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06080072CITY' OF CUPERTINO Co TNFORMATI(.k�I BUILDING DIVISION PERMIT s 8 -•trvy BUILDING ADDRESS: CUPERTINO PLUMBING PE`MRNo' 06080072 10142 AMADOR OAK CT 'S NAME: PEBMrI SUE OAT: TISH HELEN 1300 DELL AVE UE C 08/10/2006 BE SANITARY NO. CONTROL NO. (408)253-0618 ARCHnECTIFNGINEER: B=ING PERMITIN BLDGF1ECf PIlIMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I tmeby a1Rrm Jw 1 am B mad "M Plovlao°s a Chaper 9 (samme t rhh Saban 70)0) of Dlvui«t 3 or N° Bud^^•• and Pmfosasau Code. and my Ikcrtx u in rat l[Io= u� p "; COPPER RE -PIPE, WATER -MAIN CHANGE OUT, REMOVE Oi'lafa 3^ c' r ti _I AND REPLACE WATER HEATER o ARCHITECT'S DECI.tRAn N I uMenaanJ my Plwu stall k mN u Pithk n nds Licrn¢d Rofosdonal OWNER -BUILDER DECLARATION 1 kmby affirm NUI I am oemp from til Conb tel License law far We i following rtAmm (Satan 70313. Buslnas and Pmfemou Code: Any oily or aunty W hill nytums a Pa,min to anmun. alw, snR . acmnlIsh. « mpur any rvvctum ! prior in its iuumo,auutcauka do applkant for mch permit in nil a sig«d awemai LLa Sq. Ft. Floor Area Valuat$�000 thitim.ken dpmwaatoft nfain. esucOinisnow',L (mpm,9 . (c«nmencln{wiihsavnnr0f)0)NDiviuon3oflk Builrct+ ud Prnrossi°nacoOcl« Nu k 1, amen' Ituefmm and be bola to, Je aflord -.I'd. Any v6nlaian of p cu an e Occupancy type Soctka 7O31.5 by any applkant fix a Peanth mb)ecu Je-WIsoant to aciWl pmasyN a« come Nan nw lttvdma dollar (53(10;. 34M820.00 ❑ Lc,aweerk. Jk pmpury.a ampenotkn• Required Inspections q P ifempbyca oBlr frIkircoil Jc Oe Bud onuawesot Rend r«aakfply andda to . mvigh of he T i— L f Cade: Covucmrs Lkrnx Law aoa cot apply and sim Co ny a,,sova f t propenY Wk W iMs «Impows theeaa, and W lm da,nmeh wrk sivud(«Ifrwgh has, m awncmp Jeanmch yap.toold auue coli, f«»k B. Ofomanemd dsyss,ffing.tl taboo, Iheau ;sag« imgo,rnrrntLnla.ghin omyur offto p on,meow«a- W W taw Un burden of pg that k did as build «hopmw f« pvryoe of sado 1. uk.L co L u awaer of this, paepeny, .B eacl®wy eanaaning Wild U-sassdC mmraum m [«mutt (Sec. B and Cade)Tk Cmtrae Py ,,hd«u of Q. nd ceoae Inon a«a cot apply' m m owrcr d Paopeny woo tuna, «ueymaea IIGNa aaa. dos. to an w Woo rnnuacu f« avd Projttu WJh a e«uan«(s) Umt:d pmmaon to Ise Cmvrcmh IJccac Taw. ❑Tun ...,,,qurdv See .Bd PCf«NU leasao WORKER'S COMPENSAnON OC-CLaRATION 1 to oby affmn colder'° sly of pvrjtvy arc of the follawlog aalarYianc Q Ibawmd Lmamusioac.0 teofc .."ttouH-I"^,^f«w«ters Compoo- viaca station, u laef« by section 3'!00 of Ne Lab« Code. r« Jen ped«ai— of this wank f«Wtch NisP itis iwcd m 1 law aad will malnldn w"ke, C«np scion lasavara, u ngdrtd by Scrum . 37OD of de Lab«Code. for Its, Pcrfasmance of Ne Wank f«wild this nail IsI , A My W«kerJs) pa- —Camlemauon Inwrmcc camiu and Poky rwmbc ao . �y VL—«5 Polley Na: tf, r? 5 Canter. I CERTFlCATE OF WCEMP'nON FROM WORKERS' COMPFNSAnON INSURANCE CnIs mlm ead not k compkcd a Its pcmit is fmore handd dollen ($IBM less) 1 «rury Nat to the perfvmua of Je w«t f« Whkh this pttmit U imetl. I stag Trot employ my person In my mamter,oumbeameaub).t on Ne Wwten'C«npensaJan . C of Cdlrarola. Dam Applkam NOTICE TO APPLICANT: If, afkr maMng this C«tilkatc a Esmption, yw sanutl became "I= m til Wo 'a ConaNnuJev Pr ons a We Lab« Cade, you moa i� foMwitb comply will such pravukm or Jds permit Nall k deans motel n f N LENDINGkndinGENCY tya, 4.00 ageaer r«NcpMormmcc of 1 kmbyaBlam Jutdineu arm . (Six. 3nknaing the does for which Ws pvmh u iuucE lsa. 3093. Civ. G) I1nOcrs Nave ' Isdcrs Addmn Z I cetifr that 1 haw rad this application and awe mw til Naw Infmmatiun ii rococo I n= in c«nply With dl city and Moly ardlnanes and tam laws muting to Wilding onsu,eti sod of this city succors upontle show menti. N pmpcny f« unlemian Purpme. in, on.incbyauJwdmop tammiws (We)grne ms .indomafy and! tap Ne City of ot ( ,y In m .'ainattodd City n Iubllltla,fodgmrnu,coau a,dof""amit- may In mywyaameagdnu Sala City Z °gCANT 66 APcmury«rceaf ;KD S D5 AND ILL COMPLY WIT; ALL NON -POINT Issued by: Date SOUR U Re -roofs Type of Roof Slgoaturt ,'A RDOUSMATERIALSDISCLOSURE Oam WIU Ile wpH W t «r««e btdlding aauPwt a«C «hmlmc haaalloos maeald denned by the Cupmino Murwipal Code. Chapter 9.11. and the Health aril Way S«,ion1553xan—/ Y. All roofs shall be inspected prior to any roofing material being installed. El j�Na If a roof is installed without firs[ obtaining an inspection, I agree to remove will Jen applbu«m fnum Wildingoavpam me cgoiMent«dnim Wbkb wo haura«m air conum1. u and by Je Bay Arta Ai; Quality Maaall=nt all new materials for inspection. Duo- tt7 ❑ Ya Ihuxmdtil hanrdtats mUtcrlaumquimmeuurdcrQupus695of Nc Calif«- /V "v nu FldN&SdttyC W.SDS, 23577 7357s.l uvlcrvard llutifJc dddiny �1•--. Iwtc tri Was ltv fy lk oavp,ntMJs mqu mmcntsar met r. Cttufaae � /// ( S' re f -Applicant Date �� All roof coverings to be Class "B" or better O•v «wtharbcdspot Dam' 1 1 of 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34232020.00 DATE ISSUED.......: 08/10/2006 RECEIPT #.........: 35585 REFERENCE ID # ... 06080072 SITE ADDRESS ..... SUBDIVISION ...... CITY .............: IMPACT AREA ...... OWNER ............: ADDRESS ..........: CITY/STATE/ZIP ... RECEIVED FROM .... CONTRACTOR .......: COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ... TELEPHONE ........: ir FEE ID UNIT BPREPIPE NO OF FIXTURE BENERGY PERMIT FEE BPWHEATER PER HEATER PPERMITFEE FLAT RATE BPWSVCS WATER SERVICE TOTAL PERMIT 10142 AMADOR OAK CT CUPERTINO TISH HELEN OPERATOR: amyw COPY # : 2 FRANK CARDIA CARDIA, FRANK L LIC # 612 CUPERTINO PLUMBING 1300 DELL AVE, STE C CAMPBELL, CA 95008 (408)253-0618 QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL 9.00 81.00 0.00 81.00 0.00 1.00 34.86 0.00 34.86 0.00 1.00 10.79 0.00 10.79 0.00 1.00 -38.,37 0.00 38.37 0.00 1.00 9.00 0.00 9.00 0.00 ---------- 174.02 ---------- '0.00 ---------- 174.02 ---- 0.00 VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING Ap VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY .0 OUPEkTINO i Community Development 10300 Tone Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building De artment JOB ADDRESS: /4rr,��r PERMIT # OL0OgcX512 OWNER'S NAME Ie -r PHONE # SO - 9(,7 - c,,S y GENERAL CONTRACTOR: FAX # I am not using any subcontractors: ignature Date Please check applicable subcontractors and complete the following' ormation: jb"er7coriractor Signature Date 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 jb"er7coriractor Signature Date CITY OF CUPERTINO REPIPE/SEWERS/MAIN SERVICE 10 PERMIT APPLICATION FORM APN # d� Bldg. Permit Fees BUILDING Date: Building Address: PLUMBING PPERMITFEE / q BPREPIPE Owner's Name: kle1en PLUMBING BPI:IXTURE Phone #: 605—%G7-�s�/� c�o`ntractor: Phone: Main Water Service License #: Cont t: Phone: PLUMBING Cupertino Business License #: Sewage Disposal 09,39// Building Permit Info: BUSLIC Business License Bldg ❑ Elect ❑ Plumb ��— Job Description: Residential Commercial ❑ Cost of Project - 8 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 Repive of Fixtures PLUMBING BPI:IXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING •