08100168CITY OF CUPERTINO
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BUILDIN[—ISION PERVIIT
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BUILDING ADDRESS:
PERMTTNO.
20064 JOHN DR
NEYJ ST
OWNER'S NAME:
PERMIT ISSUE DATE
N
A 0. 8 a 8 CONTROL NO.
(408)364-2143
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
!'
BLDG ELECr PLUMB - MECH
0 0 0 0
LICENSED CONfRACTOR'S DECLARATION
Job Description
I hereby affirm that I m licensed under Previsions of Chipper 9 (Commercial
with Sarlen70(MB of Division 3 of /the Busircu and Prof Code. and mylkenscu
lo full forte ani cff —30 2
COPPER RE -PIPE, 50GAL WTRHTR, WTER MAIN
_
License CI I.ic. g
Dam Danusnm
DEC ON
As
Audi
understood 1 uunJ my AlaMall ho used u puM1lic mcordg
Licensed Pmfesckmal
OWNER -BUILDER DECLARATION
1 hereby aRm that I am exempt from the Contracrora License law for th,
fallowing sawn. (Satime 701.5, Business and Pc frssiom Code: Any city in County
which auroras a permit on ConLrrtct, alcor. improve, demNish. Or repair any flrunun,
Prior b its I=... she mquims the appliesnr forsuch Permit to file a signed statement
ties he is licensed pursuant o the provisions; or the Contractor's Littera Law (Chap= 9
Sq. Ft. Floor Area '
Valuation
(commencing with Section 7000) of Division 3 of the Business and Prefenions Cade) or
that he is exempt themfrom and the bash for dm alleged exemption. Any violation of
00
APN Number
Occupancy Type
P Y YP
SeNan 7031A by any applicant far a permit subjects the applicant to a civil penalty of
not mart than five hundred dollars ($30)).
36934027.00
❑L,siowucrofthe Property, arty amPloym withwago utheirsekeampeoadon,
Inspections
win do thewmk, tide the i ret kmnaea a oRcred (sank (Ser. 700x, Businm
Code: The Canaanola License law aro ant apply 1f rt owns of
and he Com
.Required
who ares suchwmkh roffearthreugh his
property h W who
pmpenywlc Wildsaimpavvth
imp vee orofferedfor
own employees,provided that wen imprevemenu are not ear
9c comm-
the buildingorimprovementissold within one year ofimproefor the
Wilderr,
purpose velli have the Wada of proving that he did rot build m improve far purpose of
i
tam.).
❑ 1. as owucr or the property, am eaGusively contracting with licensed Contretan to
catuhuct the project (Sm. 70,14. Busiruu sad Prafessiam Cade:) The Cmtrctors U
,
c. Law, dao art apply a, an owns of paperty who Wilds our hopovu theman. and
who mnuans far such pmjecu with a canasnm(a) licuued pmsuani to On Canuctoh
_
Ideease Law.
❑ I errs exempt undo See . B At P C for this recon
.
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby a1Rrm under penalty, or perjury ore of the faltering declanuons
1 bow aM will c unain sert • Cerol am *(consent to self-infa Workers Comped
doe. as provided for by Section r/110 a the labor Code, fa the perfamance of the
wort for which this Permit is issued.
❑ I haw anal will maintain Workers Compensation Insurance, u required by Section
37Wof,h.LLaabbpamr Code rJmperra an¢ofthewarkforwhic Oispemitisiuwd.
Carrier.//r pe u nwr� nni PolicyN.: 1` ra¢:
CER IFIC ATE OF EX PrION FROM WORKERS'
COMPENSATION INSURANCE
(ThisseNoa need rotho complemd ifthe permit Is form hundred dollars (SI00)
our kis)
1 comfy that in do pesfoma of the work Ch this permit is issued. 1 Mail not
employ any pawn in in rorw subject to the Wmkeri Campemation
Lam of Cuifomia C
AppO.a.
NOTICE TO�PtRANT: IL aw0mr making this Cennau, of Exemption, you shoubl
become subject to the Warden's Compensation, provisions of the lana Code. you mail
ford with comply with such previsions or this permit shut x deemed rewind.
CONSrRVC`nON LENDING AGENCY
1 hcmby aRm that Nero I.. command. andiml ageay, far die perfomarce car
Ne work for which this Permit Is issued (Sac. 3097, Civ. C.)
Leaders Name
.
fenders Address
I cvtify Nal I haw rued this application and gum must the show information is
coma 1 agree to comply with all city and county omit arces and shoe laws misting to
Wilding conversation. Md hereby authorize reprawmutive, of this city to enter upon the
shove-mcntimcd Property red inspection purposes.
(We) agree to save, indemnify and kap hamlets the City of CoaNno against
j Iiabllida,judgments, casts and expcnms which may in MY My acme gaiot said City
in consequence of tint of this pe
t APPLICANY ERSTANDS LL COMPLY WfH ALL NON -POINT
Issued by: Date 27
SOURC GU
e -roofs
Type of Roof
��J
Siywum of Applian aARDO Dau
HAZARDOUS MATERIALSDISCLOSUREmmeoSURE
Win the Of Imus Wilding atom orhandleto h
C
e, Chert
eaNaad Safety as denote by the Cupertino Municipal Code. Chapter 9.12. and Ne Health and Safety
aapplicantCupertino
Code, Section 35531(x)7All
C] Yet
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
Will dm applicant or future Wilding ottupanl ace equipmem in deepest which
it havaNno air conumimeas as defiad by the Bay Ama Ail Quality Management
all new materials fo t pection.
m7
0Yca �]attr
m
Ihawmail the aH rcquimmenu unser Chapmr6.95 of Ne Wilding
ria HcalN&Safety Cade,Sa 303.]5533 and .luedcrsmnd thatifthC Wilding
docs not cumntiy now ran . that k u amihilityu ratify ave oats r nr Nc
reqummenrs wh' afacwncmearoca
ignature of Applicant Date
02%��
All roof coverings to be Class 'A!' or better
Owner a mthorvc0 agent Dam
• 6 ITEMS OF 6
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 36934027.00
DATE ISSUED.......: 10/27/2008
RECEIPT #.........: BS000006467
REFERENCE ID # ...: 08100168
SITE ADDRESS .....: 20064 JOHN DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ..............
MICHAEL TIMPANARO PERROTTA
ADDRESS ..........:
20064 JOHN DR
40.79
CITY/STATE/ZIP ...:
CUPERTINO CA,
95014-4415
RECEIVED FROM ....:
LEONFRIDLIG
CONTRACTOR .......:
FRIDLIB LEON
LIC # 26052
COMPANY ..........:
NEW STRUCTURE
PLUMBING INC
ADDRESS ..........:
PO BOX 111143
CITY/STATE/ZIP ...:
CAMPBELL, CA
95011
TELEPHONE ........:
(408)364-2143
FLAT RATE
• FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
1BPWATER
UNIT
1.00
40.79
0.00
40.79
0.00
1BPWSVCS
WATER SERVICE
1.00
20.40
0.00
20.40
0.00
1BSEISMICR
VALUATION
8,600.00
0.90
0.00
0.90
0.00
1PPERMITFE
FLAT RATE
1.00
40.79
0.00
40.79
0.00
IPRWHEATR
UNITS
1.00
24.48
0.00
24.48
0.00
1TRAVDOC
FLAT RATE
1.00
40.79
0.00
40.79
0.00
TOTAL PERMIT
168.15
0.00
168.15
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
168.15
---------------
168.15
VOICE ID DESCRIPTION
-------- ----------------------------
106 SEWER & WATER
507 FINAL PLUMBING
0
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ---------- ----------
301 ROUGH PLUMBING
ClTi OF
46UPEkTINO
•
0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
PERMIT # v�
OWNER'S NAME: .r.Po
PHONE #
GENERAL CONTRACTOR:
�� #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
66
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature
Date
,rv�, .
CITY OF
• CUPEI�I
OS'/() 0/ c,::, 'F'
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
PERMIT APPLICATION FORM
APN # 2/ o �2-7, (�
Date:
Building Address: /
Fee
Group
Own is Name: ��
Phone #: 82/ 4�e
�jOB"
ae�' e Q
Commercial building
sewer/sanitary sewer
Contractor:
Phone #:
Fax #:
Contact:
ta
Phone #: Q8 3l5
eal-!
G 1Aie/0
Fax #:
Contractor License #: 6 3 72 V Fr
Cupertino Business License #:
1BSEISMICOM
Job Description:
P
�.e C —
Residential Commercial
❑
Valuation:
Project Size: Express L Standard GT Large ❑ Major ❑
1PRSEWER
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.
IRPSS
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
�+
i
1PRSEWER
Residential building
sewer/sanitary sewer
P
IRPSS
�g
CITY o
CUPERTINO
CITY OF CUPERTINO
REPIPE/SEWERIMAIN SERVICE
FEESCHEDULE
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1PRREPIPE
Residential re -pipe per fixture
P
1RPRP
IBPWSVCS
Water Service
P
1CPWS or
1RPWS
1PPRSEWG
Private Sewage Disposal System
P
1PCESS
Cesspool
P
/
113PWATER
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
1PLMBLNCK
Plumbing Plan Check
P
IPLMBINSP
Other Plumbing/gas Insp.
P
/
I
1TRAVDOC
Travel & Documentation Fee
B
1BUSLIC
Business License
B
f3P eat-cL
Revised 6-16-08
•.
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0