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06060136 (2) CITY OF CUPERTINO �« �^.,+ ^ a a a� "•��"' + `� "^ �`'"` -BUILDING DIVISION PERNIIT .�cortz.R .c�r Ti1VU,IxMATIN. BUILDING ADDRESS: GREENFIELD PLUMBING PERMff NO.06060136 1192 CRESTLINE TIP OWNER'S NAME: PERMIT ISSUE DATE HUNG 3513 MADRID NE: SANITARY NO. CONTROL NO. (408) 921-8980 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 Sap LICENSED CONTRACTORS DECLARATION IO �n I hereby affirm that I,m licensed under protides,of Chapter 9(commencing with Section 7000)Of Division 3 ofthc Busirese and Pmfcuwna Code,and my lkmsm is aji� in fa ITTddoff COPPER REPIPE $2 License CI Lle.g °ate OSDECr JUN 27 2006 HIIECI'S DEC I undonund my plana shall be axed as public ucmdr r��t�++Qyynn��{e{t �we�wwweeeerrravva��eeeeee�ff�ff BUIL® ! `yG Licensed Proimminal a OWNER-BUILDER DECLARATION , 0 S nil I Main affirm that 11. exempt(ram the demons Co License taw for the C p o which reason.(Sedan]1131.5,Business and ere.demi Calc: me em at county $ which nqusa a pomp reconstruct,alar,improve,h po nnit t ore a sig any awmum $1500 z ire "I kIacamed aalsur 1.the tbe inions of for sucCmairertre Um esiaw(Chaned ment (Chapter �< IMlbeulittnsod pumrantlo de pmvisiov of the Canuxeree,IJcense law(CNpur9 Sq.Ft.Floor Area Valuation ,51 C (cndng with Section 7000)of Division J of the Businessand Profeulan Codc)he mmonthat he Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjec,the applicants in a civil penally of Occupancy Type act more than five bundmd dollars($500). 0 1,as owner of tial property,or my employees whh wages as Their sole eempevano. will do the warp and We Income Is natintended mafferad forsale(Sec.7044,Bwineu Required Inspections and profession Cade:The Communes Liame Law dues sat apply m in awes of q P propeny who builds or improves Nom n,and who does such wart himsed f m tlnugh his awnemplaym,provided dem such Impronmena are notlnmmYa arolrend for Wa IL however,Ne buildintor imphommas is mid within one year ofcompledon,the awnr- bullder will haw the burden of proving dust he did ms bulb or improve for fourpoae of sa e.l. ❑1,ss manor of the property.am exclusively"Amusing with licensed cunmioan in outsmart dee project(See.7064.Busines,and Profesuov Cade:)Ile Comosetter s U. cove law doe act apply in an owner of Property who builds or Improves thereon,and who Mo..for each pmjeN with acanuamer(s)teamed Moment to dem Committees Licenss Law. ❑Iamaemptunder Sege y�y ,BaPCfarthis. Ower .-�--- /' %/ - Dau . 0 W``pp F SATION DECI.ARATIO I hembyalum under'.dty of perjury ante of the fallowing declarations: 1 have sad will maintain a CeelOate'of Content to self-Inure for WorkeesCamper. sedon,we provided for by Section 3700 of the labor Code,for pus performance of dee west for which This permft is issued. • ❑1 ban and will maintain Wmtees Compenauian Insurance,as required by Seeman 3700.f Ne Labor Cade,far the perfermive of dee wart for which this permit Is laved My Worker's Compensation Inmratra cattier and Policy number an: Carrier. Policy No.: CERTIFICATE OF E%EMFnON FROM WORKERS COMPENSATION INSURANCE (Thu section need ambecompleud if du permit Is furan hundred delurs($1001 or less.) I certify dem in the perfurmana of the work for which this permh is heated.I still not employ any person in any maaaran as u becomosubject To the Worker'Compemadon Laws Of Califomu.Date Applicant NOTICE TO APPLICANT.If,afar making this Certificates of Exemption,you should become subject To the Workees Compensation provision,of the Labor Code.you must OZ forthwith comply with such Provisions!or the permit shall be domed evoked. ZO CONSTRUCnON LENDING AGENCY t.v 1 Mreby.hires that Thee is a construction lending agency for the performance of (Yi > in.work fm which tiffs permit is issued(Sec.3097.Or.C.) Q Ledoes Nurse ,7 z LeMees Add. U 0 1 comfy Nu I have read this application and mace that dee above far..due is D,F cosset.I agree re comply with all city and county on in saes and sum laws Existing To DU building construction,and hereby amhonre epreaenutives of This city to enter upon the {Y.1 above-meadaned property for Impaction purpxes. (We)agree to save•indemnify and Loop harmless do City of Cupertino against Taj) lietiilites.judgments,Costs atM expenses which may in any my oma agalnl said Chy U 7 in eavegance of dee grearms of this permit. •^• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. �- ---J� ��j��t Re-roofs Signatue of Applican Data 71 pe USM Tg occum DISCLOSURE '')) Of Roof Will The a CRantmforum building ac hapten ,1or handle Health anmaterial Is dented by the Cupertino Municipal Cade.Chapter 9,13,and the Health and Safety Cale,Secure 25532(,)7 All roofs shall be inspected prior to any roofing material being installed. Dyes I�u 40 Will the applicant or fulan Wilding era If a roof is installed without first obtaining an inspection,I agree to remove g gams sac equipment or MMI which omit District? ter anumivnts u dcOned by dee cry Ara Air Quality Managcmcm all new materials for inspection. DlsuktT ❑Yes �fiu Ihawmwl thematerials25ST5.25533 and 25534. chapter6.95ofthe Califor- ` n niaHulNaSefcty Code.Sections35S03,25377 and 23534.1undcnund thatifde bWldin{ C does MI mm,ently have•.4 dust Ice u my nmpovlld Y re worry the maupmr,or dee nyuinmcnts which malabemet priormlssu M rnifaau of Occu anus. Signatureo pplica It alt ��. Owner or anthariynd,{ent D,te All roof coverings to be Class"B"or better ( CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw .m COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36224036.00 DATE ISSUED. . . . . . . : 06/15/2006 RECEIPT #. . . . . . . . . : 34883 REFERENCE ID # . . . : 06060136 SITE ADDRESS . . . . . : 1192 CRESTLINE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : HUNG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5035 RECEIVED FROM . . . . : TOM IRAN CONTRACTOR . . . . . . . : .TRAN, TOM LIC # 20711 ,. . COMPANY GREENFIELD PLUMBING . ADDRESS . . . . . . . . . . : 3513 MADRID DR CITY/STATE/ZIP . . . : SAN JOSE, CA <95132. . . - TELEPHONE . . . . . . . . : (408) 921-8980 'PEE ID UNIT. QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL __________ _____________ __________ __________ __________ __________ __________ BPFIXTURE UNITS . 4 .00 36.00 0.00 36.00 : ..'. 0.00 BPREPIPE NO OF FIXTURE 1.00 9.00 0.00 9.00 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 ..0:00 BPWSVCS WATER SERVICE 1.00 9.00 0.00 9.00 0.00 __________ __________ __________ ---------- TOTAL PERMIT 92.37 0.00 92.37 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ -__------______--- OTHER 92.37 VISA TOTAL RECEIPT 92.37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING • Community Development 10300 Torre Avenue i ! Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 INUPEkTINO Building Department JOB ADDRESS: PERMIT # c D(.DU(,OI S(p OWNER'S N u ti PHONE # v GENERAL CONTRACTOR: — FAX # id I am not using any subcontractors: _ 6< ' 0 ignat a Date Please check applicable subcontractors-ard 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 Owner/Contractor Signature Date CITY OF CUPERTINO REPIPE/ EWERS/MAIN SERVICE AN CUPEkTINO PERMIT APPLICATION FORM APN# 8 d 2 Date: (0 15 p Building Address: Z r- Owner'sName: Phone#: Contractor: Phone: License#: 9� Contact: fPhone: Cupertino Business License#: * 12 (7 Building Pennit Info: Bldg ❑ Elect ❑ Plumb Job Description: 0 8 Residential (�" I v -Uminercial ❑ Cost of Project: • du 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 Re i e of Fixtures PLUMBING BPFD{TURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING 3) . G