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06100078 CITY OF CUPERTINO BUILDING,DIVISION PERMIT � `J[�ATC)R BUILDING ADDRESS: CUPERT INO PLUMBING PERMIT NO. 06100078 19480 RICHWOOD CT OWNER'S NAME: PERMIT ISSUE DATE .� KEN KISHI 1300 DE NE: SANITARY NO. CONTROL NO. (408)253-0618 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 O p LICENSED CONTRACTOR'S DECLARATION V E- 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description 2 w with Section 7000)of Division 3 of the Business and Professions Code,and my license is �y in full force and net L2 y I v REPIPE- GALVANIZED TO COPPER Z License Class - Lic.# t o Date Contractor C CHANGE WATER SERVICE ARCHITECTS DECLARATION .a U 1 understand my plans shall be used as public records 4—PLEX H Licensed Professional "n< OWNER-BUILDER DECLARATION 3 a I hereby atTirm that I am exempt from the Contractor's License Law for the .00 following reason.(Section 7031.5,Business and Profession Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure Z} prior it)its issuance,also requires the applicant foe such permit to file a signed statement =e 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 $10000 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy not more than five hundred dollars(5500). P y Type ❑1,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(See.7044,Business 00Required Inspections and Professions Code:The Contractor's License Law dors 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 We.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.). co L as owner of the property, exclusively contracting with licensed contractors to construct the project(Sec.7044,.Business and Processions Code:)The Contractor's Li- cease Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a conuactor(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: U I 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 arc: Cartier. !: -(-' rKIK• Policy No.: S Z 3 0 L CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 1 certify 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 O forthwith comply with such provisions or this permit shall be deemed revoked. z N CONSTRUCTION LENDING AGENCY Fr►. I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) Q Lender's Name 0 z Lender's Address U C) I certify that I have read this application and state that the above information is LL,► correct.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. G], (We)agree to save,indemnify and keep harmless the City of Cupertino against H lA liabilities,judgments,costs and expenses which may in any way accrue against said City r U Z in consequence of the granting of this permit. APPLICANT UNDU4TANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC Re-roofs SpV0b&dWr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal- ,Chapter 9.12,and the Health and Safety Code,Section 2,5532(a)? ❑YesO.N. All roofs shall be inspected prior to any roofing material being installed. 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 I.hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. I_,trict? O Yes IEfNu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently ha ant,that it A' my rcspons' '' to notify the occupant or the rc ' ments met ' to iss of a CertificateOccupancy. F0- i,- OG Signature of Applicant Date Owner authorized crit Date All roof coverings to be Class"B"or better ag CITY OF CUPERTINO m 2 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37501009 . 00 DATE ISSUED. . . . . . . : 10/11/2006 RECEIPT # . . . . . . . . . : 36394 REFERENCE ID # . . . : 06100078 SITE ADDRESS . . . . . : 19480 RICHWOOD CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER KEN KISHI 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 26 . 00 234 . 00 0 . 00 234 . 00 0 . 00 BPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ---------- ---------- -------- -- ---------- TOTAL PERMIT 281 . 37 0 . 00 281 . 37 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -- - --------- - ---- -- - --------- ---------- ------- OTHER 418 . 74 VISA TOTAL RECEIPT 418 . 74 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/ . /MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # Date: Build' / /Address: Owner' Name: Phone#: Contractor: Phone: License #: (�� 4 �� .�� _ �,E 2 .5 0(0 Contact: Phone: Cupertino Business License#: FrC,,,A,- - 30 •-3 9 > ) Building Permit Bldg ❑ Elect ❑ Plumb C, Job Description: Residential Commercial ❑ Cost of Project: /p,C)c- 6) 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