06010162 (2) CITY OFCUPERTINOn .31ae `IAF '•'^.rx �';
BUILDING DIVISION PERMIT .Gb1Y G RMV �RO1I
BUILDING ADDRESS: GREAT AMERICAN PLUMBING CC PIFIMO'O6010162
10648 GASCOIGNE
WNER'S NAME: PERMIT ISSUE DATE
CHRIS BEIT 166 GRAHAM AVE- 01/30/2006
NE: SANITARY NO. CONTROL NO.
(408) 995-6400
ARCHITEC IENGINBER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
300 LICENSED CONTRACTORS DECLARATION Job Description
iI 1 hereby affirm that 1 Am licensed under provisions of Chapter 9(commencing
with Section 70(p)of Division 3 of Om Business And Pru etiou Code.and my license is
ni
in In A-1eBem. REPLACE SEWER LINE W/PROPERTY LINE C/O
j 1? Lice
has
Lk.N
c DateL=�canlraXLA& & 1 WAY CLEANOUT FOUNDA
liqI undusunJ my phos still W used u public rtcords IV\ (
iG Licensed Professional
OWNER-BUILDER DECLARATION
5? 1 boreby afOnn that I Am exempt from the ConVamo/s License Lw for IM
O O following moon.(Section 703 1.5,Business and PmCos
fessmas Code:Any city w county Q7 S
C$ which requiresa permit to construct,alter.hnprem demolish.or repair any s=cum a Cos
doesWItsigwnc4 also eq.thm thonisiocanl for such permit lLinfile uLaw(Cligned tement '��� _ s
< thurk,itsceuedpursuwmthitheAponaffWCchpermit oiecmclaw(CNpmr9 Sq.Ft.Floor Area Valuat
I' (cammemin with Section 7000 of Division 3 of the Business and Profession Cacti or `�`
$
that bo h exempt therefrom mm de bub for the alleged exemption,Any violation of r<�vs� dry.
section 7031.5 by any applicant for a Permit subjects the applicant m s civil penalty of 4ey �+�T �T er OCCUP�YY JIB
wt mom than five bonded dollars(M). 3 /Mff . 00
` `�
Q I,u mwner of the propny,w my employes with wgm u their tele campcwdm,
will do the work.and theswnum ianot7mmnded oroRered formic(Sec.7044,Business Required Inspections
and Profession Code:The Conuacmri License Law n donot apply m e an owner of q P
propenywhobuilds wlmpnvea"men,and wbodoessuchwork himselfor Waugh his
own employes,provided that such improvements art noNneeded araQemL fwule.If,
however,the building or improvement is sold within on year of completion.the owner-
builder will have the burden of proving that he did not build or Improve for purpose of
sale.).
❑1,As owes of the property.Am exclusively conouting with licensed eonu icon to
construct the projea(Sec.70th,Business and Profession Code:)The Comment's Li.
cera law des not apply m an owner of propenywh r Wilda or Improve daemon,and,
who mouacu for such projecu with a comin ctor(s)licensed pursuant in the Contmmruh
License Law.
❑1 am cannot under Sec. .B R P C for this mason
nu Dau
WORKERS COMPENSATION DECLARATION
I hereby sin=under Penally of perjury one of the following declarations:
❑I haveand will maintain•Cemfinmof Camenuoself-imum furWorke/sCompen-
smor .Provided for by Section 3700 of the labor Code.(or the performsrce of the
we forwhichth A permit A use0.
I have and will maintain Worker's Campensation Insurer=,As required by Section
3700 of the laborCede.(w the performance of the woh fes which Nb permit 4luued
My Wo e mpcnution sat rxe tamer and Policysober see:
Carrier. Policy No.:
C RTIFI(ATE FE%EMPTION FROM WO 1
CO ENSATION INSURANCE
(Ibissection most not W completed iffi a permit is fwone hundeddollm(S100)
or less.)
1 certify that in tho performance of she work for which this permit is leaved,l shall not
employ any person in try manwr an a an becomesubjoet in the Warken Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this ceniOnte of Exemption.you should
Wow subject m the Workefa Compental provisions of the LAWr Code,you was
.7z forthwith comply with such provision or this pnnit shall be dwmed evoked.
z w�. CONSTRUCTION LENDING AGENCY
(.. I Aeby a(Ilan that lhre is amnswclinn lending Agency for the performance of
a> the work for which this permit is issued(Sec.3097,Civ.C.)
a Q Lender's Name ,
7 2 Lender's Add. _
V Q 1 sonify that 1 have read this application and sum than she above information is,
{s.^ correct.I agree in comply with all city And county onfinances and tum laws misting to
Wilding construction,and hereby euthodm representatives of thbcity meaner upon the
W above-memiurted property for Impaction purposes.
(We)agree m ave,indemnify and keep harmless the City of Cupertino against
y Ilabilider,judgments,cost and expenses which may in any way accrue against said City
jU
7 in consequence of the granting of this permit.
F7 APPLI UNDERST ND s AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU EG
-' Re-roofs
Ne
gnalure APPI -VContsacOU 61SCLOSURE Dam Type of Roof
WilItic Al il.semimure i naaccowitioncorhandchmardonmateriat
as defined by tite Cupertino Municipal Cade,Chapter 9.13,and the Health sed Safety
ode.Section 25532(o7
❑Yes (}qo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant in future Wilding occupant use equipment or devi=s which If a roof is installed without first obtaining an inspection,I agree to remove
it havardnus air conumin,nubs defined by the,Bay Area Air Quality Management all new materials for inspection.
District? (/
[3 Yea ❑Nu
1 he.cad the haurdms materials requirements under Chapter 6,95 of the Celifor-
nieHealth cry
Cade.sections 25505.25533 and 25531.1 understand ren irNe building
does res Ally how• n it b y Imponllaily m notify the Occupant of W
rey Ire Miic must — 'or m' aaceafa Ccnificacof Oc a Signature of Applicant Date
or w 'm a Date All roof coverings to be Class "B"or better
CITY OF CUPERTINO
I� 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37522019.00
DATE ISSUED. . . . . . . : 01/30/2006
RECEIPT #. . . . . . . . . : 32988
REFERENCE ID # . . . : 06010162
SITE ADDRESS . . . . . : 10648 GASCOIGNE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHRIS BEIT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : GREAT AMERICAN PLMB
CONTRACTOR . . . . . . . : CORPORATION LIC # 18061
COMPANY . . . . . . . . . . : GREAT AMERICAN PLUMBING CO INC
ADDRESS 166 GRAHAM AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
TELEPHONE . . . . . . . . : (408) 995-6400
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FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPSEWER SEWER SYSTEM 1.00 21.58 0.00 21.58 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
' ---------- ---------- ---------- ----------
TOTAL PERMIT 59.95 0.00 59.95 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- --------- -- ------------------
CASH 59.95
TOTAL RECEIPT 59.95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
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W
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: 1 ;S PHONE
GENERAL CONTRACTOR: �k �a , tl� FAX # -- 19=d
I am not using any subcontractors:
Si tune Date
Please check applicable subcon actors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical - -
Excavation
Fencing
Flooring. Carpeting
Linoleum/ Wood
Glass/ Glazing F,
Heating
Insulation
Landscaping '
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing -
Septic Tank
Sheet Metal
Sheet Rock
-- Til
— _
Ownerr/C n�'tractor Signature Date
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
40CUPE"PTINO PERMIT APPLICATION FORM 0
APN# 375 a a o/ Dare:
Building Address:
kOCAJ6 & SG OL
OwName, Phone#:
s
Cptract r: Phon : License
A #^
12�—
C tact: P o . Cupertino Business License#:
0
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ®-'
Job D ription:
Resp ential ®" Commercial ❑ 87 m rv�a�n tie.
Cost of Proje- 7� `�-I
•
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 Repipe of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
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