06010167 (2) CITY OF CUPERTINO
• BUILDING DIVISION PERMIT
aCONTRACTOR INFORMATIOON
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BUILDINO ADDRESS: CUPERTINO PLUMBING PERMIT NO.06010167
1120 S STELLING R17)
OWNER'S NAME: PERMIT I5SUEDATE
LEMMER ROBERT A AND OPAL J 1300 DELL AVE T 01/30/2006
NE: SANITARY NO. CONTROL NO.
(408) 253-0618
ARCHf1ECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION O O O
C I hereby affirm that 1 sm licensed under provisioes of ClupRr 9(commencing Job Description
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b iN section 7")ofDivision 3 ofthe Business and Profession,Cods.and my license,is
>„ mmnmReone nese (J COPPER REPIPE, WATER MAIN
2 License Clan Lie.N u {�j��
f p Date, Contractor NM r.. ' V` {("'
'J' ARCHITECTS DECLA AT N `L�^ Lp
U I understand my plans shall he used as public records FEBro Licensed FQZ, 2006
3 OWNER-BUILDER DECLARATION �a
<� I hcrchy affirm that I am exempt from the Contracto's License Law for the /yrs
p 00following reason.(section R)]L5,Bassin..s and improve.
deruns Cade,:Any city or county n�4 5 Ot��t�=
WIIRh feyYlrc]a pcmtll to CMIatNel,eller,im)ImM,dC111nItiM1.M repels my rINLWR
zy prior m is issuance,also,rcquiRs the applicanttot such permit to file a signed statement '
< that W is licensed pursuant to the provisions of Contractors Licenso Law(Chapter 9 Sq.Ft.Floor Area � '\: ,Valu3tionllll V\'zJ
yF`$ (commencing with section?")of Division 3 of the Business and Prefessiots Code)or
that W is aempt therefrom and the basis for the alleged exemption.My violadun at
Section 7031.5 by any applicant for a permit subjects the applicant an a civil Penalty of
not mom than five hundred dollars($500). r Occupancy Type
❑1.as owner of the Property er my employees with wall as Heb role.,.do.,
will do the wort.and Neswnu,it not intended or offered fo,min(Sm.71M0.Business
and Professions Code:The Conuutor's License Law docs not apply to an owner of Required Inspections
propeny who buildsorimprovcs thareon,andwho doessuch work himselfor through his
Own employees,provided than such improw:menu ate not intended Maffeb d for m1&IL
however,the building or improvement is to within one .of mmpledon,to..,-
builder wi0 have the burden of proving that M did am build or improve for purpose of
sal..).
❑Las owner of one property,am exclusively contusing wish licensed rontra.to
construct the project(Sec.7W.Business and Professions Coke:)The Conuacm s Li
cense law does not apply to an owner of propeny.who Wilds or improv Hereon,and
who contracts for such pmjcm with a commelou(s)]!=need pursuant R the Contractors
License Law,
❑1 am exempt under sec ,B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby of tee under penalty of perjury one of the following declarations:
1haveandwillmaintainaCe finRofC=ntwwlr-insumforwo escompen-
sadem,as Provided for by Section 37M of the laWr Cade,for He per....ate of rte
work for which His permit is issued.
❑I have and will maintain Wprkor's Compensation Insurance,as required by Section
37m of the Labor Code,for tW pe formance at the work for which this Permit is issum.
My WMkera Compensation Insurance carrier and Policy munk,are: 2 ,
Carrier: f/h✓T;_Policy No.: -&-( 2_3��-3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the permit is furore hundreddollas($100)
or leas.)
1 certify Het In the pert on.of the work for which this permit u issued.l shall not
employ any person in any manner ars u to become subject o He WaM1crs'Co rf cmadon
Laws of California.Dat
Applicant
NOTICE TO APPLICANT:If.after making this CeniEcam of Esemption,you should
become subject m the Worker's Compensation provisions of the Labor Code,you most
.,O foMwith comply with such provisinro or this Permit hall he deemed revoked.
Z y CONSTRUCTION LENDING AGENCY
'T+ 1hemhy-Mon that HCR iso monarminn lending agency Or the faururmmm of
C(i the work for which this lemon is issued(Sec.3M7.ON.C.)
0 Lender's Namc
z Landers Address
U C) I certify Net 1 have mad this application and state that He about information is
U.F carted.1 agree W comply with all city and county ordinances and sure laws relating R
C)U Wilding construction,and hereby aulhorim repreaentmiv of this city to enter upon the
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aWvcm' ionedpmpertyst for inspe..purposes.
(We,)agree to save,indemnify and keep harmless He City of Cupertino against
U N incom-pocdgmcnh,cassia.,expcmcswhich may in any way attmc againstssid City
U z in eoasequencc of He granting of His permit.
" APPLICANT UNDERSTANDS AND W L COMPLY WITH ALL NON-POINT Issued by: Date
SOUR O ,
Re-roofs
S71-
i t d Apel' VCo ser Dale,
HAZARDOUS M RIALS DISCLOSURE Type of Roof
Willth applicant Dr future W' Tog occupant or handle haardous roaNral
asdefined by do Cupertino Muni' al Coee.Chapter 9.11,a tW Health and Safety
Code. oynazss3z(a)? All roofs shall be inspected prior to any roofing material being installed.
Yes No
If a roof is installed without first obtaining an inspection,I a ree to remove
Will the applicant or future dung occupant vu equipment M devices which g P g
-rain harardn.air contaminant defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I have Rao the Wurdsms materialsmquircmcr s underchapter6,95 of the Califor-
pis HcalH&Safety Code,Sections M505,25533 and 25534.1 undersand than ifthc Wilding
not cu a mien.that it is capamiM1ili y m mot y He occupant of Nc
ts uuWmetp�p a is,he0D ppanry' Signature of Applicant Date
/ P307,7
owner or eolhorimd agent Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
:J Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
46UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
0 e/lin fdc( (j661()1 7
OWNER'S NAME: Vn in or PHONE # _2
GENERAL CONTRA OR: 3
I am not using any subcontractors: �1 /l�1 / ' 3o-U
'gnature 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
go-off
ner Contractor Signature Date
CITY OF CUPERTINO
7• 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 2
SeC: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36226008.00
DATE ISSUED. . . . . . . : 01/30/2006
RECEIPT #. . . . . . . . . : 33012
REFERENCE ID # . . . : 06010167
SITE ADDRESS . . . . . : 1120 S STELLING RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . ... . . . . : LEMMER ROBERT A AND OPAL J
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5021
RECEIVED FROM . . . . : FRANK CARDIA
CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612
COMPANY . . . . . . . . . . : CUPERTINO PLUMBING
ADDRESS . . . . . . . . . . : 1300 DELL AVE, STE C
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408)253-0618
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
______ _____________ __________ __________ __________ __________ __________
BPREPIPE NO OF FIXTURE 2.00 18.00 0.00 18.00 0.00
BPWSVCS WATER SERVICE 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 65.37 0.00 65.37 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ ____---_________--
OTHER 65.37 VISA
TOTAL RECEIPT 65.37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
�CUPEkTiNO PERMIT APPLICATION FORM
APN # 3 A 2 2 O Date: / 3U
Building Address:
/n
Owner's Name: v Phone#:
iZ T -�2s7 - 32v8
C t actor: Phone: License #:
� r� o p/�� 6� ypo5
Contpck.. Phone: Cupertino Business License#:
Ta✓� l� 09-5e/ /
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ®-�—
Job Description: Co�� A2 IfLQ _ l
9
Residential Commercial .❑ 1�
Cost of Project:
•
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
2 BPREPIPE Repipe of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
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