06070095 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT O<'Z RACI'ORANFORMATIfJN
Mkil
BUILDING ADDRESS: C PION PLUMBING PERMTTNO06070095
10670 LA RODA DR
OWNER'S NAME: PERMPIISSUEDATS
KANT 2059 CAMDEN AVE. #271 07/17/2006
10 NE: SANITARY NO. CONTROL NO.
(408) 437-1507
ARCHITECTIENGINEER: BUILDING PERMIT INFO
0
BLDG EIFR PLUMB MECH
t� 0
:0o
LICENSED CONTRACI'OWSDECLARATION Job Descri tion
1 bercby affirm that 1 art licensed under provisions of Chaper 9(wmmcncing P
with Senian 70D(dofDiviuon 3 ofthe Businessaad Professions Code,and my It...is
t in full force and effect. 3?G '), COPPER REPIPE
jMZ License Class Lk.R -!-
Dow Contractor
ARCI ECTS DECLARATION
$ undo an m� ons sh be used u public rcantlb
>d
Li nal
3 / OWNER-BUILDER DECLARATION
I hcrchy allirm that 1 am exempt from the Conu erm7 License Law for the
p c following mason,(Scum,7031.5.Business and Professions Calc:Any city Or county $4960
5 8 ff which requires a Permit to comma,alma cu
improve.demolish,or repair any arorc
iy primto its issuance.also requires the applicant for Such permit to file a signed Stsmmnl
`e that he Is licensedptmoaprovisionsada.ContraomraluemnLaw(Chapter9 Sq.Ft.Floor Area Valuation
meman
5€� (commencing with Semkn70DO)of Division 3 o the Business and Professinu Cade)or
s .. that he b eaempt therefrom and the basil for the alleged resumption.Any violation of
Section 7031.5 by any applicant fm a permit subjcv the applicant to a civil penalty at Occupancy Type
not more than Ann boatload dollars(55003
❑I,uawrcs ofth property.m my wplayen with nguuthvsore eampmwthw.
will do the work and the strucmrc b mlmanded oraffered funk(Sc.ION,Hualtess Required Inspections
and Pretensions Code:Toa Cwuactora ueeue Law coat nal Apply to an Owner Of
9 P
property who builds m i mpraws thereon,end who does such work himself or through his
awn employers,provided that such impmwmenu are w,Imendad.offered far salla If,
however,the building or improvement Is mid widan ane wan of completion.the awrmr- -
builder will have Ne burden of proving flex,k did not build Or Improve for purpose of
sale.).
0 Las cater of the pmpeny am ncluiwly contracting with licensed wnuacmrs to
construct the pmiem(Sec.7014.Buinen sad Prafusiam Crede:)The Conuamors U
'sums Law does out apply m an awns of property who bailets or improve theoaon.art .
who contracts for such pmjcts with a rnnuaemrt licensed pvrsnm to thsu Contramorb -
License Law. '
❑lune undv3 .B A P C far thin nun.
owner Dam —1 7—
WORI 'S �MPENSATIO(DECLARATION
I hereby Speirs oder penalty of perjury ave of the fallowing declaration:
I hsw and will maimun aCertiftare of Cament to self-insure for Workers Compw-
alliw,as provided for by Section 3700 of the Labor Cade.fm de performan of the
watt for which this pewit is issued.
❑1 have and will mumun Worker's Computation Insurgence.as requited by Section
3700 of the Labor Code,fm the performance of the weak for which this pemtit is laved. Ik Air
My Warkee,compensation kwrena carrier and Policy number sm:
Carrier. Policy No.: n
CERTIFICATE OP EKEMPnON FROM WORKERS' ANITAR
COMPENSATION INSURANCE fair
Crab semlw send not he completed if the permit is for we hundred dollare($IW)
I certify that In the performance of the work for which this permit is tared.I shall not
employ any perm,in any mannerm as to become subject to the Workut Compensation
IswsApplica California Dam
NOTICE
NOTICE TO APPLICANT:If.after Compensation
this Certificatesof Labor Cad you shwa Ago become abject to the Workers Compens this pmvit imil of the Islam Cede.. roup00 faMwithcomply with Such provimm mthis permilshall be deemed tacked.
,zCONSTRUCTION LENDING AGENCY
E•-' IMoaby a Rum that them is a construction lending agency for the perfurmma or
Ili 7 the wish for which this penal,b iuued(Sec.3097,Civ.C.)
L[1 Q Lenders Name
a Lemlee Addrours
PZ
U0 I«mfy that I haveread this appliutiw and bum this the show Informative b
It,F coma I agme to comply with all city and county ordinance and sum laws relating to
DU buildingeonawnion.and herchy authorize rcpreenmiva,f Nis city to enmr upon Ne
LIt above-mcmioned property for imptcuon purposes
f1 (We)agree to Save,indemnify and keep harmleu the City of Cupertino against
,y rA Ilabilitiu,judgmcnts.costs and expense,which may in anyway acme agalnnssid City
V sZin r APPLIegw rUNe of D&STAN f this
WILL COMPLY WITH ALL NON-POINT Issued by: Date is
SOU CU O
Re-roofs
Sips at pplian stn Dam
A0.D0US MATERIALS DISCLOSURE Type of Roof
WIII the eC tiro Muni building wcupantstorcm loadHealth nmperial
ss de0nc0 by me Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
Calc.Semon M5334)? All roofs shall be inspected prior to anyrooffng material being installed.
❑Ya oifr
Will the applicant or future building=owl use equlpmen,or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hnsrdon air contaminants as daDncd by the Bay Arta Air Qualhy ManApcment all new materials for inspection.
District?
❑Yes CC—
I have mad the harmlo ssmau.Malsrequiremens underCMper6.95ofthe Caifor.
nia HUI,h&Safcty Cade.Swd=25505,33533am125534.1.d.V Mthetifdc building
I
ms not cwrendy have•enan,,that It b my oaApotsinfity,to wdfy the occupant of the
mquirements which must hemet prior anissuance afaCertificate afOccupancy. Signature of Applicant Date
1 Owner car summered age,( Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36933013 . 00
DATE ISSUED. . . . . . . : 07/17/2006
RECEIPT # • • • • • • . . . : 35275
REFERENCE ID # . . . : 06070095
SITE ADDRESS . . . . . : 10670 LA RODA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KANT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CHAMPION PLUMBING
CONTRACTOR . . . . . . . : TIM FAY LIC # 23793
COMPANY . . . . . . . . . . : CHAMPION PLUMBING
ADDRESS . . . . . . . . . . : 2059 CAMDEN AVE. #277
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 437-1507
4kEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
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
---------- ---------- ---------- ----------
TOTAL PERMIT 47 . 37 0 . 00 47 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 47 . 37 VISA
TOTAL RECEIPT 47 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
CITY OF CUPERTINO
-'- ' REPIPE/SEWERS/DRAIN SERVICE
• OF
CUPERTINO PERMIT APPLICATION FORM
APN# 9 '•�2 OI2 Date:
Building A dyess ✓✓ J e 0
Owner's Ne: Phone#:
D- � 0
Contractor: Phone: License#:
_/ 37 _/570
3-31-
Contact;,-�7N N � Phone: ,5�c) 7 Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential Commercial ❑
Cost of Project: G �J
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
BPFDCTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING