B-2016-2578 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO:B-2016-2578
10166 BONNY DR CUPERTINO,CA 95014-2904(359';11048) GLADIATOR REPIPE
j INC
SAN JOSE,CA 95136
OWNER'S NAME: JON LEWIS DATE ISSUED:08/23/2016
OWNER'S PHONE:408-7614014 PHONE NO:(408)444-2696
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C--3S Lic.#1008291
Contractor GLADIATOR REPIPE INC Date 10/31/2017 X BLDG _ELECT X PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing N ECH X RESIDENTIAL COMMERCIAL
with Section 7000)of Division 3 of the Business&Pro IFessions Code and that my
license is in full force and effect, JOB DESCRIPTION:
REPLACE WATER MAIN SERVICE;RE-PIPE WATER LINE;REPLACE
I hereby affirm under penalty of perjury one of the following two declarations: 50 GALLON WATER HEATER IN GARAGE;(N)GAS LINE TO MAIN
1. I have and will maintain a certificate of consent to self-insure for Worker's REV#1-REPLACE BUILDING SANITARY UNDER CRAWL SPACE
Compensation,as provided for by Section 3700 of the Labor Code,for the SFD;ADD FOUNDATION CLEAN OUT-ISSUED 8/25/16
erformance of the work for which this permit is issued. REV#2-ADD PROPERTY LINE CLEAN OUT-ISSUE 8/29/216
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. % Sq.Ft Floor Area: Valuation:$9000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and;hereby authorize 359 11 048
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We),agrto save indemnify and keep harmless the
City of Cupertino agains abiliti judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against,
gainst City i consequence of the,granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally;thea cant un rstands and will comply with all non-point
source regu_tio erthe upertino Municipal God ction 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8/29/2016 Issued by:Kim Dunbar
`. Date:08/23/2016
1herebyaffli. that I am exempt from;the Contractor's License Law for one of the RE-ROOFS:
following tw, reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is,
1. - as owner of the properly,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code),
I,as owner of the property am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:8/29/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534.1 will
permit is issued. maintain compliance with the Cupertino unicipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 2553 a should I store or handle hazard
shall not employ any person in any manner so.as to become subject to the material.Additionally,should I use a ui meat or devices which emi zardous
air contaminants as defined bIthe
y ea Air Quality Manage nt District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance withpgitino Municipal Code,C apt and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Ctions 25505,25533,and W34.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. ier or authorized agent:
APPLICANT CERTIFICATION ' ate:8/29/201$
1 certify that I have read this application and state that the above information is E
NCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a cons uction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is 1 ued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs;and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal
1T'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 8/29/2016 Professional
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISIO
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228`• FAX(408)777-3333•buildingQcuper ino.org
+CUPERTINO
mist;
ZBRvG O MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN n
ON NERNAME I PHONE y R�'f/ J E-I`ZAIL
STREET ADDRESS I CITY,STATE!(,ZIP FAX
CONTACT NAME j PHONE �y E-MAIL
cc
STREET ADDRESS ® CITY,STA E,ZIP FAX
V) IEl.
o-mxER. ❑ OR'NER-BuiLDER ❑ ORN.TFRAGENT ❑ CONTRA ❑CONTRACTORAGENT ❑ ARCHITECT ❑. GATEER ❑ DEVELOPER ❑ TENANT
CONITRACTOR NAM LIC ' E NUMBER LICENSE TYPE BUS.LIC
P � lZc �q
COMPANY NAIM E-MAI FAX
STREET ADDRESS � C T.T .ZIP � PHC�NB
ARCMTECTIENGNEER NAME LICENSE NUMBER BUS.LIC r
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE,
USE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDI.AATD ( PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes ❑ No
DESCRIPTION OF WORK
TOTAL VALUATION: RECEiVEDBY
By my signature below,I certify to ac f the ollowine: I aur the rope] Vo,-,nper'..�,authwized/.ent to act on the pr perry owner's be lf. I have read t 'sapplication and the information I hai p o id is correct. have r ad the Dno and verify it is ac to I a e to comp. wi I applica le I cal
ordinancesand state laws relating to i] in construction. autho zereprs of Cupertino to enterth b e e erty o sp c on mos s.
Signature of Applicant/Agent: Date:
L INFO I TION REQUIRED
SUPPLE E TAx ., . oFFICE LSE 6?. Y7
a
O�ER-THE COUTTER
E. I] EXPRESS '
D STAn'D�.RD
U �
<
'�2�70R
h1EPn7iscApp_7011.doc revised 03/16111
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2578
10166 BONNY DR CUPERTINO,CA 95014-2904(359 11 048) GLADIATOR REPIPE
INC
SAN JOSE,CA 95136
OWNER'S NAME: JON LEWIS DATE ISSUED:08/23/2016
OWNER'S PHONE:408-761-4014 PHONE NO:(408)444-2696
LICENSED CONTRACTOR'S DECLAI2 TION BUILDING PERMIT INFO:
License Class_QK Lic.#1008291
Contractor GLADIATOR REPIPE INC Date 10/31/2017 X BLDG —ELECT X PLUMB
_
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
REPLACE WATER MAIN SERVICE;RE-PIPE WATER LINE;REPLACE
I hereby affirm under penalty of perjury one of the following two declarations: 50 GALLON WATER HEATER IN GARAGE;(1)GAS LINE TO MAIN
1. 1 have and will maintain a certificate of consent to self-insure for Worker's REV,#1-REPLACE BUILDING SANITARY UNDER CRAWL SFD;
Compensation,as provided for by Section 3700 of the Labor Code,for the ADD F6 UN,],?- CLEAN OUT-ISSUED 8/25/16
performance of the work for which this permit is issued. 1
j
� r d� .
z have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this ,
permit is issued. Sq.Ft Floor Area t�alutio�{ $9Q110 Q0 r ° ,
APPLICANT CERTIFICATION s
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 359 11 048
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 liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will corpply with all non-point
source regulatiIs per the Cupertino Municipal ede,Section 9.18. 180 DAYS FRO -INSPECTION.
Signature i Date 08/25/2016 Issued by:MELISSAN
Date:08/23/2016
ER-BUILD DECLARATION hereby affirm tha I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as owner of the property,or my employees with wages astheir sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/25/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's -
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I us quipment or devices which emit hazardous
air contaminants as defined by th y Are utility Managem(n�istrlct I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with th ertino Municipal Cod Cha ter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safe }; :tions 25505,25533,and ,534:
Labor Code,I must forthwith comply with such provisions or this permit shall i
be deemed revoked. Owner or authorized agent
APPLICANT CERTIFICATION Date:08/25/2016
certify that I have read this application and state that the above information is CONSTR6
-NDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a constru�i pp lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued,(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name v
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino MunicipalARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 08/25/2016 Professional
GENERAL PERMIT APPLICATIONM P
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
IGUPL'RTt[�It (408)777-3228•FAX(408)777-3333 buildin4Ca cupertino.or
T;ry
•RLUMBING ❑MECHANICAL ❑ELECTRICAL, ❑MISCELLAl�EOUS
PROJECT ADDRESS l C" f' �OUWAb N Y l' I V
OWNER NAME if l It PH // E-MAIL
STREET ADDRESS CITY, S TE,ZIP "y FAX
CONTACT NAME % PHONE E-MAIL
q
STREET ADDRESSt � CITY,STATcE ZIP _ Aa
is-•s.., C�d"•�-. .�...,_`�-
Il IowNER ❑ omAER-BUILDER ❑ OWNERAGENT / RACTOR 11CONFIRAA. AGENT El ARCHITECT ❑LimLNEER El DEVELOPER ❑.TENANT
COhTRACTORNAME / LICENSEIQUfj2BELICENSFYPE BUS.LI
« l l C
�-
COMPANY NAME MAIL FAX
�Y.✓�/GL-`:If—� �I�✓ /�4.� ,C� `��'�G%a°�(�,.. ice.- .?
Ll
STREET ADDRESS / CITY, ZIP PHONE
ARCHITECT/E GINEERNAME I LICENSE NUMBER BUS.LIC
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE,
USE OF / SFD or Duplex ❑ Multi-Family PROJECT IN NVILDI:AI\TI) I PROJECT IN
STRUCTURE:: ❑ Commercial URBAN INTTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ Na
DESCRIPTION OF WORK c
zL
TOTAL VALUATION: RECEIVED BY '
By my signature below,I certify to each of thlowing; I am the rooe,ty nsx�er_nr authorized went to act on the property owner's behalf. I have read this
application and the information I have pro ed is comic. ave read the Description of\oind verify it is accurate. I gree to comply with all applicable local
ordinances and state laws relating to ction. thAE�elneserC Caves o Cuperti to enter above-i ntified property for ips ection purposes.
i lJ
Signature of Applicant/Agent: _ _•.•--- Date:
i
)?F-)"IvT1ENTAL INTFORMA QUIRED
ER 7HF COUNTER
f' ❑ EAPRESS� ,
N ARD,
LARGE
A&EPA7iscApp_201I.do revised 03/16111
i
i
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRES CONTRACTOR: PERMIT NO:B-2016-2578
10166 BONNY DR CUPERTINO,CA 95014-2904(359 11 048) GLADIATOR REPIPE
INC
SAN JOSE,CA 95136
OWNER'S NAME: JON LEWIS DATE ISSUED:08/23/2016
OWNER'S PHONE: 08-761-4014 PHONE NO:(408)444-2696
LICENSED C NT CTORIS DECLARATION BUILDING PERMIT INFO:
License Class CC-36 Lic.#1008291
Contractor GLADIATOR REPIPE INC Date 10/31/2017 X.BLDG _ELECT XPLUMB
I hereby affirm that I�m licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL—COMMIDRCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force nd effect. JOB DESCRIPTION:
REPLACE WATER MAIN SERVICE;RE-PIPE WATER LINE;REPLACE
I hereby affirm under penalty of perjury one of the following two declarations: 50 GALLON WATER HEATER IN GARAGE;(N)GAS LINE TO MAIN
1. I have and 7ill maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
2. I have and v ill maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$9000.00
APPLICANT CERTIFICATION
certify that I have re d this application and state that the above
information is:corrects I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 35911 048
representatives of thicity to enter upon the above mentioned property for
inspection purposes.t(We)agree to save indemnify and keep harmless the
City of Cupertino againfstlliabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against�said ity in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,thea plicar) unders and v�rili comply with all non-point
source regulatio �pe upertino Mun'ei al Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signatur Date 08/23/2016 Issued by:Kim Dunbar
Date:08/23/2016
ION
I hereby affirm h t I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two re is us All roofs shall be inspected prior to any roofing material being installed.If a roof is
t. I,as owner pf the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec,7044,Business&Professions Code)
2. I,as owner bf the property,am exclusively contracting with licensed Signature of Applicant:
contractors o construct the project(Sec.7044,Business&Professions Code). Dater 08/23/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and {'ill maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and v�ill maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify tha in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay ArZ Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cup, tmo opal-Gude;Gha ter 9.12 and
exemption,I become subject to the Worker's Compensation provisions ofthe the Health&Safety Code,Se -1
,n 25505,25533,and 2 534.
Labor Codes I must forthwith comply with such provisions or this permit shall,_,,
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:08/23/2016
I certify that I have read this application and state that the above information is CONSTRUCTION zTrLC_1�
correct.I agree to comply with all city and county ordinances and state taws I hereby affirm that there is a constructs n lending agency for the performance
relating to building cgnstruction,and hereby authorize representatives of this city of work's for which this,permit is issued $ C.
3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,an;d expenses which may accrue against said City inconsequencLender's Address
Code,Section 9,18 of the ranting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
p y it non-point source regulations per the Cupertino Municipal
and will come) with I I understand my plans shall be used as.public records.
Licensed
Signature Date 08/23/2016 Professional
GENERAL PERMIT APPLICATION M E
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE-AVENUE-CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(a1.cupertinCUPERTIN'Oo.org gm I S
1 3-go/& -ajj
JI ,UI�QBII�TG DMECHANICAL []ELECTRICAL ❑MISCELLAI\TEOUS
PROJECT ADDRESS 1
i
l/4 tr APNY `7 0 j
OWNER NAMF PHONE E-MAIL
74W w,
STREET ADDRESS I yJ f F4190ITY, STATE,ZIP � FAX
CONTACT NAME PHONE E-MAIL
STREETADDRESS I CITY,STATE,ZIP Fps
r
❑ OAT'ER ❑ 016TER-BUILDER ❑ OWNTERAGENT 2 CO"RACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑.TENANT
CONTRACTOR NAM .`L -� �S r ' LICENSENUMBER CENS �E �� BUS.LL
/ �
E-MAIL c
l
COMPANY NAME i FAX` �
STREET ADDRESS I' _ CITY,ST.TE. P l g HONE,
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC r
COMP.ANYNAME F_MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF I`/2 FD Or Duplex El Multi-Family I PROJECT IN WrILDLAND I PROJECT rN
STRUCTURE: /❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO
i
DESCRIPTION OF w0 "
I
TOTAL VALUATION: L9 O
i
I
i
f
By my sipature below,I certify to each of the foilvv' a: I a",rhes,o erty owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have pro-vid - ect. I have read the Des ci' of Rork and verify it is accurate. I agree to comply with all applicable local
ordinances and state!laws relating to co ction. I authorize representatives f Cupertino to enter the above-id tified pr erty forection proposes.
SiQnatureofApplic+t/Agent: a .- Date: in
a6
SU'PLEMENTAL II�tFORR7 N REQ IRED � ;_ �. ._ ,
n R Y r ❑ OLER=THE COLTTER
., ��. a t' ,❑ E7�PRfiSS � „K ;..
v a
LARGE
I] �2470R
I
MEPMiscApp_7011.doe revised 03116111