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06080074pC iwE 0 !�2 r I s'u �<] ;oc ase -z> 4�a i�• 0 � ZS U '- UL UC OF UV '< CI,TY OF CUPERTINO '4CONTRAGTQRIIVFORMATIONN x t '` ev " •'' ' `�'' - BUN.DIN44DIVISION PERMIT ,9r.RC',.W4s,. .x5;:.r 4,.e-� v BUILDING ADDRESS: CUPERTINO PLUMBING PERMIT NO 1114 YORKSHIRE D OWNER'S NAME: PERMIT ISSUE DATE SANDER INGOLF 1300 DELL AV E: SANITARY N0, CONTROL NO. (408)253-0618 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description hereby affirm Nat I am licenced under pmviaoM of Chapsv 9 (commencing with Section TOM) of Division 3 ofd" B enommend Prof"sium Code, and my licensee 10 In,and erre /' 2 y rr C) s COPPER RE -PIPE License Dao; F5-10�-i�—Conuaeam 011 ARCHf1ECT'S DECLARATI 1 1 undcrmnJ my plans shall k uuJ ss puM1lic "cards ' Licensed Professional OWNER -BUILDER DECLARATION 1 henhy a1Erm that 1 am exempt from ft Contractors License Law far Ik fallowing mason. (Section 7031.5. Business and Professiom Coda: Any city or county which royrims a pumit to cmussuct. alcor. improve, demolish, in ropair my suuetum $5000 ! prior m its issuance, els. requires the applicant forsmh permit to file a signed mmmem the Canaanare Uccnu Law (CMPW9 Sq. FI. Floor Area Valuation i that he is lkcmed lmrmant an the pmvisiom of (commencing with Section 7000) of Division 3 of be Business and Profevimn Coec)m Nat he u exempt Uson and be basis for be alleged exemption. Any violation of r Occupancy Type Scuba. 7031.5 by any applicant for a permit mbjects into applicant to a civil Penalty of not more Nan five hundred dollars (5500). ❑ 1,mnwmroftheg pmty,armyemploye"withwagem Noirmlecompcm don, Required Inspections craw, will dot:wmk. chat: she it=rsa apply in an hamir of and Cade: The oboimener Li Law, dors oro apply if an awMr of q P and who aressuchwork himselfor through his nny wh bis improvesbecmrs nd who propertywho bisitch i ed bit such improvements awn employees, ea, proal:d that such improvements aro not inreMW aroResd for sale. If. Csenwnvf buildu be buildingorid didnot year ofimrove NALED form. buildu will have burden of proving that did not build or improve for purpose of b sok.). ty®JI Q I. as owmr of the property, am aclvuvcly communing with Hemostat "nacres in construct the project (See. 70ia, Business and PNfemions Cade:) T: L'mmiebra I.J./ come Law does Ont apply he an "net Of Properly who builds or ImpmM3 NCRon, and (p who contracts for such projects with a cantracto (s) licensed pursuant to dm Consrumrs License Law. ggtpa fh ks to ® ❑ 1 am "empt under Sec . B h P C for this mason .pas. [tWY/�ls 1C9g9j�FQL®II owner Dau Nom'® p�f tr7�gJJ glpNf]f WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty or perjury one of the following decWatimtc 1 ham and will maintain a Certifcme"consent m mlf.m.r. farwormes Compen- sation, as provided for by Section 3700 of be Lobar Cade, far the performance of the work for which this permit u issued. gy 1 have and will maintain Workers Compensation Insmada, as reyuirud by Second . 37M of the Labor Cod. fm be performance of be work for which Nis permit is issued. ` My Workers ompeomuan Wuramm artier ana Paliry number ase: Cartier. r Policy No.: 19 12- 3-0-.2: CERTIFICATE OF EKEMPTION MOM WORKERS COMPENSATION INSURANCE (Thu section recd not k completed if the Permit is forom hundred dollars (SIM) m less.) I cenify Nat in to performance of the work for which this Permit is issued, l bull not employ any person in any manner so as to became subject to Ne Workers' Compensation ' Laws of California. Dam ' Applicom NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should become subject to be Wor er's Compensation provisions of be Labor Cade, you in= ' forthwith comply with such provision in this Permit shall he domed revoked. j CONSTRUCTION LENDING AGENCY ' I her rue Nad ft.orkI umsed(Sm. 3M,nding agency fm Ne perfurmamx of ' which work for which this permit u issMd (Sec. J097, Civ. C.I Le nder's Name • Ladder's Address 1 certify that 1 have read Nis application and sum Nat the above ufo..him is ' ' COMM 1 agree m comply with all city and county ordinances and mu laws relating to building consuucsion, and hemby authorize representatives of this city to enter upon the above-mentioned Pmpcny for impccurn purposes (We) agree to save, indemnify and kap hasroless be City or Cupemno against j liabilities, judgments, casts and expenses which may in any way accrue against mid City in cnnseguemc of dm granting of N' perno APPLICANT UNDER D WILL COMPLY WITH ALL NON -POINT Issued by: Date 6 Ca S URGE REG NS. !—' s0 Re -roofs Type of Roof Signatureof n pare AZA OUS MATERIAL$ DISCLOSURE illtheapplianl or Imam hade'ingaaupantstem or MMIChv I fiord Uummamrfu 0e Cupertino Munici i Coac. Chapter 9.13. and Ik HCaIN and Safety Com, Section 35532(a)? io ❑Y" Na 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 applicmt or future building occupant use equipment or dcviccs which remove emit hazardous air contaminants an defined by be Bay Arca Air Quality Management all new materials for inspe ' Dia t? ❑Y" No in ve mal the hvaNsws materials rcquimmcnts under ChaPmr 6.95 of the Califon r a G not Health& SafoyCock. Sectio nt2iM5.35533 and 25534.1 understand NeaifNc building '/c' door not currently have a mnan4 th I it is my rcsprnsihility ro Mufy the oocupant of the rcyuircc hmh � mr1numerric,of.Ccrofrr�a¢ifOccupmc� fp a Signature of Applicant Date v' (6,v All roof coverings to be Class "B" or better Owner ma.m <aage _ Dam !m 3 of 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Elk: Lot: APN ........: 36208008.00 DATE ISSUED.......: 08/10/2006 RECEIPT #.........: 35585 REFERENCE ID # ...: 06080074 SITE ADDRESS .....: 1114 YORKSHIRE DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: SANDER INGOLF ADDRESS ..........: CITY/STATE/ZIP .... , OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: FRANK CARDIA CONTRACTOR .......: CARDIA, FRANK L LIC # 612 COMPANY ..........: CUPERTINO PLUMBING ADDRESS ..........: 1300 DELL AVE, STE C CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: (408)253-0618 •FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ------------------------------------------------------------------------- BPREPIPE NO OF FIXTURE 11.00 99.00 0.00 99.00 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 TOTAL PERMIT : 137.37 0.00 137.37 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 494.41 VISA TOTAL RECEIPT 494.41 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING • n Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: //Ikj vrsk1it PERMIT # OADeCC 1 OWNER'S NAME: Th 1 S4 dog PHONE # 7 - 9 2 / GENERAL CONTRACTOR: !� 6 FAX # r u I am not using any subcontractors: Si r Date Please check applicable subcontractors and complete the following information: er Contractor Signature �o-off 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 er Contractor Signature �o-off Date an oc .CUPEfI;TINO CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE PERMIT APPLICATION FORM APN # 3 (49�— 08 - CO8 Bldg. Permit Fees Date: Building Address: I Gas Piping System Fee PLUMBING t/% orsA i,, �. Plumbing Permit Issuance PLUMBING Owner's Name: old ��1a-rs Re i e of Fixtures Phone #: `x73 -9z17 Ctract Phone: Pbl . Fixture License #: Conta t; Phone: Main Water Service Cupertino Business License #: BPSEWER Sewers PLUMBING Building Permit Info: Sewage Disposal PLUMBING Bldg ❑ Elect ❑ Plumb ©--� Job Description: r O Business License BUILDING Residential Commercial ❑ Cost of Project: jU r • Qty. if Applicable Fee ID Fee Description Fee Groun 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