 am123534. IuMernaat thaifdm Wilding
does not curtcmly have a tenant, that it u my resp mobility to of, On acupam of the
mquiremca which sola t an y . tu Lssuana of a emOOcam Of Occupancy.
Signature of Applicant Date
_
All roof coverings to be Class "B" or better
OwneL wr,Ymarvma anent Date"
sm 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:'
APN ........: 35617074.00
DATE ISSUED.......: 05/03/2006
RECEIPT #••.......: 34230
REFERENCE ID # ...: 06050027
SITE ADDRESS .....: 11112 WILKINSON AV
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: amyw
COPY # : 2
OWNER ............: TATIANA TATARKO
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4736
RECEIVED FROM ....: ALL VALLEY PLUMBING
CONTRACTOR .......: MARY SANDBRINK LIC # 23015
COMPANY ..........: ALL VALLEY PLUMBING
ADDRESS ..........: 3345 SELDON CT
CITY/STATE/ZIP ...: FREMONT, CA 94539
TELEPHONE ........: (510)376-4816
•FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
--------------------------------- --- ------------------------------------
BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
TOTAL PERMIT : 49.16 0.00 49.16 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 49.16 7185
TOTAL RECEIPT 49.16
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF
SPEkTINO
JOB ADDRESS:
OWNER'S NAME:
GENERAL CONTRACTOR:
I am not using any sut
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building De artment
PERMIT �
/ PHONE # �i- z L? -
FAX #
Signature Date
_ _ ..7..a.. A— 4: ,lI n�erina infnrn1AHnn_
Please check
appucame sumu,Lua
SUBCONTRACTOR
�.� �.0 ��_- -�•� -- - — --
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
GerlConactor.
Date
CITY OF CUPERTIN 0 o(VC)6C0,11
WATER HEATER
• CUPEtIiTINO PERMIT APPLICATION FORM
Date:
Buildin I��' �V-e
Owner's Name: ��jGvy� & T47"Q/ /l J
Contractor:
Contact:
�i.-u' �i0/Y/J�•E'/NK
Applicant/Contractor: �
Ruildine Permit Info:
is
0
me
Sq.Ft�Floor Area:
Architect/Engineer:
Type of Construction:—�
Qty. if
3//71
Phone #:
License #:
ef � — 79y�90
Phorr��e #:
/C, ) err _ 9�9c
#.
$/Sq.Ft.:
Valuation:
veo no ��.,ri„n
Fee GrouD
A Ilcable rcc u�
BPWHEATER
PPERMITFEE
- -- — ----
Water Heater / Vent
Plumbing Permit Issuance
BUILDING
PLUMBING
BPERMFEE
Bldg Permit Fees
BUILIDNG
BMITIGAT
Housing Mitigation Fee
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BUSLIC
Business License
BUILIDNG