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06100152 CITY OF CUPERTINO yy`�t0. ioi BUILDING'DIVISION PERMIT CUPERTINO PLUMBING BUILDING ADDRESS: PERMIT NO. 06100152 10059 DOVE OWNER'S NAME: PERMIT ISSUE DATE KENT GRINDSTAFF 1300 D )NE: SANITARY NO. CONTROL NO. 408253-0618 ABUILDING PERMIT INFO RCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 o p LICENSED CONTRACTOR'S DECLARATION Job Description ro I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z uj with Section 7000)of Division 3 of Ute Business and Professions Code,and my license is <,, in full force and t_� yU COPPER REPIPE .nA ;A(/ t v�Z License Class�•�Lam•# F-p Date Contractor ARCHITECTS DECLARATION a< 1 understand my plans shall be used as public records .96 u y Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the i00 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to concoct.alter,improve,demolish,or repair any structure } prior to its issuance,also requires the applicant for such permit to rile a signed statement =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3APNIR r. 0 0 Occupancy Type not more than five hundred dollars(5500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered forsale(Sec.7044,Business Required Inspections and Professions Code:The Conuactoes License Law docs not apply to an owner of q p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contacts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sea B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I]1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Carrier. �G?'-+)4-t-,, m°, Polity No.:.71 1(O v`" 3180 ERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is far one hundred dollars($100) or less.) 1 certifv that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,Z forthwith comply with such provisions or this permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of p(� the work for which this permit is issued(Sec.3097.Civ.C.) W Q Lender's Name Lenders Address U O I certify that I have read this application and state that the above information is LL►" correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against E'y to liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. / ►� APPLICANT UNDERS S. WILL C WITH ALL NON-POINT Issued by: Date OURCE R Re-roofs Signature of icant/Co for Dare T Of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. C]Yes QNo Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contamin;No as dcf y the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have read the hazardous materials requirements under Chaptcr 6.95 of the Califor- nia Health&SafctyCodc,Sections 25505,25533 and 25534.I understand thatif the building d n t current y ha t, my responsibility to notify the occupant of the on m ri t0 iss cc o ,Cate of Occupancy. Signature of Applicant Date All roof coverings to be Class"B"or better Owner or aLVf ori=d agent Date Community Development i,itte 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 SO CIN OF Fax(408)777-3333 "UPEkTINO Building Department JOB ADDRESS: PERMIT # a as L --4: OWNER'S NAME: PHONE # 5�-y _7O SS GENERAL CONTRACTOR FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 Ker/ ontractor Signature Date CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN 34232098 . 00 DATE ISSUED. . . . . . . : 10/20/2006 RECEIPT # . . . . . . . . - : 36506 REFERENCE ID # 06100152 SITE ADDRESS . . . . . : 10059 DOVE OAK CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER KENT GRINDSTAFF ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : FRANK CARDIA CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612 COMPANY . . . . . . . . . . : CUPERTINO PLUMBING ADDRESS . . . . . . . . . . : 1300 DELL AVE, STE C CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE (408) 253-0618 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - - - - ---- - - - --- - ---- - - - --- ----- -- -- ---- ---- ---------- - ----- ---- --- --- --- - BPREPIPE NO OF FIXTURE 9 . 00 81 . 00 0 . 00 81 . 00 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ----- ----- ---------- --------- - -- ------ -- TOTAL PERMIT 119 . 37 0 . 00 119 . 37 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -- -- - --- - - --- ---- - ----------- ----------------- - OTHER 119 . 37 VISA TOTAL RECEIPT 119 . 37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---------------------------- ----- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING CITY OF CUPERTINO O&1 C0 5"` REPIPE/S ERS/MAIN SERVICE CUPEIOTINO PERMIT APPLICATION FORM p APN # Date:�� 12�, �2-��C� �CU �- 2 U •-CJ�o Building Address: /00 q Owner's Name: Phone#: evl �., 5 c �'F 5cq-'7095 Cntractor: Phone: License#: �2'4 9 �!, j-41�-- Cont ct: v Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb G�-- Job Description: Residential Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING