06080073 (2) ;2"(0, 078
TY OF CUPERTINO . *• '��'`' ` ' ` °�` `` '" '
BUILDING DIVISION PERIVIIT ,@UNTI2A�''TO',R ,II'�RMATI'( 1V
DINGADDRESS: CUPERTINO PLUMBING PERMITNO.06O8O073
JOHN D
ER'S NAME: PERMITL4UE DATE
CONRAD PFUND 1300 DELLE: SANITARY NO, CONTROL NO.
(408) 253-0618
ARCHITEL7/ENGINEER: BUILDING PERM"INFO
BLDGELECT PLUMB MECH O O C= l�
Ips LICENSED CONTRACTORS DECLARATION Job Description
I hemby arRrm Net I am licensed under provisions of Chapter 9(commencing
t1 with Section 7000)o Dlvlslon 3 of the Business and professions Code.and my license is
Or mluorce aneertmt, O COPPER RE-PIPE WATE�- i,N, GE T, REMOVE
Doensc w Lk.N l p(�/
l8- Dam GonDEC A AND REPLACE WATER
t^�^� ```''' ��� ""AAAACHr1ELTS DECLARATION i'
1 undersand my plans shall be used as public records
yLL
�p Licensed Professional (Abcyf7fl��
OWNER-BUILDER DE Ce CorboON �1... _ n
i c C I hcrehy alum that 11. exempt from ac COmunal Co License taw for the
.O O which
mason.(Sadat 7031.0.Badness and Improve,
d professional Cade:My shy s Pec my �J
S$fi which requires a permit r mwrucL slim,i t forse,demur W,or .sig any sumure
•Z't Priormiu rmmec.alm requires the
ovisiot o the Con Permitm0rs Law(ed summem
a—Q that heislrensed Pursuant mom of Divlam oftheLi Prue Law(ChaPmr9 Sq.PI. FIOOC Area VaruaC1�16000
(dor he sexempt Section rafrom 00 dr Division 3Of the eg Business and AnyaN Cade)or
— Natio r exempt any dap li and ata aper tar see alleged exemption.iCMLto Any l Penalty
of
Section than lay arty•pd doll for a permit mbjeeu the applicam Iq a civil pmxlty a( APN Number Occupancy Type
eat more than Rw hundred callus 01500h 36934026 . 00
1,u owner of tb pmpmty.or mY employee wW vmgn u aetr Gale eompewdon,
will do it.work.and the cvuc7um Is act mteMed or anered lorsar(Sec.704,Basixu Required Inspections
and Profession Cade The Conucme,License Law don not apply m an owner of 9 P
property who build,or improv daemon,end who doessuc h work himself or through his
own employees,provided that such Improwmenm art notinunded aronered fmwle.if,
howewe the building or Improvcmmt Is within me yes,ofampletion.as asn er.
builder wW have Use bumet of proving apt he did Cul build or Improve far purpose of
ale.).
❑1,as swear a the property.am ealuuvcly contracting wide licensed morstem a m
contract the project(See 704,Business and Professions Code:)The Cmtmcmra Li.
cease law dom not pply m an owner of property who builds or improv Ihemon,and.
who convects for such pmjecls wit a canvaclar(s)licensed puraant mac Convamors
License law.
❑lamuemptuneer See ,B&PCforthisrouon
nm Date
WORKERS COMPENSATION DECLARATION
I hereby M.under penalty of perjury one of dee following daluumns:
1;31.1
hew mrd will mpinuin a CanlBmtear Consent s.self-imam for worker.Compm-
n.u provided for by Lon 3700 of the labor Cade,fm see performance of the
k for whkb ser permit r road.
have and will mainuie Workers Compensation Insurance,u required by Section
af the labor Code,far see performance of dee work for which thin Permit is issued.
Workers pemedon Insurance tanker and Policy number am:.. - ,r vw Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This action need naWcompkmd If 0e permit is foram hundred dallan($100)
ser leas.)
I cenify that in the perimmanco of the work for which this permit is issued,l shall not
employ any person m any manner an u m become mbjectto the Worker'Compensation
Laws of California.Dam
App l tent
NOTICE TD APPLICANT:If,after making this Ccrtidum of Exemption,you should
became subject to the Wohers Compensation provisions of the labor Cade,you most
Z forthwith comply with such provisions or this permit shall Ise damcd mated.
EV) CONSfRUCrION LENDING AGENCY
t-r Ihereby affirm apt Gert is a camuvuctian lending agency for the Performance of
athe wark far which this permit r essuW(Soc.31197.Civ.C.)
nd
Wry~n. Leers Name
Z) z Landers Address
U Q I ceNfy au 1 have read this application and sum that the show information Is
CL. P correct.l agree to comply with all city and county ordinances and sum bws ranting to
0U building construction.and hereby authorim mpesemadves of this city to crier upno the
cLU above mentioned property for inspection purposes.
t:0. (We)acme to ssw.indemnify and keep harmless the City of Capenino aPirst
rA liabilities,judgments.care and expenses which may us any way amus against Wd City
U Z in consequence or the grating of this permiL -
^' APPLICANT UND§RSWDS AND W11.1.COMPLY WITH ALL NON-POINT Issued by: Date
Re-roofs
Sigwumar " r Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will On applicant or future building oempmtstae an handle ha ardour material
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
area,Section 3553x(.)7 � All roofs shall be inspected prior to any roofing material being installed.
0 y" eNo
Will the applicant or future building Occupant use equipment or device whichvaIf a roof is installed without first obtaining an inspection,I agree to remove
emit hrdom sir cauwu u
mimdeftmd by tiro rea Bay AAir Quality Management all new materials for inspection.
Dis rict7
0Ym Na
I have us materials tequimmenu under Chapmr6.95 of he Caliror.
ob Hc.lth&sofa 25505,25533and 25534.lumkruned thmifthc building
docs re, y he ant, It y pomibllity m notify the m"Pml ser the
event,wit m afxc.rdn,yBf,Yeaypmtey� Signature of Applicant Date
own anmarirca agent
Irv-76/D/.m All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36934026 . 00
DATE ISSUED. . . . . . . : 08/10/2006
RECEIPT # . . . . . . . . . : 35565
REFERENCE ID # . : 06080073
SITE ADDRESS . . . . . : 20078 JOHN DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CONRAD PFUND
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
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 10 . 00 901. 00 0 . 00 90 . 00 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 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 183 . 02 0 . 00 183 . 02 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPERTINO
Building Department
JOB ADDRESS: PERMIT#
079) 3-0 k 3
OWNER'S NAME: Coe, cc,d. PHONE # .2—S-2-- 5 4 I
GENERAL CONTRACTOR: Pt FAX #
I am not using any subcontractors: �� �/� ��dc,'UL
igna a Date
Please check applicable subcontractors and complete the following 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
-/U- O(o
Own Contractor Signature Date
H CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
�CUPQfINO PERMIT APPLICATION FORM
APN# 3�r]� 3 Date:
Building Address: (�
Owner's Name: Phone#:
Contractor: Phone: License#:
Ga Cl TOO
Conta t: Phone: Cupertino Business License#:
rc,VV �09-
Building Permit Info:
Bldg ❑ Elect ❑ Plumb 0�
Job Description: / A
Residential Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbin Permit Issuance PLUMBING
10 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
OFW HCAT —