08060078 (2) CITY OF CUPERTINO t��p��� a��a���` ryx.-:;;vy % "'`�^ � '*(�`•
BUILDING DIVISION ,PET ��Q,1ln11L1C 1R IV.N.
BulLply`1CA,5pQR NORTHSHORE SQ SUPERIOR ROOTER 08060078
OW NIERU'SyNAME: - PERMIT Mn DATE
GREG HEIKKINEN 2487 ALUM ROCK STE 27 06/10/2008
NE: SANITARY NO. CONTROL NO.
(408) 568-2544
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
trop LICENSED CONTRACTOR'S DECLARATION Job Description
rd U 1 heroby afro That 1 m licensed under Provisions of chapter 9(commencing P
with Section 70W)of Division 3 ofthe Business and Profession Cede,and my license is INSTL NEW GASLINE FM MTR TO SHUTOFF VLV BHND
in full farce and effece
312? Likens,Class Lk.g STORE
=Fp Dab Commelaf
q uuuys�� ARCHITECTS DECLARATION
< 1 undersand my plans shall W used n public records
J'u
a c G Licensed Pmfcati...I
3OWNER-BUILDER DECLARATION
N I hcrthy alis Nat I am exempt from the Contractor's License Law for the
i O O following reason.(Section 701.5.Business and Professiaes Cade;Any city ar county
j g� which recoures a permit to crumMuct,alter.improve.dcmW W,or mptir any structure
Z 4< prior b its issuance.A.requires the applicant far such permit to file a aogned sUhMeWo
s That he is licensedpursuanttoOcprevisionsofthe Contractor's Linn¢law(Chapbr9 Sq.Ft. Floor Area Valuation
x (commencing with Section 7000)of Division 3 of the Bualness and Prelmone Code)or 1195
y F 2 that he is exempt therefrom sad the bass fm the alleged eaempuon Any violation of
Section 7031.5 by any applicant far a permit subjects the applicant in a civil Penalty of
not more than five hundred dollars(SM. 31638029 .ENumber Occupancy TYpe
❑I.as..of the PreP'rty nmy.,[,a.with wages as Neto sale compensation,
will do the wort.and rhe armttum is not imendr i or offered for sale(Sec.7044,Business
and Prafesdan Code:The Coomcmr's Li.law does oro apply in an owner of Required Inspections
property who W(Idaarimprones the ern,and whadoessuch work himtelfor Omugh his
own employees,proNded lhatsueh impmwments art not imended oroffemd farsale.If.
h orm,cr,the building ar improvement is to within one yen of completian,the awner-
Wilder will haw the burden of proving the be did not build Or Wpfow for Purpose of
ale.).
1
,,as owner of the property,am exclusively conrnuing with licensed contractors in
ntmet the project(See.Toad.Business and Profession Code:)The Contractor's V-
cone taw does not apply at art owner of property who Wilds or improve thereon,tool,
who morsels for such Mgms with a examscbr(s)seemed pm]Wnt b the COnt(mlat'a ' -
Lice.Law.
❑I am exempt under Sec ,B d P C for this lesson
Owns Data az_ �.
WORKER'S COMPENSATION DECLARATION
1 bemby alum under penalty al perjuryon of de fallowing declarations,
01headwllmansnaCd6mwof Comntwelf-inumfoWsCmpcn-
wooroknfor whichdNedis(poremi tSection 3]00 of the lobar Code,for the perfesaree of the
is issued. ,
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Lata Codc,for Oc pedaron.e of the work for which this permit is issued '
My Worker'.Campemadon loam o e caries tad Policy number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thus seems reed not buconpleed if the permit is forone hundred dollars(SIM)
or ins.)
1 certify that in the per...of IW work for which this Permit is issued,I cost rat
employ any perm.in anymannermazm me myeclbthe Worters'Compewtion
Laws of California.Data
Applican
NOTICE U :IL a0cr eking Our Certificate of Esemption,you should
becmh�ficbjksl an the Waiter's Comperuadon provision of the tabor Cade,you most
.JO forthwith Comply with such pmvoswro
IS M the Permit shall W deemed oked.
z y CONSTRUMON LENDING AGENCY
[-� 1 hereby anis that them I..eonnrution looting agency far the of..of
(Y,> the wart for which this permb is issued($cc W.Co.Q
T8 A Lenders Name
=z Under,Address
UO 1 ossify that I haw read Nix application and m o Yw Ns,abort WhoMatior s
LI.E corrcorrect.I agree eb comply with W city anal county ardinaruss and title laws relating to
-� Wilding construction.anal hereby aubmire representatives afths city w enter open the
a Ww-mentioned popery for impaction purposes
F y (Ws,)agree w ease,indemnify and keep hamdes the City of Cupertino agtint
Z In COi WgWW me the grass mdOft is Mushich may in any war'accrue gaiaztsaid City
Uz In of UNDERSTANDS
of this Mush.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �lG Lo
SOURCE REGULATIONS.'
Re-roofs
lir ppm
onDa
MATERIALS DISCLOSURE ype of Roof
Will the applicant or future Wilding aspans now or handle henrdous material
az dc6oed by the CYPtrtiao Municipal Cade.Chapter 9.12,and the Health and Safety
Cade,Section B532(a)7
❑Ye )T(N. All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
WIII de applicant of forum building amPam use equipment or dcvioss which g agree to remove P
emit hvardon air contaminants as defied by the Bay Area Air Quality Management all new materials for inspection.
District? �
❑Yes i�ilvu
I have read the hvardmumawriasreyuimmcnts undcrC7upwr6.95 of the Califor.
riaFee]"SafuYCode,Secdau 25505.25533 aual25531.Its krsnand the ifthc Bolding
docs Out currently haw a e.anl Naz It s MY reapomibility b stify de msopho of the
requirements which most be met prior M issuance of a Ccnifwam of Occu err. Signature of Applicant Date
ow�a�,a gear �j�,w- All roof coverings to be Class';q"or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31638029 . 00
DATE ISSUED. . . . . . . : 06/10/2008
RECEIPT # . . . . . . . . . : BS000005062
REFERENCE ID # . . . : 08060078
SITE ADDRESS . . . . . : 10929 NORTHSHORE SQ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GREG HEIKKINEN
ADDRESS 10929 NORTHSHORE SQ
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0533
RECEIVED FROM . . . . : GREGORY J HEIKKINEN
CONTRACTOR . . . . . . . : JOSE HERNANDEZ LIC # 29417
COMPANY SUPERIOR ROOTER
ADDRESS 2487 ALUM ROCK STE 27
CITY/STATE/ZIP . . . : SAN JOSE, CA 95116
TELEPHONE (408) 568-2544
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 1, 195 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PGASRES OUTLETS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
-- ------- ---------- ----------
TOTAL PERMIT .. 143 . 27 0 . 00 143 . 27 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 143 . 27 MC
---------------
TOTAL RECEIPT 143 . 27
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---- ----------------------------
--- ----------------------------
106 SEWER & WATER 301 ROUGH PLUMBING
507 FINAL PLUMBING
•
o�o(o 0071
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
loiJ 5 Vo- tks olc S� , C4 '75-D/y
Owner's Name: Phone#:-
:661 1,.e
11,.e 9 H-e(,k4/-1z . y�o - Z
Contractor: Phone #: yce S&dr. , �5 /z1
Sc,ntr:or (��•�er l ��,r, SR�� Fax#: �Oc' 2 '---
Contact: Phone#: e
JOSe ��/1 97'-dC Z
Fax#: yo e 2-;z-G- L4 0g
Contractor License #: fj6OZy�
Cupertino Business License #:
• Job Description:
�n5 k II /Lel, tis �inP r-cM 4.c
Residential Commercial ❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set& the sheet index. 6 4,
Quantity Fee ID Fee Description Fee Permit Type
Grou
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
IBPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System p
1-4 Outlets
• 1BSEISMICOM Seismic Commercial P
/ I BSEISMICR Seismic Residential p
1PRSEWER Residential building P 1RPSS
4, CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
CUPERTINO FEE SCHEDULE
Quantity Fee M Fee Description Fee Permit Type
Group
1 PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFIXTURE Plumbing Fixture P
/ 1PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+Outlets P
/ 1 PPERMITFEE Plumbing Permit Fee Issuance P
/ 1PLMBLNCK Plumbing Plan Check P
1PLMBINSP Other Plumbing/gas Insp. P
/ 1TRAVDOC Travel & Documentation Fee B
1BUSLIC Business License B
a
Community Development
10300 Torre Avenue
Cp
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
OUPERTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: ,-_ ; PHONE #
GENERAL CONTRACTOR: n�� S, FAX # 2
I am not using any subcontractors:
G
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
•
Owner/Contractor Signature Date