Loading...
08120111S�z aoo UZ< �=N � z t• CCK JyU L Lp< ZOO i$� YEN _z1 at 1- e5= 02 zC V a� LL � C UFF 0 C FD Ue CITY OF CUPERTINO CONTRACTOR4NF0RN ATI0N, BUILDING DMSiON PERMIT BUILDING ADDRESS: PERMITN0. 234 HANKI OWNER'S NAME: PERMIT ISSUE DATE '2808 p SAN CONTROL NO. ARCHRER/FNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ALJN A GAS LINE TO THE O O O O LICENSED CONTRACTOR'S DECLARATION FIREPLACE Job Description 1 hereby affirm that 1 am licensed under previsions of Chapter 9 (commencing winSection 7000)ofDivislon 3 of the Business and Professions Code, mal my licenic is in full forte and effect. License Clazs Lik I Da..'s P -ky(C_ Can L� DELL a I i ARCHITECTS DECLARATION 1 undenvand my plans "I be used as public rxords Licensed Professional OWNER -BUILDER DECLARATION 1 boost, ofiires not 1 am eacmpl from Oe Conmsam s Licame Law for the fallowing mason. (Sxtiun ?In 1.5, Business and Profeuiom CWc: Any dry or county which records a permit to construct. slur, impmw,, demolish, or repair any structure prior' m its issuance. atm rectums the applicant for such permit to file a signed statement Sq. Ft. Floor Area Valuation that W is licensedPursuant he the provisions of the Conuacmre same Law (Chapter 9 (commencing with Section ]DDB) of Division 3 of the Business and Prorcniom Code) or Nat ibe is asempl thertlmm and to bazu for the alleged exemption. Any violation of APN Number Occupancy Type Section 703M by any, appliant for a permit mbje ou the applicant to a civil Penalty of nut ares than fin hundred dollars ($50(y. I, az awmx of lie pm"y. w my employem win wages u noir mle compcnadon, Required Inspections Will do the Work. add the muctum Is nnlmlended.,.Read(nmol.(Ser. M .BusinW and Profession Cade: The Cantmctor's Licertse Law does not apply to an owner of property who builds or im proves thereon, and who dos such work himmlf or through his awn employees, Provided thatsuch impounmenta ase not intended ororte nd formic. IC however. the building W improvement's sold within oa sear of impletion, the owner - Wilder will have the Wman of proving that he did not build or improve fon, purpose or sale.). 1, as ..(ft property .m exclusive, canna ting with licensed centra users to comtmm the project (Sec. 7044, Busm. and Professions Code:) The Canuxeces Li- cense law does not apply man owner of property who Wilds of impro. mems.. and. who Contracts for such pmjecn with a comVdemr(a) licensed pursuant to me Commences License law. lomexemplumder Sea ,B&PCfaOisroaren Owner Data WORKER'S COMPENSATION DECLARATION 1 thereby affirm under penally of perjury, ..of the following declammuns: 1 haw and will maintains Certfrate of Consent to self -loom forWorkees Compcn. an, az provided far by Scamm 37M of the Labor Code. for the performance of the Wort for which this permit is issued. ❑ I have and will maintain WmIal'S CDmpeoollma bnursna, as oc uned by Section 3700 of the lobo Code, far me performance of the Work far which Out poran, is issued. - MyWorker's Compensation Insurance carrier and Policy number am: ^.t ' n Carries i Ma- e. a � Policy No.: a?1r 0 0 C3()i A. \.Tsa CERTIFICATE OF EIKEMPTON FROM WORKERS' COMPENSATION INSURANCE fNu aemiw nerd not he wmploed i(ne permit Is far one hundred dollus ($100) or less) I anify Oat in the performance of to work for which this Permit is Oned, 1 shall not employ any person in any monnerso as to become subject o the Workcd5'' Compensatan Laws or California. Dam Applicant NOTICE TO APPLICANT: IL after making this Certifieate of Exemption. you should become subject to me Wohc's Compcmvadon previsions of me Lata Code, you mum ' foMwith amply with such provisions or OTs permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY for the penfarmance of thereby aRrm Net there issed(See 0lendingagency ' the work fur which This peomit Is issued (sec. 3(97, Civ. C.) ' Landers Name , Lenders Address 1 cmtify mu 1 have mad this application and sum to the above information is ' comm I agree to comply with all city and county on nomas and slow laws relating to Wilding conaudectnn, and hereby mnoria repureartatives of tris city to enter upon the shove -mentioned property for inspection purpnsea (We) agree to on, indemnify and keep harmless the City of Cupertino against Iiabilitm,jud,nums, costs andespemm which may in any ways.. agar attaid City in c.nseeucncs of Oe Starting Of this permit. D APPLICANT UNDERST NDS ND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCEREG LA71y Re -roofs Type of Roof Foy ;< f ,� W-,�2 Pr Sugn rCof App c onmacmr D AZARDOUS MATERIALS DISCLOSURE Will the appltant or future Wilding occupant more or Mambo Meallons material at defined by to Cupertino Municipal Code. Chapter 9. 12. and to Health and Safely Conn. s:]Yesiss3l(a)7 //ta All roofs shall be inspected prior to any roofing material being installed. Ye C:] Yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant aha future building occupant use ccuipmcnt or devices which it ha.cardous air c.nlominants as dcOncd by the Bay Area Air Quality Management all new materials for inspection. thrid? ❑ yen t4'N. 1 haw, mad me haaaddn s, materials requirements under Chapter 6.95 of the coiror- niaHalm&SafctyCedc.Savas1 M5.25533a 25534.1undcrm ifnc Wilding dao it curmntY how, ate m that" u mY aespomitilily m nouly tic naxam, of me mgaimnmmwwhich m as asncam.ecrtifeate.rOce.pancy. Signature of Applicant Date ai` All roof coverings to be Class'%¢!' or better 'r Owns or aur genu D m' • 4 ITEMS OF 4. CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 34255005.20 DATE ISSUED.......: 12/17/2008 RECEIPT #.........: BS000006838 REFERENCE ID # ...: 08120111 SITE ADDRESS .....: 23400 VIA VENTURA VD20 SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER .............. MR & MRS BRINKMAN ADDRESS ..........: 23400 VIA VENTURA VD20 CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: MARK A HANKINS CONTRACTOR .......: MARK A HANKINS LIC # 26518 COMPANY ..........: HANKINS CONSTRUCTION INC ADDRESS ..........: 38227 FREMONT BLVD CITY/STATE/ZIP ...: FREMONT, CA 94536 TELEPHONE ........: (510)795-9654 • FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL 1BSEISMICR VALUATION 750.00 0.50 0.00 0.50 0.00 1PGASRES OUTLETS 1.00 61.19 0.00 61.19 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 143.27 -------- ---------- 0.00 143.27 ---------- 0.00 METHOD OF PAYMENT' ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 143.27 --------------- 143.27 VOICE ID DESCRIPTION 301 ROUGH PLUMBING • REFERENCE NUMBER -------------------- DISCOVER VOICE ID DESCRIPTION -- ---------------------------- 507 FINAL PLUMBING �kA 4 s+�vyk� CITY OF f UPEI�TIN0 i Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: LXr VA v� ��} V�llit� w SDL PERMIT OWNER'S NAME: PHONE # 6to lqe-c1(,GV GENERAL CONTRACTOR: -r FAX # ICS (� I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: O r/Contractor Signature Dake 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 O r/Contractor Signature Dake Of I ai-Q, CITY OF CUPEI�TINO 0 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE PERMIT APPLICATION FORM 021 a 0111 APN #� � � � I �v Date: n () Building Address: Fee Group Owner's Name: // Phone #: QS Commercial building sewer/sanitary sewer Contractor: Phone#: / Y., b ( C FILL Fax Contact: Phone # W) / 1 Fax #: Contractor License Commercial Gas Piping System 1-4 Outlets Cupertino Business License Job Description: t10 (-� 1BSEISMICOM esidential Commercial ❑ Valuation: 1BSEISMICR Project Size: Express © Standard Ll Large ❑ Major ❑ P 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. 1PRSEWERResidential Green Building Points: P Quantity Fee ID Fee Description Fee Group Permit Type 1PCSEWER Commercial building sewer/sanitary sewer P 1CPSS IBPREPIPE Commercial re -pipe per fixture P 1CPRP IPGASCOM Commercial Gas Piping System 1-4 Outlets P 1BSEISMICOM Seismic Commercial' P 1BSEISMICR Seismic Residential P 1PRSEWERResidential building sewer/sanitary sewer P 1RPSS (v. CITY OF CUPEkTINO CITY OF CUPERTINO REPIPE/SEWERIMAIN SERVICE FEE SCHEDULE . '. Quantity Fee ID Fee Description Fee Group Permit Type 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 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 / ITRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B Revised 6-16-08 0 1J E