05080010 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT . CUN'TACTQRfo IN `U,'�tMATTN,,
BUILDING ADDRESS: MIKE COUNCIL PLUMBING INC 1ERMITND'05080010
108 8 SYCAMORE CT
OWNER'S NAME: PERMIT ISSUE DATE
PANOS KOUGIOURIS 1977 O'TOOL AVE 08/02/2005
NE: SAMTARY NO. CONTROL NO.
(408) 272-4900
ARCHIIECTIENGINEER: BUILDING PERMIT INFO
BLDGELECr PLUMB MECH
(�
jots
LICENSED CONTRACTOR'S DECLARATION Job Description
I u� 1 herby art,-dial I am's�or�ed under pmvisiona of Chapmr 9(amenc
mo{
with Stw o t]001))of Division 7 of Ne Buarcas ask Professions Code,aM my license in
e'1 in full force andefren GAS LINE (TO EXTER. .HEATER)
jjZ License Class Lic g e-7 Z C-3
FFF Dam Convcmr
' ARCHIIECrS DECLARATION
SSSS I undcrsurk my plans shall W used u public ma oks
s� Licensed professional
OWNER-BUILDER DECLARATION
SS I hereby inbred that I am exempt from Uro Convector's License Law for Me �/A(�/(]1
00 following popeon.(Section 7(01.5,Business and Professions code:My city or county (/y `'®.tt $1900
$E which requires a Permit m cnnaruct alter,improve.demolish,or mpalr any structure
_Zi prior to its issuance.thou requires the appliaed for inch permit to fix a sl0rcd comment I f'a /�//
< dosha la licensed pursuant toathe pmrisioauf Ne Canuacmr's License Law(Chapter 9 Sq.Ft. Floor Area
� '' / Valuation
!{(,S❑0 fee mencing with Sdon7000)of ea
Division3efdm Busidaand Profcuioru Code)or
L a 9 Nat he is exempt therefrom and the basis for IM alleged exemption.My violadon of v !/
Section 7011.5 by any applicant for a permit subjects the appliance in a civil penalty of nn '" Occupancy Type
W,mart Nan five hundred dollar(SSW).
❑I.u owner of ti a property,or my employees with mgr u Heir sok emnpenudan, $$$
will do the work,and thesuuare
ure Is not intended offered formic(Sec.70W.Business I& led•0 ectons
surd Profeukns Code:The Compcmr's License Law don set apply m an owner of Q 4 b(/p�
property who builds orimproves themon.and who doessuch work himelforthrough his
man employees,provided that such improvements are nmtidmoded reoffered for We.If, 4
however,Ne building or improvement is sold within one year of impletion.the owner.
Wilder will have Ne burden of proving Nat be did net build or Improve for purpoe of
asle.).
❑1,u owner of the property sm exclusively competing with licensed convumn an
construct Ne pmjm(See.7014,Business and Pmfessions Code:)The Convectors LI-
cone law don not apply m an owner of property who buil&or maimem dwrmn.sed,
who contracts for such projects with aimremr(q licensed pursuant In Ne Compactor's
License Law.
❑I am exempt under See ,B k P C for this mated
Owner Data
WORKER'S COMPENSATION DECLARATION
I herby aRnm me,penslty of perjuryarc of Ne folbwin{deduuiodr.
I haw ms will mein Wn aCWRcueof Conum m elf-inure for WorkeraCompen-
nation,u provided for by Section 37W of Ne Labor Code,for tha Performance of Ne
work for which this Permit is issued.
1 have and will maintain Worker's Compensation Wunnce.u required by Section
1700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number art:
Csker.rPlr/ IA�f .. Policy No.: S 00q 49
CERTIFICATE O6MPTION FROM WORKERS'
COMPENSATION INSURANCE
(This mcdon need r mbecompiemd If da permit k form hundred dollars($1 0))
or loss.)
1 ardfy,that In the perfmmance of dm work for which this permit is issued,I shall ma
employ any person in any mender an u In become abject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cerifl am of Exemption,you should
become subject In,the Workers Compensation provisions of Ne labra Cade,you most
.'O forthwith comply with such provisions or this permit shm
all be deemed reveled.
CONSTRUCTION LENDING AGENCY
[ti I herby afirre that Ncre kainspucdnn lending agency for the performance of
C ti
to work for which this permit Is issued(Sec.3007,Civ.C.)
GQ Lender's Name
a Z Lender's Addrw
V O 1 certify that 1 have rad thin application and am that the above information Is
ly F correct.1 agree to comply with all city and county ordinances ask cum laws refiling to
0 U building construction,and hereby authosim representatives of this city to cors upon to
W ahove-mentioned property for Inspection purposes.
(We)agree to save,indemnify and kap harmless the City of Cupertino against
s.w rrAA liabilities,judgments.ecu and expenses which may in try way we=against said City
(„)7 In consequence of the gMdng of this permit. rsT - ^
v7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO7-P0�1 Issued by: Date F .4 o
soap7al�tll.�uoNs. _ & 12/S Re-roofs
Signishom orAWlIcanspCopprawor ane
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will Oe applicant or future building oaupmt am or handle haxekou material
as de0ned by the Cotentin Municipal Co&,Chapter 9.12,and the Health and Safety
mrd.Semen 25532(a)7 All roofs shall be inspected prior to any roofing material being installed,
❑Yes `[l No
Will the applicant or future Wilding occupant ase equipment or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous air contaminants at defined by the Bay Area Air Quality Management all new materials for inspection.
DimicO
[3 Yen *IN.
I haw mW the hutkmo mammals requirement,under Chapter 6.95 of the Califor.
nb Health&SalctyCode,Sections 21505,25533 mal 25534.1 umins alNu ifthc Ind dim
does trot eunenLI he s moat vias it p my responsibllity m notify the race t of
aqui a abemeIpriormiuumccafaCenifiamof'upancy Signature of Applicant Date
1am
owner n ata All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
p Fax(408)777-3333
�UPEf�TINO
Building De utment
JOB ADDRESS: PERMIT#
iD 9a8 Cf 4 c4A440,2Q27 O ,S-Oeoo( o
OWNER'S NAME: )24AjoS 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 OA t u>v g t L 3 O 33
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
/Contractor Signature Dat
CITY OF CUPERTINO �r
Z
REPIPE/SEWERS/MAIN SERVICE
CUPE �NO PERMIT APPLICATION FORM
APN# S� Date:
J z b� $ z os
Building Address:
-
Owner's Name: Ph on #:
S -.rd4
Contractor: Phone: License#:
®�=27 C-
Contact: ��J,, Phone: Cupertino Business License #:
Me-r E V Q —g 3 -O 6 5- z3 0-S3
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential Commercial ❑
Cost of Project: �90�
•
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 Repipe of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
/ BENERGY Energy BUILDING
BUSLIC Business License BUILDING