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06080260 (2) CIMWUPERTINO - BUILDIN DIVISION PERMIT 'XONTRACTORINFORMATION OUILOING ADDRESS: PERMIT NO.O F)OBO2EO 10715 PENINSULAR AV OWNER'S NAME: PERMIT ISSUE DATE DAVID HERRIT NE: SANITARY NO. CONTROL N0, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 100 LICENSED CONTRACT'OR'S DECLARATION - Job Description U(5j 1 hereby affirm that 1 am licensed under provision of Chapter 9(commencing ;2w with Section 70)(y)of Division 3 ofdo Business and Professions Code.and my us in fall forrooand wer !y/ 77 5 ADD PROPERTY LINE CLEAN-OUT AT CURB & BACKFLOW v�x Urchins Clear Lic.a_z •F O DateCO _ ntraclat / S/ (a w f I 'oj CNOECTS DECDAIRMON ce� I understand my plan shall W used as public mennts tyU '0� Licensed Professional OWNER-BUILDER DECLARATION c c I Wneby.(Rens that 11. cacmpt from Ne Cctures ren License Law for she ❑O following mora(Section IDS LA Basi....aha improve, dr iron h.or My city or sunny which mruims a issuance.also 1.re air s the ahcr,M I mSu,h remit fie pair any awmum 2 B O O fouI y done x)s l ensedpills.requires the inions of fnr Contractor's noicense..(Clo4nIrn1 < shazWisliccnxJ Pursoam to the provision of she Conuacmr's l.tim^•-law lChapter9 Sq.Ft.Floor Area Valuation FO (commenting with rations and of Division 3 of do Business and Prt.Any vi Code)or 3 this io uexempt1.3 bshom(mm and or bun for bj alleged esemptis.Any violation of Section]031.5 five any red d all fora permit subjects de applicant to a civil penalty of r Occupancy Type not more Yon five huntlned drllan(5300} 0 1,u owmr of de propoty,m my cmploym with wages u Noir sok comp=w on, win as do work.nd,heswnumisnotinmndcdo,.ffemdf.,.M.(Sec.7W,Budnw Required Inspections and Profession n Cade:The Contractor's Lt..Law dorot apply m m e owner of q P Property who Wilds orimprow thereon,and whodecssuch work hi ndelfor through his J own employers,provided than such improvements art not intended oro6ese4 for sale If. however,de Wilding or improvement u sold within oro year of completion,the owner- builder will love the omen of proving that k did nos Wild or improve fm purpose of / sale.). 0 1.as owner of the propeny,w aclwively contracting with licensed snuannrs to construct she p ajea(kc.7W.assumes and Professions Code:)The Commemr's Li. come law don non apply to an owner of property who Wilds or improves thrcoo,and. who contacts for such projects wish a conuauor(s)licensed pususns to the Convector's License law. ❑lam.temps under See .Bk PCforthisneawn Owner Date WORKERS COMPENSATION DECLARATION 40 1 hateby affirm under penalty of perjury one of the following derlantions: I ha.c and will maintain a Ccnifiste of Cormenuo self insure for Workers Compete sudden,az provided for by Section 3700 of she Laoor Code.for the perform urs of do work for which this print t is issued. 0 1 have and will maintain Worlo ri Compensation Insurance,u rerouted by Section 3700 of the Labor Code,for the performhn of Ne work for which this Permit is issued. My WarkeYS C aha Poliq number,are Cartier. r-' Polity No.: CERTIFI ATEOF E ONFR WORKERS' COMPENSATIONSATION INSURANCE (This seoinn need not W i,ornpil if the permit is fora..hundred dollars(SIM) or less.) I certify that in the performance of the work for which this permit is issued.I shall employ any person in any manner as as to Wcome subject re the Werecri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Esempnion.you should become subject to the Worker-s Compcnation provision of the labor Code you mus. .JO forthwith comply with such provision m this permit sballo dared mvoked. E7 CONSTRUCTION LENDING AGENCY (-+ I hereby M.this them u a eMormctinn lending agency,lar the perform.of tY.�-. Ne were for which this permit is issmd(Sec.309],Civ,C.) 0.W Q lender's Name ` .7 z Lrodres Address U0 I cmtify that 1 hale send this application and sate thaz the hove information is LT. F" cen.p.l Agnes,to comply with all city and county eminences;and sum laws relating to 0 U building conswceon,and hemhyauthorim representatives of Nis city to enter upon the r Lt1 above-memiun.J ss.,us for de.Nuon puryos.a E~ G (Ws,)agree to save,inJemnily and kap harmless the City o(Cupenino again, rq inComintern" ominter "ofth,cram And eapmmamil. may in any why acme against said City U Z. APPLICANT UN Ehe RSTANDSAranting or nND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU ERE ONS. ^T� v Re-roofs Signature fAppli a,= br Dam I HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the listsorpi Wilding acevpcntstone m handle haufdon material u tlerined by 8 c Cupertino Municipal Code,Chapter 9.13,and she Health and Safety Cole,Section 25532(.)? All roofs shall be inspected prior to an roofing material bei. 41 ❑Yes �a P P � Y g g installed. If a roof is installed without first obtainingan inspection,I agree to remove Will to air emoato. .ta a Wilding oythesByAeyuipmentmJManaement P g emir ha'raNnus air conuminanm u JcOncd by dte Bay A.Air Quality Management all new materials for inspection. D'svicR ❑Yes °r'-'ys(\ I have most she havardo s materials neruimmcnm under Chapter6.95 of the Caliper M.Health 6r Safcsy Cotic,Sectimm 25505,23533 and 25534.1undcrsand thaziftW Wilding Jars not curremly ha a tenor Nat in is my responsibility,o notify the..P.,of the tern / n khustWmeIprixmissnmerracertil' an.y. SignatuTzofApplicant Dale Owner or atmrriam gen, role/ � 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 •CUPEkTINO Building Department JOB ADDRESS- PERMIT # /0 9/> elo , u 42 x OWNER'S NAME: ✓ o r r PHONE # .20 5—5-%7 oo GENERAL CONTRACTOR I am not using any subcontractors: ignature Date Please check applicable subcontractors Tete 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 CITY OF CUPERTINO sm 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32603044 . 00 DATE ISSUED. . . . . . . : 08/31/2006 RECEIPT # • . . . . . . . . : 35856 REFERENCE ID # . . . : 06080260 SITE ADDRESS . . . . . : 10715 PENINSULAR AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DAVID HERRIT ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : RICK JOHNSON CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : •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 CITY OF CUPERTINO SUM ' REPIPE/SEWERS/MAIN SERVICE � OF UPERTINO PERMIT APPLICATION FORM APN # -3,2–Lo—ca-o44 �_Oa-O44 Date: :� - 3 - oma Building Address- '�/ S Re.v( A-) SL-c /A-eZ AU r' Owner's N e: Phone#: Co�tjqcto : n Phone: License #: < ON .57-10c/ 573-002 Co t: Phone: Cupertino Business License#: KIJ, C>� D - 7 O Building Permit Info: Bldg ❑ Elect ❑ Plumb–K Job Description: /� 1 ECes,defnpt,raolj � Commercial ❑ ect: pZ �O6 • Qty. if Applicable Fee 1D 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 •