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CITY OF CUPERTINO
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BUICDINC-DIOSION PERMIT
II FU1:iMATi '134 _
kCON.Ti2AC'fQR
BUILDI D ESS:
1601 TONITA WAY
JM DRAIN CLEANING AND
PERMIT NO.
08100127
OWNER'S NAME:
PrUMBTNG
PERMIT ISSUE DATE
GLUMAC GEORGE J AND EMMY B
1725 ROGERS AVE STE C
10/20/2008
NE:
SANITARY NO. CONTROL NO.
(408) 903-8184
ARCHITECT/ENGINEER:
HURb1N0 PERMIT INFO
_
ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 hereby affirm Wu 1 w licensed under pmvisimu of ChapterI 9 (Commencing
with Sm9on 7")of Division ] of die Busimss and Profcuiou Code. and on Izcmeu
COPPER RE—PIPE FRM WTRMTR TO ENTIRE HSE, RPLC
!'.nUUcU,a`.nd`D%"�/s Lr.x
DRAIN LINES UNDR HSE ONLY W/ABS PIPE
Dam. Camramor
ARCHITECT'S DECLARATION
1 memorunJ my plans shall be used u public meords
Liccwcd Pmfe ssumad
OWNER-BUIIDER DECLARATION
I hereby affirm that I am ucmpt from the Conlranera License Law for dK
following n:amn. (Becton 7031.5. Busmen and Proliuions Cade: Any City or County
which mquims a permit to conamc4 slur. impmve, demolish, on o fed, any suanuro
prim m its issuance. also requiem the applicant forsucb permit m filea signed suument
the the Communes License Law (Chapter 9
Sq. Ft. Floor Area$8887
Valuation
that he is licensed pursuant in provisions of
(eomcmting with Section 7000) of Division 5 of Eve Business and Professions Code) or
m
Chun he is uempt the mborm and the basis for the alteged exemption. My violation of
35914008.W Number
Occupancy Type
P Y YP
Section 7031.5 by arty applicant far a permit anbjem the applicann m a civil penslty of
ant mole than five hundred dollars ($5=
I,ntwmrof tie pmpeny,m my wpmyw withwagesrthc(Cole c
Required Inspections
out intendedesoReret formic (Sao. 1014,ow..••
doIhoamok. and NL oe .Berman
oil he Law tau of apply lf an wnor of
ons Cole: The Conuucmr's
i
and Prty
progeny who Wilde orimprovusbeeon,end w6atlasuch wink himselforlaough his
wh ndwho
waemployma, provided tiw mach impro art not ioero mofierW foe n
wit Completion. nacr,
,the building m Mprovemmt is sold within arc Sear or mproe for du awea-
old
Wilder wi8 haw the modem of pvving tun he did Con Gtid or improve for purpose of
Witter
uteJ.
❑ 1, ss carer of the Property, w eslu ely contracting with BansW mnaacun In
commuset the pmjen (Bee. 7044. Business and Rafessica s Code:) Tho co mnures Li.
man, law tlau not apply m an Owner of property wW builds or improvm Neon, and,
who contracts for such prejecu with a conwnor0) licemed pursuant in tier Conm entoYa
Llanee law.
❑ I am Laempt under See .B A PC for this seaon
Owner Data
WORKER'S COMPENSATION DECL ARATION
I hereby a0iunder Penalty of perjury one of tic following dimauto s:
m
Ilura and willmarbina C.37M of
WfachaC
deLab rslde.rorsear
of
utile. u provided fPe Salim 3]00 of Ne labor Code. fm the porfoemamm of Ne
'
mi
wink for which Nu Permit is Issued.
❑ I have and will maintain Worker's Compensation insurance, as required by Section
1700 of the labor Code, for the performance Crus work for which this Permit is issued
'
My Workds Compensation hns ourace cantor and Policy mumbo are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
mos scum need othecomplecd if to permit is foam hundred de0an ($100)
of Iota)
1 certify win in the performance do, woyrak
which this Permit u ivucd. I mall on,tin
�osf cffor
employ y Peron in my m u•C`mp`nent.
.
laws of CAHfam & fsf
Applluhu
NOTICE TO ng Nu Cenifiuu of Eamptian. ym should
too me subject m the Worker's Compensation provisions of the labor Code. you mut
'
Forthwith Comply with such provisions or Nu Perrin shall W dcemed revoked.
CONSTRUCTION LENDING AGENCY
this then is a muuuNnn agency, for the perfmman¢ of
I hereby isa
cEm
7. Cin.
the woes for which this permit u issued (Sec. J09'I, Civ. CJ
Lender's Name
,
.
leader's Addmat
i 1 mnufy that 1 have rod this appliation are rum thu'the above information u
' tartan. l agrm m comply with all city and county ooinmas and sum lave relating in
building Construction, and hereby othons rtpmamutivea of this city in Cour upon the
I show-mendomd propeny for inspection purpsuea
(We) agree m use, indemnify and keep hazardous the City of Cupertino against
j Iiabilimi. judgmenu,cos and expemu c which may in my way amnagainst mid City
in Constgueoe of the grantng of this pmmiL
APPLICANT UNDERSEAND5_AND WILL COMPLY WITH ALL NON -POINT
Issued by:9 Date
SOURCE
Re -roofs
Type of Roof
:"
Si of ppl nuamm Dam
' HAZARDOUS MATERIALS DISCLOSURE
Will theapplicant or fretum building uaupmtaoo, or handle hauNou ro esisi
as dcfiod by the Cupertino Municipal Code. Chapter 9.11. and the Health and Safety
'
Code, SectionM31(a51
All roofs shall be inspected prior to any roofing material being installed.
❑ll /(DNS
�\
If a roof is installed without first obtaining an inspection, I agree to remove
g
WIII the applicant or future building by the Bus equipment m desire which
II hvaonu air canumirunu u defimM by the Bay Area All QWiny Managemenn
all new materials for inspection.
ClisCeiem7
❑Yu No
I have retl the huandous matetsla mquha nmts under Chapter 6.95of the Glif ar-
niaHeal" SafcmyCndeSatiw25505,25533 and 25534.1 mdentand thnifthe Wilding
does not cuarLnty have a scr m, that it rmpamlhillty m really ftmtuPNl Of the
mquiremcnue which Catbor_I m.1.CcNBcateafocm
Signature of Applicant Date,
m
All roof coverings to be Class'W' or better
..
own' Date
a
uth porn
• 6 ITEMS OF 6
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35914008.00
DATE ISSUED.......: 10/20/2008
RECEIPT #.........: BS000006402
REFERENCE ID # ...: 08100127
SITE ADDRESS .....: 10411 TONITA WAY
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............: GLUMAC GEORGE J AND EMMY B
ADDRESS ..........: 10411 TONITA WAY
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2931
RECEIVED FROM ....: JOSE L MENDEZ
CONTRACTOR .......: JOSE MENDEZ LIC # 29513
COMPANY ..........: JM DRAIN CLEANING AND PLUMBING
ADDRESS ..........: 1725 ROGERS AVE STE C
CITY/STATE/ZIP ...: SAN JOSE, CA 95112
TELEPHONE ........: (408) 903-8184
FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
1BPWSVCS
WATER SERVICE
1.00
20.40
0.00
20.40
0.00
1BSEISMICR
VALUATION
8,887.00
0.90
0.00
0.90
0.00
IPPERMITFE
FLAT RATE
1.00
40.79
0.00
40.79
0.00
1PRREPIPE
NO OF FIXTURE
10.00
102.00
0.00
102.00
0.00
1PRSEWER
UNITS
1.00
20.40
0.00
20.40
0.00
1TRAVDOC
FLAT RATE
1.00
40.79
0.00
40.79
0.00
TOTAL PERMIT
225.28
0.00
225.28
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
225.28
---------------
225.28
VOICE ID DESCRIPTION
-------- ----------------------------
106 SEWER & WATER
301 ROUGH PLUMBING
50,7 FINAL PLUMBING
0
REFERENCE NUMBER
--------------------
MC
VOICE ID DESCRIPTION
-------- ----------------------------
202 UNDERFLOOR PLUMBING
400 SEWER/LATERAL
��F
• CUPERTINO
F—
L L
oef/oo /027
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
PERMIT APPLICATION FORM
APN #� n / yo
Date: /O �_
l
Building Address:
\'.
Permit Type
wner's Name:
Phone #:
(p
P
S (9
Contractor: 3"M �;L
Phone #: ypB Q
Commercial re -pipe per fixture
P
1CPRP
Fax #:
Contact: C`Z,
Phone
P
Fax #:
Contractor License #: S
1BSEISMICOM
Cupertino Business License #:
P
Job Description: Cpm �A1/� V /—�J w
G}�
1BSEISMICR
Seismic Residential
P
1PRSEWER
Residential I _ Commercial
❑
Valuation: 0 99
Project Size: Express L Standard Large Ll 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
Group
Permit Type
1PCSEWER
Commercial building
sewer/sanitary sewer
P
1CPSS
1BPREPIPE
Commercial re -pipe per fixture
P
1CPRP
1PGASCOM
Commercial Gas Piping System
1-4 Outlets
P
1BSEISMICOM
Seismic Commercial
P
1BSEISMICR
Seismic Residential
P
1PRSEWER
Residential building
sewer/sanitary sewer
P
1RPSS
I
r ��
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
FEE SCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
/0
1PRREPIPE
Residential re -pipe per fixture
P
1RPRP
1BPWSVCS
Water Service t
P
1CPWS or
1RPWS
1PPRSEWG
Private Sewage Disposal System
P
1PCESS
Cesspool
P
1BPWATER
Install/alter Water Pipe
P
1BPFIXTURE
Plumbing Fixture
P
1PGASRES
Residential Gas Piping System
1-4 Outlets
P
1BPGAS
Gas Piping System 5+ Outlets
P
1PPERMITFEE
Plumbing Permit Fee Issuance
P
1PLMBLNCK
Plumbing Plan Check
P
1PLMBINSP
Other Plumbing/gas Insp.
P
1TRAVDOC
Travel & Documentation Fee .
B
1BUSLIC
Business License
B
Revised 6-16-08
is
•