07020020 CITE'OF CUPERTINO
BU'LDING DIVISION PERMITvlk�INFO
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UIL 1 G D ESS: PERMIT NO.
CONRADIA CT CHAMPION PLUMBING 07020020
OWNER'S NAME: PERMIT ISSUE DATE
BABU 2059 CAMDEN AVE. #277 02/05/2007
)NE: SANITARY NO. CONTROL NO.
(408) 43'7-1507
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
!0 p LICENSED CONTRACTOR'S DECLARATION
v F I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
:Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is SEWER/WASTE BELOW HOUSE
y in full force and eft 7 r
t z Licetuo Class Lic.R
F Date - - J —contractor C. aw+w 1 dA ut+tn
LU
ARCHITECTS DECLARATION
i < I understand my plans shall be used as public records
7yU
u H Licensed Professional
OWNER-BUILDER DECLARATION
< 1 hereby affirm that 1 am exempt from the Contractors License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
$ which requires a permit to construct.alter,improve,demolish,or repair any structure
Z; prior to its issuance,also requires the applicant for such permit to rile a signed statement Ft.Floor Area Valuation
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 :riff
af— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $2500
y`;. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of q Number Occupancy Type
not more than five hundred dollars(5500). 3562305'
. V
❑1,as owner of the property,or my employees with wages as their sale compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of 9 P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's U.
ccnse Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insurc for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued. RY
❑1 have and will maintain Workers Compensation Insurance,as required by Section NITA
3700 of the Labor Code,for the performance of the work for which this permit is issued. SA
My Workees —M
Compensation Insurance carrier and Policy number are:
Carrier: Z:Al Policy No.:JaD0 4t S ZI WvO
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
1 certify that in the performance of Ore work for which this permit is issued,1 shall not
e D
employploy
any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
(-t I hereby affirm that there is a construction lending agency for the performance of
pC the work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name
z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
LL h-r correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorise rcpresc rives of this city to enter upon the
W above-mentioned property for inspection purposes.
Ia. (We)agree to save,indemnify and keep Ere the City of Cupertino against
nF•h lA) liabi'' ,judgmcnls, is and expenses which rip in any way accrue against said City
U z h bunco of the mr.
t"
PP
�EREG
T UND ANDS DWI OMPLY WITH ALL NON-POINT Issued by: Date
SOUR __
S'0Re-roofs
of Applican on r Dam
H US MA ALS D[SCLOSURE Type of Roof
Willi the applicant f turc buildi cupant store or handle hazardous material
defined by the Cuperu unicipal Chapter 9.12,and the Health and Safety
code,Section25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes e+�
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new mi teri or ins tion.
District?
❑Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- J:2
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy. Sign ure of Appl ica Date
Owner orauthorized agent Da1e- All roo overings to be Class"B"or better
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Bl}_: Lot:
APN 35E23055. 00
DATE ISSUED. . . . . . . : 02/ 05/2007
RECEIPT #. . . . . . . . . : BS000000392
REFERENCE ID # . . . : 07020020
SITE ADDRESS . . . . . : 211,14 CONRADIA CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER BABU
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . :
RECEIVED FROM . . . . : REC'EIPT INTERFACE
CONTRACTOR . . . . . . . : TIN FAY LIC # 23793
COMPANY CHiMPION PLUMBING
ADDRESS 2059 CAMDEN AVE. #277
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE (408) 437-1507
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 REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 59 .95 VISA
---------------
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 01 02.0p)-o
I alF
REPIPE/SERV S/MAIN SERVICE
CUPEI�TINO PERMIT APPLICATION FORM
APN # Date: Z _ S _ r
35to��-3~b55
Building Address:
Owne` s Nae: Phone#:�_—O / �l?7
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Contrac . ��✓� J Phone: L U License #: 1
4ln�l inrnN
v
Contac• one: 3 d Cupertino Business License#:
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Building Permit Info:
Bldg ❑ Elect ❑ Plumb 91--'
.
Job Description: � �•� Wks,
Residential V mmercial ❑
Cost of Project: 2-
Qty.
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Cray Pipin System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE F_e ipe of Fixtures PLUMBING
BPFIXTURE Fblg. Fixture PLUMBING
BPWSVCS Vain Water Service PLUMBING
BPSEWER c ewers PLUMBING
BPSEWAGE c ewage Disposal PLUMBING
BUSLIC Business License BUILDING