06070180 (2) CITY.OF CUPERTINO �T"v�' {�k,(y F✓rr4+r p7f"royyyyrr�a "s `
•BUILDIN$DIVISION PERMIT ytLvV
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BUILDING ADDRESS: I TRIPLE A PLUMBING IMMITND'06070180
7613 ERIN WY
OWNER'S NAME: PSRMrT ISSUE DATE
DONNA JAHN 1230 PEAR AVF, 95 07/26/2006
NE: SANrrARY NO. CONTROL NO.
(650) 964-4935
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLOC O O MO
lop LICENSED CONTRACTOR'S DECLARATION IObD0SCr1 IIOn
I hereby grace that 1 am(kens d under pmvisiona of Chapter 9(commormem, P
withSermon 700Q cf Dividoa 7 of she Budnexsmd ProfosNonsde
Ca .and my license,u
dfull f
erta PROPERTY LINE CLEAN .OUT
LulleCl.ClLk.N
Dam Contractor
ARCHITECT'S DECLARATION
I understood my plans shall be used Is Public reeorN
'Q Licensed Prormed ..I
sac OWNER-BUILDER DECLARATION
i S 1 hereby art..drat I am exempt from the Canuamm"Lieanm Law for the
m o inllowini won.(Sadao 70313,Buafneas and Professions Code:My city or county d
which requires•permit to construct.eonset,alter,improve,demolish.or repair any ncture 2
�^ priorwi0 iesmac.alta requimadmapplimirormchNmilso Blmaalgnedsmwmmm
deal heis licensed purmmltothcprovisions ofthe Contracns
mtor'sLlcoeLaw(Chapter9 Sq.Ft.Floor Area Valu n
(commencing with Section 7000)of Division 3 of the Bmiru.-and Professions Code)or
`<..
that he d exempt therefrom and the basis for the almged a tempdmt.My Volition of
Section 7031.5 by any appii mt far a permit objects the applicant to a civil penalty or MrhSeruuOccupancy 1pe
not mom than five hundred dollen(M),
❑I.uawrcr of the propeslY.amY wPlaym with wgesu thou mm emnpewtian,
ane P�onfins work,the cmc These Coontractor,Ll�e Or de;n an[apWY t�'awne,Of Required Inspections
Prepenywho builds ar improees thereon,and who doesauch work himself of through his
awn emPloyces,provided that meh improwmenu art metimmnded aro@rad forsale.If.
however,the buildingor Improeemmt d mid within arc year of completion.the owner.
Wilder MR haw the burden of proving Nat h did an,ddb or Improve for purpose of
ask.).
L
as owner of the property.am exclusively contracting wish licewd coluato
emrs mct the project(See.7044.Sminw and Pmfeumm Code)The Contractors Li.
move law dote not apply to as owner of property who builds or immoth Corton,and,
who contracts for such projects NN a rnnuacms(a)licensed purwm m the Comracmfa
License
w LLaw.
❑tom emyf ydder gee. ,BKPG lot thla reamn
I
DamWORK COMPENSATION DECLARI hereby affirm under penslty of perjury ane ofshe following decian0am:
1 Mw and will mainWn aCeNOeamafCovent to sat f4susa fmWorkers Comptean,u provided for by Section 3700 of she labor Cde,fm We performance of the
rk for which this permit is tnuod.
1 have and will maintain WmIOrI Compensation Insuranm,u required by Section
0 of the LIM,Code.for the performance of the work fa which this permit busted.
Worker,Confiscation Waren artier and Policy number art: -
Catsier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' Q D
COMPENSATION INSURANCE
(This section need set be completed Hm llthe permit is foraundreddallN($1001 O -
orless,)
I certify that in the performance of the work for which this permit d issued,I shall net
employ any person in my onaDNlZp membjat 1.the Workers'CampuuNm
laws ofCydomr Daw-"r//-ss/�Y
Appncmr I z
NOTICE TO APPLICANT.If.after making this CenlOcete of Exemption,you Amid
become subject to the Worker's Compensation provisions of the Labor Cssde,you most
.JO forthwith comply with such provisions or this permit Nall M deemed smoked.
,z,r vN., CONSTRUCTION LENDING AGENCY
[.v I hmrehyaffmn that them is a construction kndingage¢y for the pelf ursnanco.r
rL the work for which dds permit Is issued(Sec.3097,Civ.C.)
WMA Lenders Name
7 Z Lenders Addle
U 0 1 certify that I have lead this application end sum that use who.information is
fL(~•' correct.l agree to comply with all city and county ordinances and Issue laws relating to
0 V Wilding convection,and hereby amhame mpresenutires of this City to enter upon the
LU ahovc mentioned property(at Inspection purposes.
t••t G (We)agree to uw,indemnify and keep bamrlw the City of Cupertino against
� ) liabilities,judgments,cosh and expeams which may In my my accrue against mid City
V in APPLICANof the T Aof IND
NTUNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date
Siglnetuto afAppiiean on / D� Re-roofs �'
torOUS MATERIALS DISCLOSURE Type of Roof
Will she applicant Or future Wilding occupantdom Or handle hrradaos material
Is de0ned by the CupeNao Municipal Cock.Chapter 9.12,and she Health and Safety
Cade,Section 25532(2)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yo, XNa
Will the applicant or future building oampam um cqulpmmt m Mite which If a roof is installed without first obtaining an inspection,I agree to remove
emit huaNnos air conuminsnu u defined by she Bay Ams,All Quality Management all new materials for inspection.
District?
GYes �C]No
I have mad she hv�rdousmaterialsrtquiremcnu under Chapwr6.95ofthe Califor.
nu Hal"Safety Codc,ScW=25505.25533atd2553C.lundemandtheifthe building
dam rot currendy Mw a wnan4 that it u my reaponsihility to rmdfy,the occomet of the
m me hichmustbemetPorinin"'ofaCmriRcamofOc war Signature of Applicant Date
Q(o
Owner mau 'mdagcnm All roof coverings to be Class°B°or better
Community Development
' 10300 Torre Avenue
? i Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
j&UPERTINO
Building Department
JOB ADDRESySi, ( , 1� PE O6O# 70 ? d2, 6
—j•(p W
OWNER'S NAME: J� JAPHONE # g qq - 135
GENERAL CONTRACTOR Q FAX# 050 - 2$
I am not using any subcontractors: oho
Si a Date
Please check applicable subcontractors and com let-the followin 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
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35920017 . 00
DATE ISSUED. . . . . . . : 07/26/2006
RECEIPT # . . . . . . . . . : 35391
REFERENCE ID # . . . : 06070180
SITE ADDRESS . . . . . : 7613 ERIN WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : DONNA JAHN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : DONNA JAHN
CONTRACTOR . . . . . . . : DAVE TORRES LIC # 21359
COMPANY . . . . . . . . . . : TRIPLE A PLUMBING
ADDRESS . . . . . . . . . . : 1230 PEAR AVE #5
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043
TELEPHONE . . . . . . . . : (650) 964-4935
'FEE ID UNIT QUANTITY AMOUNT . PD-TO-DT THIS REC NEW BAL
---------- ------------- --- ------- ---------- ---------- ---------- ----------
BPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 47 . 37 0 . 00 47 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 47 . 37 2990
TOTAL RECEIPT 47 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
•
owol o
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
'CUPEkTINO PERMIT APPLICATION FORM
APN# 3�_ 20— 0 F] I
Date:
Building Address: q (A 3 0,W WAY,
Owner's Name: Phone
vyg)
Contractor: PhoLicense#:
&(5) 59 3(al ca
Contact: Phone: Cupertino Business License #:
PAIL , 9 Lf93
Building Permit Info:
Bldg ❑ Elect ❑ Plumb K
Job Description: Prz�PGR.r; CLE4W-OuT
Residential ( ( r Commercial ❑
Cost of Project: ^
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping Sys ern Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Repipe of Fixtures PLUMBING
BPFD{TURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
RUG-08-2006 08:40 MARK THOMAS CUP 4082535173 P.01i01
4gANITo.. o r
s
DISTRICT MANAGER-ENGINEER SO BOARD OF DIRECT0R9
MARK THOMAS&COMPANY,INC WILLIAM A.BOSWORTH
DAVID E.ROSS DR.JOSEPH F.BROWN
DISTRICT COUNSEL ,pf 4A� JOHN M.GATTO
•4Bl IS NE0 19CURTIS B.HARRISON
ATKINSON AN,FARASYN,LLP
WENDELL H.KERR,JR.
HAROLD S.TOPPEL 20833 STEVENS CREEK BOULEVARD,SUITE 104
CUPERTINO,CALIFORNIA 95014,2154
(408)2537071 PHONE • (408)2535173 FAX
File: CuSD—MOP
Building Dept.—Cupertino
City of Cupertino
Atm.: Building Department
10300 Torre Ave.
Cupertino, CA 95014-3202
Subject: PropertyLine Clean Out
` Name: Donna Jahn
Address: 7613 Erin Way
APN: 359-20-017
Permit No. 06070180
No additional conditions/requirements by the District.
Inspector: George Santos/Tony Soares............................................
Date:...8-08.2006................... Sanitary Sewer Location:
cc: Property owner 30
FR PL _ t? 6
SUNFIYINO SANITARY SLW iw SFNNICES FOR: Cm OF CNFIRT110, I0971DNS'OF TNN CITIES OF SARATOGA, SUNNYVALE, Los WETS ANO Sunoutio N0 UNINCORPORATED AREAS
www.cup or lin Ds onir D rydis Frirl.ed ITT
TOTAL P.01