08100082 CITY OF CUPERTINO -
BUILDINc:RlVISION'-' PERNIIT °X0NTIU61r,ORM_ - ORM TION
BUILDING ADDRESS: PERMIT NO.
10180 BONNY DR GIANT PLUMBING, INC 08100082
OWNER'S NAME: PERMIT ISSUE DATE
JACK KEMPF 2111 DRY CREEK RD 10/15/2008
NE: (408) 445-8507 SANITARY NO. CONTROL NO.
ARCHIIEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 � 0
woo LICENSED CONTRACTOR'S DECLARATION Ib Description
ith S
m 1 hereby snorts NOBSCTIP
at I am licensed under provisions of Chapter 9(commencing
� � Section 70M.Miviunn 3ofde Bssincesaed Profeadom Code.and my licensee COPPER RE—PIPE
in full forte atad effcCL
j$Z License Clan _ Lic.9 (af;tm
1„q Dao: conOsaor
¢7W
ARCHITECTS DECLARATION
W 1 ucrvand my plans be most as public rero
Mon
Dg,V '
y G r^ I.iccnxd Professional
,�5 OWNER-BUILDER DECLARATION
i I I hereby.Turco ths 1 am s urnin from to C.numco'.License Law for the
D O following moon.(Section Tin I.S.Business and Pmfemium Cade:Any city or county
i$ which ro,nines a permit on conMet glare improve.demmish,or espW any aractum
Uzi prior m its issuance.aim mluires the applicant for such permit m rile a signed statement
< that he is licensed pursuant le Ne provisions of the Contractor's Linz Law(Cluster 9 Sq.Ft. Floor Area Valuation
x€$
(comms
ndngwithS on7")of Mi ion3offt Business ftfrs Cade)m $5000
Nn M.exempt therefrom and the basis for the alleged exemption.My violation of
Section 7031.5 by any applipnt(ora permit subjem the applicant a.civil penalty ofNumber Occupancy Type
trot mom man fsw hundred dollars(Ssoo). 3 5 9 110 4 7 .W
❑I.Wo ofthapropeM.mmysmploymawIOWa asuebmlacompnuuon,
will do the .it.and the about.is or intended or offered fmaale(See.7DµBum. Required Inspections
and professions Code:The Contractors License Law docs tat apply m an owner of q p
property who builds or impoms Raman and whuduessuch work Wassu for through hint
own employees,provided Nat such impmammenu are not intemlm reoffered forsase If,
however,the Wilding or improvement timid within one year of completion,the ovmer-
Wildm will ban One Widen of proving that W did out Wild or impose for purpose of
sale.).
❑1,u owrcr of the poppy,w uclusinly contracting with Bared co mracters to .
mnatnnr Ns project(Sec.7014.Business and fiafestloru Cod:)The Coruncmr'a LL
cense Law does not apply N an owner of property who Wilds or Wproav Neteen.and.
who conuana for such projects with acanusbr(s)licensed pursuant at the Conation
Lics.Law.
0 lamaomptundm See ,B&PCfearthureawn .
Owner I Cuts-
WORKERS
ateWORKERS COMPENSATION DECLARATION
litI hereby affirm under penalty o(prjury m of me following dMantions:
1 have adl will maintain aCenifmamof Coasent m self-insure fm Wmkces Compa-
n,as pmvidcd for by Section 3700 of the labor Code,for this performance of the
work for whim this permit is issued.
❑I haw road will maintain Worker's Compensation Insummos.u mulched by Section
3700 of the LaWr Cade.for the performance of the wools for whim this permit is issued. '
My Worker'.Cmopeasuion Insumnce arrim and Polity number ass
a�
Carus Policy No.: '
CERTIFICA7EOEXEMPTION FROM WORKERS
u/ �n �6
��( Ce CO �AATa10GGNIINNS�S��LIvRANCE aro /Ol
rNatssmim reed not k4dtltdepvmnisf bonded do0sn I
or leas)
1 certify Wt in the performance of the work for which this permit u issued.I mail not
employ any person in my manor su as b become subject o the Workeri Cooper sudon
Laws of California.Dam
Applicant
NOTCE TO APPLICANT:If,after making this Comliiam of Exemption,you should
become subim in the Worker's Compensation provisions of the labor Cade,you most
z forthwith comply with such provisions or this permit Nall W decmrA orw m.
z CONSMUCTON LENDING AGENCY
.N., Ihemh anon this then is a emuvuctinn coding
F Y g agency,for de performance of
3.tea
the work for which this permit tisu
issued(Sec.J09'1,Civ.C.)
U
IsO landcr's Name
a.z Lender'.Address
V Q 1 rnify Nat I haw mad this application and aur that the above informauun is
if. H comct.I.area in comply with W city and county mulmmeas am sus laws totaling or
pU Wilding construction,and Wmby mthoum mpresemauva of this city to cmcrupn Nc .
r W aWw-menuoned property for inspection purposes,
gy (We)agme to save,indemnify and keep homeless the City of Cupertino ag.Wt
rn liabilities,j.dgmenu.com and expenses which may in my way arna against sold City
V z APPLnICA ncsUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR IA710N5.
61� b / Re-roofs
Signamm of AppliandConuxror Date
HAZARDOUS MA Ala s osis Type of Roof
Will tie applicant or future Wilding accopant ne, am m.to
M deBncti by the Cupertino Municipal Code.Chapter 9.Iz.m calm and Safety
code. y. )f]Ne
zss325532(.)?CAll roofs shall be inspected prior to any roofing material being installed.
Ya
Will the applicant or future Wilding occupant use sentiment or teviecs which If a roof is installed without first obtaining an inspection,I agree to remove
it hvamnus air cmumirums u delimm by Owe Bay Ma Air Obesity Management all new materials for inspection.
rinT
❑Yes �Nu
I ham mad mchu amnusmaeuais mquinmcnu under Chaper6.95ofNc Califor-
niaHaiN&SaI.LYC0ds,Sections ZiM5X533 am175534.1 unMmmoud uatiftie Wilding
Jos not chaw a count,mat it u my responsibility a notify de occupant of the
myai mswh hmmrWmctpormiacemBe.aefaapma. Signature of Applicant Date
Own or mmomed aCcm Dae-
All roof coverings to be Class'%¢•'or better
CITY OF CUPERTINO
S 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . : 35911047 . 01
DATE ISSUED. . . . . . . : 10/15/2008
RECEIPT # . . . . . . . . . : BS000006357
REFERENCE ID # . . . : 08100082
SITE ADDRESS . . . . . : 10180 BONNY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JACK KEMPF
ADDRESS . . . . . . . . . . : 10180 BONNY DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : GIANT PLUMBING
CONTRACTOR . . . . . . . : DONNY GREGG LIC # 24389
COMPANY . . . . . . . . . . : GIANT PLUMBING, INC
ADDRESS . . . . . . . . . . : 2111 DRY CREEK RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 445-8507
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- ---------- - --- ------ -------- ----- ---
1BPWATER UNIT . 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1BSEISMICR VALUATION 5, 000 . 00 0 .50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- - ----------
TOTAL PERMIT 122 . 87 0 . 00 122 . 87 0 . 00
METHOD OF PAYMENTAMOUNT REFERENCE NUMBER
-- --------------- -- ------
CHECK 122 . 87 #5469
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
- --------- ------------- ------ ----- --------
301 ROUGH PLUMBING 507 FINAL PLUMBING
•
Cc)v �a
CITY OF CUPERTINO
;GCd- REPIPE/SEWER/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN# o
I (� Date:
�
Building Add ss:
CJ � 1 _¢
Owner's Name: Phone#:
Contractor: Phone#:
Fax #:
Contact: Phone#:.160_ (��1 OS a0
�. Fax #: r
Contractor License #: /_ —r� 1
Cupertino Business License
Job Description: p�
C�o e P.� ye4
Residential Commercial ❑
Valuation:
Project Size: Express Standard F1 Large ❑ Major❑
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set & the sheet index. `
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer
113PREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
/ 1BSEISMICR Seismic Residential P
IPRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
mi' REPIPE/SEWERIMAIN SERVICE
CITY OF
CUPErZTiNO FEE SCHEDULE •
Quantity Fee ID Fee Description Fee Permit Type
Group
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
IPCESS Cesspool P
IBPWATER Install/alter Water Pipe P
1BPFIXTURE Plumbing Fixture P
IPGASRES Residential Gas Piping System P
1-.4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
IPLM 3LNCK Plumbing Plan Check P •
IPLMBINSP Other Plumbing/gas Insp. P
ITRAVDOC Travel &Documentation Fee B
I IBUSLIC Business License B
Revised 6-16-08
•