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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
PERMU N0.
1125 YORKSHIRE DR
DIJOSEPH'S PLUMBING INC
08100122
OWNER'S NAME:
PERMIT ISSUE DATE
MURDOCK ROSAMOND E
2867 KILO AVE
10/20/2008 '
NE:
SANITARY NO. CONTROL NO.
(408)365-2058
ARCHITECTIENGINEER:
BURRING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Chapicr 9
Job Description
1 hmcby .Mons that 1 un li¢vxd under provisions Of (commencing
with Sutton 70M) afDivision 3ofdu Business and Professions Code.and my litems u
REPIPE HOT&COLD WATR PIPES
in In'
Lkens Ciw Lld. g
Dale Contractor
ARCHITECTS DECLARATION
I undc nJ m tans shat aged �s pontic rtcords
License Pmfemunat j
OWNER -BUILDER DECLARATION
1 hereby afRm that 1 am ucmpt from the Cmamam'. Ucens Law for the
following mason. ($anion 7011.1. Basi. and Pm(easions Code: Any city or county
which miluims a pewit to conbnu . alms Wil., demeiah. or spar, my sm a moo
prior m its issuance. also mquim the applicant for such pewit ro Rte asigmd summcnt
NUW is lhmvod the Ne Continuous Lumex law(Chap=9
Sq. Ft. Floor Area
Valuation
pm,vant m provisimn of
(commencing with Scotian 7000) of Division 3 arthe Business and ismicssions Code) or
7 5 0 0
$7500
Nat he Is eaemp Nertfmm and the buts for Ne alleged eswpdod. Any violation or
Number
Occupancy Type
Schon 7031.3 by any applicant for a permit subjects dm applicant on a civil pnstty of
oat come Nm Rw hundred dalWs (5300).
3 6 2 0 7 016 ..q((
❑Las on ofdiepstruct Ormnotinudcdwith urgesother sole eompwtim,
Required Inspections
will Neshins and Ne om ts tied or smooth(Sec. TON,Mons
Laoffew
Of
do owrw sur
uses Li a Law dam rot apply if
Pr Cadempo Conbacmrs
and OO
rt
,ity who nduel uN wmkhimxlrm through his
pmpemY wM Wilds, impmvea thnco, andwhu doc
rovi ion m dedorORenil fm sale.IL
uiprovided semmuartrot car
'
of
Whae .ft p. is Mdiin Oroyeti Of c
however,Ne dtildingordsm
ixtrueforNeOwrcr-
ofexnattsstd
builder wiB low Ue burdrm of poring Nu K did not build or impose for purpose of
ak.).
0 1. u ornm Of Ne properly, w evdummly cmurma, with Beamed comwsors m
cora ua the Mica (Sec 7044, Business and Professbm Cade:) The Cuutra mi's U.
cense Law does rot apply m an Owner of property who builds or impmvu Nemon. and.
who contracts for such pojeas with a comaaoKs) liccued pursum on the Curbstone.
Licari law.
❑ lameaemptundm See ,B&PCfar Nisrcuun
Owner Dam
WORKER'S COMPENSATION DELI RATION
1 Mosby affirm under penalty or perjury Ors Or the following deelarml
1 naw end bid 3iab of Conserv slf-insure for WOrkce.Camper-
uNon, as r
for by Senior 3700 of ds labor Code. for Ne prlomanco of Ne
Ido for .Mmm
wall for rhicb Nu permit u issued.
for
I have and will munuim Workse. Compound. Insurwe, u rymoul by Section
3700 aft Labor Cock. for Nc prfomrmx athe work rorwhich Nis pmh Is issued.
My WOrkee.cCompmosom from. union and Policy n�u.Wr tic: T
Cassie,. / I?V N/'S Policy No.:/J/9SD_I/_?V
CERTIFICA 07�EMMON FROM WORKERS'
COMPENSATION INSURANCE
,
(This =I. reed notbccamplecd if the Amit b fororo hundmd dMan (SIOD)
or Icon)
I certify, that In the perfomanco N IW wart for which this permit u Issued. 1 shall out
employ my person in my manner so u m become subject m the Wurkme Compensation
-
laws of Coliforms Due
Applicants
NOTICE TO APPLICANT: IC afar making this Cer ificim of Eumption, you should
becmne subject on Ne Wo sees Composstim provisions of IW La Wr Cod, you most
Forthwith comply with such provisions or this petit shall nc domed nodded.
CONSTRUCTION LENDING AGENCY
I herobY alum that Ncrt is a construction lending agency for Ne perfomana of
Ne work for which this petit ts issued (Sec. 3097, Civ. C.)
Lmdefa Name
'
Lcndefs Adds,
I mrtUy that 1 have rod this application W sum Nu Nrt aWw infamadan u
coraco 1 agree in comply with all city and county Omiwxu and state laws rtlning In
building construction, and h mby auNmiss rtpr,seatadvrs of Nis city in coax upn Ne
above-mentiormd property, for inspection purpuss
I%) agrtt m ssw, indemnify, and keep harmleu Ik City of Cupcnint against
liabilities judgrmnts. cuts and eapmua which may In any way scale against said City
in eunsequcoco of Ute granting of this pcmiL
APPLICANT U ERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOUR C EGyTIONS.��_
Issued by: Date
Type of Roof
zazRe-roofs
Signuurt of AppliaHAZARDOU /T Doc
HAZARDOUS MATERIALS DISCLOSURE
Will she suppliant no fuum Wilding antmm hraN
om mgh haou manorial
u dc0ned by Vu Cupertino Mumcipl Cods. e. ChChepmr 9.13. and red HCLN and Safety
Cwe.SecdonM3z(a)7
0Yes I NO
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
WII tho applicant Or ruam Wilding Om'upaet uso comipmmt or devim which
t IuvaNnu air contaminants as defitsd by Ne Bay Aom Air QWiuy Mubecmcm
all new materials for inspection.
Isvict7
❑Ya n(Na
I haw mad Ne huardtms nowrials rtquimmcnb under Chapmr6.95ofNc Califor.
nix Health &Safety Code. Sections 2550.3, 25533 and 25534.1 undrntmd Nu if the Wilding
dons out cummly have a roam Net it is my msponamlity in notify the accupent or dc
mqulmmen nit mtat� tpiyrmaaaapt<af Ovid w raapantY.
Signature of Applicant Date
/�/ y� Lr r
All roof coverings to be Class "rya' or better
g R
—T Dam'
Owner
or mthar'vsd ascot
• 5 ITEMS OF 5
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:'
APN ......... 36207016.00
DATE ISSUED.......: 10/20/2008
RECEIPT #.........: BS000006397
REFERENCE ID # ...: 08100122
SITE ADDRESS .....: 1125 YORKSHIRE DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: pdtg
COPY # : 1
OWNER .............. MURDOCK ROSAMOND E .
ADDRESS ..........: 1125 YORKSHIRE DR
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4916
RECEIVED FROM ....: DIJOSEPH'S PLUMBING
CONTRACTOR .......: ANDREW DIGIUSEPPE LIC # 22796
COMPANY ..........: DIJOSEPH'S PLUMBING INC
ADDRESS ..........: 2867 KILO AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95124
TELEPHONE ........: (408)365-2058
FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
1BSEISMICR
VALUATION
7,500.00
0.80
0.00
0.80
0.00
1BUSLIC
FLAT RATE
1.00
110.00
0.00
110.00
0.00
1PPERMITFE
FLAT RATE
1.00
40.79
0.00
40.79
0.00
1PRREPIPE
NO OF FIXTURE
12.00
122.40
0.00
122.40
0.00
ITRAVDOC
FLAT RATE
1.00
40.79
0.00
40.79
0.00
TOTAL PERMIT
----------
----------
314.78
----------
0.00
314.78
----
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
314.78
---------------
314.78
VOICE ID DESCRIPTION
-------- ----------------------------
301 ROUGH PLUMBING
0
REFERENCE NUMBER
---------
#2535
VOICE ID DESCRIPTION
------------------ -----
507 FINAL PLUMBING
r
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I OF
CUPERTINO
CITY OF CUPERTINO
REPIPE/SEWERIMAIN SERVICE
PERMIT APPLICATION FORM
0�/ool a D-
APN # oC O 70/ (o • U
Fee ID
Date: 4'
Building Address:
Permit Type
Owner's Name:
�OSP{yjphG/ �r'l�/'�ar G
Phone #:
.2- S 3
Contractor: �,�AS //! �S �/� �i ��Irj
'y / t
Phone #:
1PCSEWER
Commercial building
Fax #:
Contact: tJh -/`
Phone #: 3,( 5",2,0T
sewer/sanitary sewer
Fax #:
Contractor License
1BPREPIPE
Cupertino Business License #:
P
Job Description: DYn�r f N� y �o�
k-,
esidential [
i
Commercial ❑
Valuation: 17 5�a
Project Size: Express ❑ Standard ❑ 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
1BPREPIPE
Commercial re -pipe per fixture
P
1CPRP
1PGASCOM
Commercial Gas Piping System
P
1-4 Outlets
1BSEISMICOM
Seismic Commercial
P
l
1BSEISMICR
Seismic Residential
P
1PRSEWER
Residential building
P
1RPSS
sewer/sanitary sewer
armlvol-,, CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
Of
CUPERTINO FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
l
1PRREPIPE
Residential re -pipe per fixture
P
1RPRP
1BPWSVCS
Water Service
P
1CPWS or
1RPWS
1PPRSEWG
Private Sewage Disposal System
P
1PCESS
Cesspool
P
1BPWATER
Install/alter Water Pipe
P
1BPFIXTURE
Plumbing Fixture
P
IPGASRES
Residential Gas Piping System_
1-4 Outlets
P
1BPGAS
Gas Piping System 5+ Outlets
P
1PPERMITFEE
Plumbing Permit Fee Issuance
P
1PLM 3LNCK
Plumbing Plan Check
P
1PLMBINSP
Other Plumbing/gas Insp.
P
1TRAVDOC
Travel & Documentation Fee
B
IBUSLIC
Business License
B
Revised 6-16-08
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