06010081 (2) CITY OFCUPERTINO '�k,� yr�.�y-.x;��� y� �+�"�,� /'�
BUILDING DIVISION PERMIT � L\;µ41CH•1�..`� TNi' „LUYAVf -
BUILDINGADDRFSS: SPEEDY ROOTER PLUMBING PERMIT N006010081
w
OW NER'S NAME: PERMITLSSUBDATa
ANA MARIA 701 ALDO AVE T 01 17 2006
NE: SANITARY NO. CONTROL NO.
(408) 234-8134
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
aoij LICENSED CONTRd DECLARATION
fChap
x 1 hereby affirm Net I am fuse Bu seeder provisions of Chapter 9 t my hear.is Job Description
n< with Sudan and
of DiviYon3af the Burneumd Pro(essiom Code,aM mYlicenm is
In full ares, eci. 1 SEWER LINE (90 ' ) & CSO
NVAI
pp Z Liccnsc Clan Lk.m
L�— Deu — — Can G/sR•^La
allARCHITECTS DECLARATION
I understand my plans shall be used as public records
c Licensed Professional
OW NER.BUILDER DECLARATION
i<i I hereby affirm that 1 am exempt from the Conummes Liuma,Law for the 'a%
Doo following reason.(Sudan 7031.3,Business and Profmstons Code:My city r county D( •,1 rQ•y
5$ which m,.ima a Permit to...curvet,shun improve,dem molish. repair my structure
z ra" prior m its Waimea,also requires the applicant fareach Permit to rile asigned.weami
FE<
dust Mbtlicensed pursuant inthe provision oflMContractors Lccone,Law(ChamM9 Sq.Ft. Floor Area Va uatiolilj
a8 (commencing with Section 70D0)or Division 3 afthe Bminessand Professions Code)or
that he as sanmpt Otemfmm and the but for the alleged exemption.Any violation of
Secdon 71131.3 by arty applicant far a permit subjects the epplteant te a civil penalty of
Met mere Nan five hundred doltara($51111). f Occupancy Type
❑Lot owner of Ilio property,ce my almeyer Mothered
an slob mc.compensation,
ess
and Prdot Newark,And the munurtlators License
ntapplyinanade(Sec. anorof
and Professions Code:The Contractors Mee law does not apply tf err much is Required Inspections
own ertywhe s provided
Improvements
who dr&suehwrk himffered hmugb his
awn employees,pmvided m roveh Impro to wit ere not intended rnplem d that a .if.
balder.the building orimprovementismide diinot )ear of improve
the ase of
builder will have she burden of proving that he did not Wild or Improve for purpose of
sak.I.
❑I,as owner of the property am mclmively cane mting with licensed mnumun m
mtuwn the project(Sec.70th,Business and Professimis Cade:)The Cmanu 's Li-
came taw dor not apply he an owner of property vho builds at Impmm thereon.and,
who conuacu for such project with a contractor(s)licensed pursuant te the Contractors
License Law.
❑I am eater,under See ,B&PC far than moon
Owner Dau '
WORKERS COMPENSATION DECLARATION
1 hereby am-under penury of perjury arm of the following declanliom:
1 have and will a ai.uin.CaNOnte of Coruemeself-nsum fr Workers Compen.
1307'
on,u provided for by Section 3700 of the labor Code,for the performance of the
rk for which this permit is issued.
1 have and will maintain Workers Compensation Insurance.u required by Section
00 of the labor Cade,fr the prformance of the wart far which this permit t issued.
y Workers Compensation In senna nrticr and Policy number am:
rtier. Poliry No.; _
CE FIC TE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Than ectioe aced cat N cempkud if ITh permit 1&fmoachundmd dolWa($100)
or loss.)
I ceAfy,that In the prfomlanca of tite work for which Nis Permit is named,I sball not
La..o Cattle on In any mannerm eM a .eabjrue the Worken'Cmpcm don
Laweyanyp I le —
APPli �0 �
NOTICETO APPLICANT:If.afar making ths Certificate afExemption,you should
become subject an the Worker',Compensation provisions of Ne Labor Code,you must
wJ O roMwlth comply with each provisions or this Permit&hall be deemed mrokcd.
'Zee CONSTRUCTION LENDING AGENCY
I••t nom. 1 hereby alRnm Nal Nerc is a mnskanien lending agency for the Performance of
C> the work for which this perms is issued(Sec.3097.Civ.C.)
GQ Lenders Name
z tender's Addrou
U Q 1 certify that 1 haw wad this application and sum that the above Information is
Ui CMMML I agree m comply with all city and county ordinances and atau laws relating to
O V building construction,and hereby authodremPresemetima(this city uenter upon fire
W shavcaaalamned property far Inspection purposes.
d (We)agree to saw,indemnify and keep harmless the City of Cupertino against
W liabilides.judgment.cmu and expenses which may in anyway amuse against saidCity
in consequence of the Starting of this permit.
APPLICANT UND RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU CE REG IL ON
_I n0 6 IUfa s tl�ln� /—/ ¢ Re-roofs
Si esu fApplim.VCo Ocala( f—Dau
HAfummb MA / A ISCLOSURE Type of Roof
WIII the applicantt r forum building e.Chapter
9.1 or handle Heardam materiel
ss dc0ncd by de Cupertino Munin ode.CWPter 9.13.and the Health and Safety
oak,Selves zssu(a>7 All roofs shall be inspected prior to any roofing material being installed.
❑Yr o
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
:mil hnaNnm air conuminams a deli
1 by the Bay Area Air Quality Management all new materials for inspection. �
Distla
❑Yes u
1 have read the hvardom materials mquiremenu under Cha ierh.95 of the Califor.
nig Health&Safety Cade,Sections 75503,23333 and 25334.1 understand this lfthe building
does act currently haw a tenant that it is my mspomihllity m notify tie Occupant of the
mquircmcntawhichm Ina me m u .fa Certif uorocc.pancy. Signature Of Applicant Date
S
Ower ear therima gensDam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
! Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS- PP PERMIT #
lq 1—f to ✓-e -e06JL/
.
OWNER'S NAME: V\� o` ' CAI ' PHONE #
GENERAL CONTRACTOR:. FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following 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
/ e
Owner/Contractor 7 to
CITY OF CUPERTINO '�1►
REPIPE/SEWERS/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
-r / C> oaf
Building Address:
L( (,
Owner'same: q/j Phone#:
40 A
Contractor: LIS Y� Phone: License#:
64;c L4-127 Z3
Cont ct: J Phone- Cupertino Business License#:
C VI
Building Permit Info:
Bldg ❑ Elect ❑ Plumb mx'�
Job Description:
`` A k 2 �� 2i tt v Old 01Aa
Residential 0�-' Commercial ❑
Cost of Project: s
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 Pbl . Fixture PLUMBING
BPWSvCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING