06120045 (2) CITY OF CUPERTINO -
BUILDIN4e DIYIsION PERMIT CONTRACTQR IriIFURMATION ,
G#„
BUILDING ADDRESS: SPEEDY ROOTER PLUMBING PERMTTND'06120045
21578 FLINTSHIRE ST
OWNER'S NAME: PERMIT ISSUE DATE
ANk JANICE & DAVID SEHR 701 ALDO AVE, STR 41 19 /19/2006
7.R
E: ,
SANRARY N0. CONTROL N0.
(408) 234-8134
I'IECT/EIJGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
loo LICENSED CONTRACTOR'S DECLARATION Job DescriptionmC I henry affirm rm al 1 am licensed under provisions of Chapter 9(commencing _
IQ with Section 7")of Division 3 of the BusiM..and Prefewuns Codl and my licemu
{ i u mlllf eandef oc< _ 3 Liea 3 / INSTALL SEWER LINE CLEAN OUT AT HOUSE
Contractor
ARCHITECTS DECLARATION
i e I understand my plans shall he used as public reemx
fyU
Gy License)Profeuiool .
3 OWNER-BUILDER DECLARATION
iF I hereby affirm That I am exempt from the Convector's License Low to,tato
20 following moon.(Secliun 7031.5.Business and Professions Code:Any city or county
e m which mquires a permit to cowrvct,abet.improve,demolish.Or repair my outcome
prior to itsissuance,akar requires the applicant for such Permit to file a signed summon
-�< Nat W is lwomU pursuao to the pmvisiom of to Cantrmtor's license low(CMpmr9 Sq.Ft. Floor Area Valuation
`,$ (commencingwit Seclion7")of Divisim3aflhe Busineamd Pmfcaions Cade)or $1000
that he u exempt thumfram and the hub for the alleged exemption.Any violation of
Section 7031.5 by my applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not mom Nan five hundred dollars(350(r).
0 1,as owner of the Property,m my employes wit wages as their sok Compoundon,
will do the work and to someone Is out handed coffered for sok(Sox.7 .Business 35629026 08
and Profession Cox:The Conuacmr's Li cesse Law does ant apply to an Moor of Required Inspections
property who builds or improve de rem,and who doessuch work himaelfor through his
own employe a,provided that such imptosements are not intended O.Reed for We If.
however,the building or improvement is sold within one year of completion.the owner-
builder will base the Wrden of proving that K did not build or imprma,for purpose of
sure.).
0 1,u owner of she property,am exclusively con=I.,was licensed commemes to
construct he project(Sec.7004.Business and Professions Cox:)The Contractors U.
cape Low does not apply to an owner of property who builds at improves thereon.and
who emmocs for such projects with a tontrxctar(s)licensed pursuant to the Contractor's
License Law.
0 l am exempt under See ,B&PC for this much
Owner Data
WORKER'S COMPENSATION DECLARATION
41 1 hereby spirit under penalty of perjury one of the following declarations: I
0 I have and will maintain a CertiBcam of Cntssent to self-insure fnrworkerscompen-
mucn,as provided for
by Stmt.37M of the Lobo Cade,far one peslormvuz of the
wok for whim this pomst is noted.
0 I have and will maintain Workers Camyem hit Insurance,at required by Section
3700 of to labor Cade.for the:pedorm urce close work for which to permit is iaod.
My Workers palinumn lnxumme carr and Policy number/.it�S
Cartier. _ z Z"1 Palley N-'n9y/2.5_96-/
C RTIFir OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE .
(This sce an need not W compkmdifte Permit is for one hendmddollars(SIM)
or less.)
I certify tet in the performance of the work for which this permit Is issued,l shall not
tropic;any person in any manner so as to become subject a the Worlora Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT:If,aRcr making this Cenilica,of Exemption.you should
become subject to the Worker's Compensation provisions of Nc labor Code,you must
.,Z faMwit comply with such provisioss or osis Permit shall he dames mated.
Z O CONSTRUCTION LENDING AGENCY
F+w'• Ilmmhyapinm dotft.iso Construction lending agency for the perfoommoc r
0: tc work fur which this permit is arses(Sec.W.Civ,C.)
QLender's Name
00. z Lender's Add.
O Q I ceniry that 1 ban mad this application and sum that the above information is
!L canta l agree to comply wit all city and county oncinances and sure laws missing In
QU building construction,and hereby authonre mpmamonics Of Wx city to enter upon the
W I'AlUNDii'M
ePmPcrsy larinspccdo s.
punas
W (We)agree to ave,indemnify and kap harmless the city or cupcnlno against
Vh lisssnd espartos which may in any way accrue agaitnt aid City
z irktng of u-nd" NDS DWI PLY WITH ALL NON-POINT Issued by: Date
MONS. 2-12 _Q
C
S Lum e(AppintNRD:lor Dam Re-roofs
HAZAAZARDOUS MATE IALS DISCLOSURE Type of Roof
Will the Cupertnt ino
future rendinge,Chapter 9.12,
handle Ialloanmamrial
u defined by IM Cupertino Municipal Code.Chapmr 9.13,and to Heart and Safely
Code,Section 355320)? All roofs shall be inspected prior to any roofing material being installed.
Ice
Will the applicant oslam building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -
cmit harardntu air contaminants u Jcfine by the Bay Area Air Qmlity Management all new materials for inspection.
District?
❑Ya
I have ehoanLms materials mquiremems under Chapter 6.95oftoCalifor-
nlaHcalt ale Cade,Sati 505, 3am12553d.l utbcrwnd tarifthe Wilding
docs no u y Imes a ton nal' s y rcspomihility to mtil'y the occupant or dm
i hleh muv 1 p6 moa of s GertlrKate oroccupancy.
2 eO6 Signature of Applicant Date
c"naullmdred.,ro Dam. All roof coverings to be Class "B"or better
Community Development
0 Torre Avenue
i S
eCprtino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
mi—
MW
GVUPEkTINO BuildingDe artment
JOB ADD SS: P/F '2 It 57mof�l2E S%- 6(26a
`-(s
OWNER'S NAME: [ 5L PHONE # a 7Y - 9 /d
GENERAL CONTRACTOR: FAX # a
I am not using any subcontractors: / A^
Signature Date
Please check applicable subcontrac rs and complete the follc4g information:
60 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/Contra Signature Date
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35620026 . 00
DATE ISSUED. . . . . . . : 12/12/2006
RECEIPT # . . . . . . . . . 37018
REFERENCE ID # . . . : 06120045
SITE ADDRESS . . . . . : 21578 FLINTSHIRE ST
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JANICE & DAVID SEHR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . :SPEEDY ROOTER
CONTRACTOR . . . . . . . : SPEEDY ROOTER PLUMBING LIC # 23086
COMPANY . . . . . . . . . . : SPEEDY ROOTER PLUMBING
ADDRESS . . . . . . . . . . : 701 ALDO AVE, STE 43
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054
TELEPHONE . . . . . . . . : (408) 234-8134
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT . THIS REC NEW BAL
----- - ---- ----- ----- -- - ---------- -------- -- ---------- ---------- - - ------ - -
BUSLIC FLAT RATE 1 . 00 107 . 00 0 . 00 107 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- - - - --- -- -- - --------- ----------
TOTAL PERMIT 145 . 37 0 . 00 145 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
------------ ----- ----------- - ------ - --------- -
OTHER 145 . 37 MC
TOTAL RECEIPT 145 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ------------------
------------ ----------
--------------- ------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
CITY OF CUPERTINO 002CDIED
Q' REPIPE/SEWERS/MAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
APN # 35W�20 Date:
Building Address: 2 / 5-79
Ft /NF'5�� I L
Owner's Name: / '
-AATl ( !.� per f2 Phone 5 �f7Z
Contractor:
SP I �� Phoned 7qg- License
Contact: , /„ Phone: g/g Cupertino Business License#:
110
Building Permit Info:
Bldg ❑ Elect ❑ Pl mb
Job Description:
Residential ❑ /V ( /I` Commercial ❑
Cost of Project: /DOD
•
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
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING