06090249 (2)0
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CITY OF CUPERTINO zt*.� bn } '"�` '`tea r''"»'"s" •z
BUILDING DIVISION PERMIT fS 'RACTOR7INFORMA'hI6
71
BUILDING ADDRESS: & INDA FONG PERMIT No.06090249
7496 ROLLINGDELL DR
OWNER'S NAME: PERMIT ISSUE DATE
JAMES & LINDA FONG 09/26/2006
NE: - SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG E� PLUMB MEOCH
LICENSED CONTRACTOR'S DECLARATION Job D0SCT1pUOn
I hereby affirm that 1 u. licensed under pmvisio" of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Proximmos Code, aha my liecoso is
in full mrccand erfea. RE -PIPE ENTIRE HOUSE, COPPER
License Clan Lie. R
Dam Contractual
ARCHITECTS DECLARATION
I understand my pians shall he used ss public records
Ucc.d Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from dm Contractors LICE= LAW for me
fallowing maven. (Saban 7031.5. Business and Profession Cade: My city at munty $2000
which requhr s permit m cortdrae alcor, imProw. demolish, or repair any suururt
prior m its issuance. also requires me applicant for such permit to file a signed summem
that he is licensed pursuant m the pmvismns of me Common's Uceosc Law (Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 70DO) of Division 3 of the Business and Prafesiam Cade) or
that he ts exempt dominate and me bast, for me alleged exemption. Any vleladon of
Section 7031.5 by any applicant f" a permit subjcm the applicant la a civil penalty Of er Occupancy Type
not mom man R. handled dollars (5500)
❑ 1, u own" of the property, or my employees with wages u their sale mmpeneadon,
will do the work, and destruction is cot mmtlded or offered far eam(Sec. 7011, Budws Required Inspections
and Prof nclons Code: The CormacmYs License law does not apply m an owner of 9 P
pmpeny who build, m imp ro. thereon, and who does such wmk himsel f" W ouah his
awn employaes, provided that such improv U art nminmrded oronemd formals. If.
however, the building or impmvemmt u sold within arc year of completion. me ewner-
builder. will have the burden of proving mat ha did not build "improve far purpose of
sale.).
ID 1, sa cower, of me Popery, w exclusively mmracting with 1lmosed mnuamon u
mosuuct Irk project (Sec. 7044, Busin"m and Professional; Cade:) The Cmmnofs U,
cense Taw Cars oat apply m an awm" of property who builds or improsm Common. and
who contracts for such projects with a mnlosen (s) Hastened Personal, he Ile Consscmh .
Lkeue law.
❑lam teem nerSm ,BkPC for
owner Dam
WORKER'S COh 'ENSAT} DE
I hereby affirm under parity o(perj ane of de following decleretiaos:
❑ 1 have and will maintain a Cemfnmm of Caosent le self-ingme for Workers Compm"
ration, Is rewided for by Section 3700 of me labor Code, for Iha performance of me
work for which this permit Is issued.
Q 1 have and will maintain Workels Compensation Insurance, u required by Section
3700 of me Labor Code, forme performance of tha work for which this permit is owed
My Workoe. Competwtien W r. cuter and Policy number art:
Carver. Policy No.: ,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
ffh4=ran eced not Mcompkte0 Lime permit is forone hundrtd debtor (5100)
nrtesal
I certify Nat In the Parr ..m r of the work for which this Permit 4lmued.1 shill not
employ any perm. in any mun cob o ub'cI m de Worlori Compcwtian
Laws of California. 0
Appllmm m Cl—s
NOTICE TO APPUC NT: If, alter making this Ccy am of Exemption, you should
became subject m the Worker's Compcator pmvK ora of me tarso C.dc, you must
7 forthwith comply with such previsions or this pormd shall be deemed revoked.
OCONSTRUCTION LENDING AGENCY
1 hereby aliirm that mere u a construction lending agency for the Performence of
> me warts for which this permit 4 issued (See 3097, Civ, Q
Q Lenders Name
z Lenders Address
Q I m tify that I have toed this application and sum mat me abmw Information t,
cotton. I agree to comply with all city and county on Inness and sum laws totaling he
C.: building construction, and hereby autharim representatives of this city to enter upon me
Lel .1Wvc-menuu.cd property far impecsian purposes,
(Wo) agree m save, indemnify and kap harmless the City of Cupertino agairel
y liabilides,Judgments. cuss and expenses which may In my way accrue against said City
Z
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I. m umucuce Of the Staining of m4 permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON- OINf
Issued by:62� Date
SOUR GULATI S 7
Re -roofs
Type of Roof
Signaturcof ApplicantlCan W`Dam
HAZARDOUS AI.SDISCLOSURE
Will the appticam ar forum W Iding mcupantemrc or hamlle huardoos mamrial
as defined by the Cupertino Municipal Cade Chapter 9.12. and the Rotor and Safety
Code, Schon 25533(x)?
❑Y" �iYe
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
WIII the applicur or future building occupant use equipment ar devices which
emit ha.mous air conumiots M defined by the Bay Area Air Quality Mansgcmcnt
all new materials for inspection.
District?
❑ Y" u
I have mal the hvudousmnmeds requimterusuadm Chspmr6.95afthe Califor-
11
niaFicalmkSafctyCode, Sections 7550.25533 au125534.1 undcntud maifmc building
does not currently have a mot. mm it 4 my cummombility m mdfy de Z.. of Ll
toquim whk;mut met Ian'ormissuanccofacmfkam Of Ocm
Signature of Applicant Date
All roof coverings to be Class "B" or better
owur"aum"4sd.gant Dam
am 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN .......1: 35651060.00
DATE ISSUED.......: 09/26/2006
RECEIPT #.........: 36216
REFERENCE ID # ...: 06090249
SITE ADDRESS .....
SUBDIVISION ......
CITY .............:
IMPACT AREA ......
7496 ROLLINGDELL DR
OWNER ............: JAMES & LINDA FONG
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
RECEIVED FROM ....: LINDA FONG
CONTRACTOR .......: LIC # *OWNER*
COMPANY ..........: JAMES & LINDA FONG
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
TELEPHONE ........:
•FEE ID UNIT QUANTITY AMOUNT
-------------------------------------------
BPWSVCS WATER SERVICE 1.00 9.00
PPERMITFEE FLAT RATE 1.00 38.37
TOTAL PERMIT : 47.37
OPERATOR: amyw
COPY # : 2
PD -TO -DT THIS REC NEW BAL
---------- ---------- ----------
0.00 9.00 0.00
0.00 38.37 0.00
---------- ---------- ----------
0.00 47.37 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 47.37 MASTERCARD
TOTAL RECEIPT 47.37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
__--------------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
F
OF UPEkTINO
CITY OF CUPERTINO ��v Pr
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN # `vw
-?"
—'J�"D�
Date y�
Gas Piping System Fee
PLUMBING
PPERMITFEE
o
Buildi 9ddress:
BPREPIPE
Repipe of Fixtures
PLUMBING
7� G all/A) b
Pbl . Fixture
PLUMBING
Owner's Name:
1 /NO
Main Water Service
PLUMBING
Phone
Cho a3 #v -
Contractor:
PLUMBING
Phone:
License #:
Er
Contact:
Business License
Phone:
Cupertino Business License #:
Building Permit Info:
Bldg ❑
Elect ❑
Plumb
Job Description: CO
er re
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i e WIIoP QSP
Residential
Commercial ❑
Cost of Project:
>07D.�
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Qty. if
Annlicable 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
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING
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