08110046 CITY OF CUPERTINO a .@sscwwa 4rcR,rk:.s > +-�' Pre
BUILDING DIVISION pERngl'r CONTRACTOR INF..URMATIQN
4 x.,rrl:r8i^. 5 ; ;>d., zt?f 'ro-i
BUILDING ADDRESS: PERMrr NO.
10990 N STELLING RD RAPID PL
OWNER'S NAME: PERMIT ISSUE DACE
PC) I�Qx 544.41 O E A 12 O. CONTROL NO.
(4 08) 866-1417
ARCHrMC`rIENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
woo LICENSED CONTRACTOR'S DECLARATION Job Description
rd F 1 thereby IicvN v
scby"m that 1 aunder provifiaof Chapter 9(commencing
'j with 5ection]1111U)of DivisianJof NC Business and ProfcssiuupCmRP endmylicenscis
"o adi bfill om.roti all O�� /T,r�' REPLC 8 ' OF 4" CAST IRON FRM GREASE TRAP TO
jJaz ucense Ciass Lie.•
Dale - - cantramm CLAYPIPE & 8 ' OF 4 CAST IRON FM R/R TO CLAY PIPE
eQ CHr1ECTS DECLARATION
eU
s I tandem and my phos sbdl W used an public records,,
kp Licensed Professional
OWNER-BUILDER DECLARATION
I hereby aRrm that I em aempt from the Canmctors Lkense Law for rho
ZOO fa0awing reason.(section 7011.5,Business and Pmiltu mns Code:Any city or county
$ which r,m.a permit to consuucl cella,improve.demalLN.or-pair any suumu-
_zi prior b its bmame.aho rtquires tho spplicut forsuch Permit on file asigned statement
< thatW is licensed pursuant lm the previsions of de Conuacmrs U..law(Ch.pa9 Sq.Ft. Floor Area Valuation
Y (commencing with Section 7000)of Division Sol the Business and Professions Cade)or
Q 3
at he u exempt thereImre and the basis for the alleged aemption.Any Aolatlon of $7500
Section 703 L5 by any applies,for.permit mbjects the applicant on.,Wil penalty of APN Number Occupancy Type
rot,ort than fw boosted dollsos(5300} 32609051 . 00
I,uowrcroftho propvty.mmy maplyea such wgusuthvsole ampenuuon,
win do ucwort,ask the sn antra is tmtintanded ornffued foresee(sec.]Oa.Busies¢
and Pmfeseems Code:The Contractors License Law clan not apply In an owner of Required Inspections
property who Wildsaimpmwsthetron,and who data suchwork himselfor through In
awn employees,protided that such improwmau ere not intended oroffered forsec.IL
howewr,the Wilding or improwment usold within one yens of completion.the owner.
Wilder in lune Ne Wed.of Front,that he did Out Wild Or improne for purpose of
sale.).
❑I.as owtler of Ih Property.am eaelusively comncting with licensed mnusaas m
comtrun the ptojm(Sec 7044,Business.ed Prefeadans Cade:)The Conuscmrs Lf-
cause law dons not apply b an owner of property who Wilds ser improws uwmon,and
who concocts for such projects with a comracmr(s)licensed pursuant to the Contractor's
License law.
❑l ate exempt under See .B&P C for this reason
Owner Dale
WORKERS COMPENSATION DECLARATION
1 barely On.under Xney of perjury one of the following decimations:
I haw end will maintain a Ceroficataof Consent m self-insom for Wor4Yf Camper-
.a,as provided for by Sado.37W of rite Ichor code.lm tho perfmmme of use
were for which this Permit is issued.
❑1 haw and will maintain Workers Compensation Iwrsnec,an me,uhad by Section
3700 of the LaWr Code,for the performance of the wort for which this permit is issued
My Workers Compensation Insurance artier and Policy number art:
Cartier. / fl }a^�4. policy No.:OGLC.AAD7 goi-7
'C�FICA E OF EXEMMON FROM WORKERS
COMPENSATION INSURANCE
(Thu mcfim read retho completed lithe Permit H forebC hundred doOars(SIOO)
or leas)
I comity thot in the perfoman¢of um work for which this permit is broad.l shall not
employ any person in any manor an an an become subject to the Workers Campco atjon
Laws of Califomis Dau
Applicant
NOTICE TO APPLICANT:If.after making this CeNnale of Exemption,you should
Wcome subject to the Wohm's Commutation provumns of tha L stmr Code you most
O z forthwith comply with such provisions or this permit shall In decreed-yoked.
.Zi y CONSTRUCTION LENDING AGENCY
[ti IherehyalRrm Wtft.i..consuuctinn lending agercy,for the perform..of
Ci the work for which this Permit u issued(Sec.3097.Civ.C.)
1 Q Lenders Name
D z Lenders Asea—,. .
U Q 1 caufy this 1 haw read this application and sen-this use show isuf rmatiun u
[I. ^ comtt I agsu b comply with all city and county on wrens and scale laws minding b
0 building conswction.and hereby suNorim rtprtscnuuws of this city to cow upon ft
show-mentioned property for ivpcmfon purposes
F0. (We)agree to saw,indemnify and kap hasmleas the City of Cupertino against
fn liabilities,judgment.cams and experms which may in any way cave against said City
U Z in eonsco,.of the gruung of this permit y-
w. AP (CANT UNDERST DS AN L COMPLY WITH ALL NON-POINT Issued b Date C G F
S R 0.EGUTA
_211-16K- Re-roofs
nat
Sigure of Appli_HAZARDOUS MATERIALS DISCLOSURE Data
Type of Roof
Will the applicant or future Wilding orcupantmrt or handle haurdous m.¢rul .
as defined by tae Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Cade-Sccom,25532(.)? —/ All roofs shall be inspected prior to any roofing material being installed.
E]Yen [jNO
Will the applicam or tumre building occupant use component or deviau which If a roof is installed without first obtaining an inspection,I agree to remove
It harard.v.ir carman Us.defood by the Bay Arca Al,Quality Management all new materials for inspection.
Wn4 --//
❑Yn SAO y
I haw mad Ne haccum.materials-quixmem s under Cluptard.95 of the Califm.
nu Haled&Safety Code.Sermons 25505.25533 and 25534.1 understood thatif d-Wilding
dm not cm-ndY haw.te..L u my home.1, 'y m nobly the Occupant of the
rats which, mel t marcs Ofa CemOcale of Occupmq. Signature of Applicant Date
rtW /.
/1->��-o�
0 .ammliYed.gml Date All roof coverings to be Class'%f{."or better
4
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32609051. 00
DATE ISSUED. . . . . . . : 11/12/2008
RECEIPT #. . . . . . . . . : BS000006595
REFERENCE ID # . . . : 08110046
SITE ADDRESS . . . . . : 10990 N STELLING RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CONRAD FREEMAN
ADDRESS . . . . . . . . . . : 10990 STELLING RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM RAPID PLUMBING, INC
CONTRACTOR . . . . . . . : BRIAN PULLAN LIC # 29716
COMPANY . . . . . . . . . . : RAPID PLUMBING INC.
ADDRESS . . . . . . . . . . : PO BOX 5144
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95056
TELEPHONE . . . . . . . . : (408) 866-1417
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ----------' ---------- ---------- ---------- ----------
1BSEISMICO VALUATION 7 , 500 . 00 1 . 68 0 . 00 1 ..68 0 . 00
1PCSEWER UNITS 1 . 00 20 . 40 0 . 00 20 . 40 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 103 . 66 0 . 00 103 . 66 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 103 . 66 #1795
---------------
TOTAL RECEIPT: 103 . 66
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------- ---
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
� e
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aCITY OF CUPERTINO
nA REPIPE/SEWER/MAIN SERVICE.
CUPERTINO PERMIT APPLICATION FORM
APN # 2a (o o c)/� o ��
Building Address:
Owner's Name:C_&VLr Phone #:644-p
Contractor: 3Fj7Ca>ir�Cc�� hone #: L60 -9&�/=
447� !//{ Fax #:
Conta : Phone#:
<ST�v� ala.d�s
Fax #:
Contractor License#: J&Z
Cupertino Business License#:
Gct-SY—L rn 4 7— C
Residential ❑ Commercial
Valuation: '
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
IBPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
1BSEISMICR Seismic Residential P
1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO
REPIPE/SEWERIMAIN SERVICE
mo
CUPEkTiNO FEE SCHEDULE s
Quantity Fee ID Fee Description Fee Permit Type
Group
1PRREPIPE Residential re-pipe per fixture P 1RPRP
113PWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFLYTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
IBPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1PLMBLNCK Plumbing Plan Check P •
1PLMBINSP Other Plumbing/gas Insp. P
ITRAVDOC Travel &Documentation Fee B
1BUSLIC Business License B
Revised 6-16-08
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