06030036 CITY OF CUPERTINO `'"
BUILDING DIVISION PERMIT + CONTRACTOR INFORMATION`"
BUILDING ADDRESS: ' SPEEDY ROOTER PLUMBING PERMMNG.06030036
. 1023S ANTHONY PT,
SRS NAME: PERMIT LSUE DATE
ILANO MARIA BELEN L AN CAZLOS701
PHONE: SANITARY NO. CONTROL NO.
408) 234-8134
ARCHITECTfENCINEER: BUILDING PERMrr INFO
BLDG EIECT PLUMB NECH
zz o 0
Ipp LICENSED CONTRACTORS DECLARATION Job Description
IC „ 1 by rod IhN I w Ikcvcd undcc povivonf of ChW=9(cammcncint p
U W co by10)af Dlvl .'1NCBmnea aM Profruh.0 Code."my Ile la
S�yR ..Licmom ° � L S�13 WATER MAIN REPLACE ABOUT 200 '
q' Doc - -- Canlncbr
3b-'�' ARCHI=rS DECLARAT� N
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e LLO Iher,aJ Pmfruiaaal
OWNERBURDFR DECLARATION
<x 1 hereby Chum Iliw eaompt frwrl Bur conn t.r'a Li on,c law fm Bc
po NIMMnt ro.(Salon)IHIS.1 Bvc.arta Pmfcalda Code:MY city or calory
<$E! which Imlodtea a pvmib m ooupum.alta.inpmve,dwnlio.d m*r any nmcam 0
Prior n rB lavarla.oaor olre,the applicant!.rich permit to flk ati¢r icalenrtnl
< Oat ki.licododP amtomepm�,aOicCo .',uaraoLa.(Cldp 9 Sq. Ft. Floor Area Valuation
f�C ICaomendoP with Sd9m7")of Diiilm J of the Buvma,and Pmrcud.Cale)or
5 $ Oar b,is.ocoop,Waefmm arW the bail,fa Bto anna5 uon W m.My dclatim of
ScWcd 7031.5 by any aipbcant for a permit ab)s the apPlfcant to a civil Parity of 3AP9x6W&F 00 Occupancy Type
aoa mac Nan!hovercl d.Wn(5500).
C]1,as mvdl of WePmWIY.or my oroldd a wYL wm u Beu,ale 000n wdon.
will dathework and Bae,lrunurt undimeruled car onerodfaak($Ce.1044.BILdrociaof
and Pmfuilmu Code The Oorcoo,LlCveho ,la,m,apply If r owner ia RegUli C .
pbopenY who build,d ed that
atex th idip.and vha arc
c,auN wart him,elf.r Wmuth ba
owe cmployx,,provided W b,ueh ImPmtemma w m,lnterldrd daRerW fd,ale.U,
hvw head ft ddca of poedg that
arm)ear of completion.ae a of
buildu 3010laic Bc bddrn of poWnt War K Nd Itm adN d MProtc for pupa¢a(
alp).
❑I.u awoer of Ux popcnY.w ucluaivcy raluuSinL wish litturl amtrslda b 'w"/ �✓_ y11
Co..Ne Pmkm(Sec.1014,Blaine„and Pmfu,im,Code)Tho Camanol,U
cc=law lora not apply m an owmuof PropurywhobuNacrIrni,n, ,Wcrton.and
who omtrua for adh PmFCa MO.cabuar4ot(N Bcanad puraad to Ne Canuxta,
Lircve Law.
❑lam comp uMc Sc. ,B&PC fid aarmm
Dal
WORKERS COMPENSATLON DECLARATON
1 bertby on.andi Peu ty M Perjury..-a Be followint dccarvionc
❑INu and w0cifor bineCWllcam of ft La Co,1-,I"dio cfodo affic
a.0.n, r phw thi for by S.13SU Jtt10 of the I�b.r Code.fa Ibe perfmmu¢of Ile
wart for which IhU pomlb u I^�M.
I ate end will mtlmam%ft,',CompensWon huurutd,as rtyuired by Section
3700 of ae(J�Code,fa Ne perfdmars of Bx,work fa which Ni,permit u ivaetl.
My Workda CodnpeuWm hoodori cartk+arW Polley nw a:
Grtic ' t"1KLT coT'k(� PdWy Na.: lS`�b b�
CERTIFICATE OF EXEMPITON MGM WORKERS'
COMPENSATION INSURANCE
(nB¢dimreel nabecomph ifIh lnmh afao oWmNeddonan(5100)
a IeaJ
1 codify that in Nc pufo of Bc wak fw. Cli Boa c miura iot.� 1001 nd
wpl%any nonan in ,caul.Rmmca,Clzlb NC �V1/�� .
Laws of Califomun ��
AMI uu
NOTICETOA to ft NT:If,¢filerric Fiowizi. ua dEarnWm,rodo,
ahooW
bccomc aubjm, as toacb P C.mpcumim Prori,i al o c de laid Colic.you mho,
.J O fdNwibh eamdY wiN idle Proritiou m dd,permi,Wall be Oeemnd nwtrd
Z y CONSTRUCTION LEb?DING AGENCY
Ibemby affirm Oat Otto a a cmunmloo kMint ateay for the Pcrfamaax of
Qi> the work fd which lhl,permit is ialn:d(S 3097.CTI.C.)
1 Q I<nder',Nae
D Z tomes,Adamu
U0 1 cm,ify that 1 Nd,c rod Oi,appliaim"1.1,IbV the¢lure infmnadm I,
IL F -dant 1 and Lo"dbPIY W iN all City and county ordinuue,and,are law,rtla,int W
buildint eau 6.,"bercby aotbod.ro r advoa of Nu city,.mW.Pon llc
W ¢hove-menBo,rcd popeny fd impemlm P. L
mare,ibot,,o y aM trop harmku the City a Cupertino apimb
yIlablll ee"mma.cma a eaNeuu wtkb mar in any way accrue atwu,aid City -
(„)z inc uercCof Ilio tBorIELal0a dc-tL
SWRCANT LAND rA AND WILL COMPLY WITH AIL NON-P INT Issued by: Date
- 3 A oL Re-roofs
Sltonure ar
P, 'C.
Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W W ec indicant d flood,Bolding o oupant abode d ba,Wk haardou,rnarcriad
u ecfi R by Ne Cupeni,m M.n I al Code.Chapru 9.12,and the Hi arM Safety
e.o,od 1553U.Y.' t ri. All roofs shall be inspected prior to any roofing material being installed.
MI.L or for.Wildint anbrped vac Wulpmm,c,Bowker whkh
If a roof is installed without first obtaining an inspection,I agree to remove
Will ft
emit h.,..dara or conami,lula u dofiecd by,hc Bay Arta Air Quality Mautcmant all new materials for inspection.
Durno,?
❑Yn j G]u
I hate had Bre lu�nd marcriaUrryuirtmew odderClb Pe&95orbbocoirm-
nu HcdN&SocrYCodc,Sootaru 25505.25773 nW 255.74.1 ur,duauad Ihcifdc blldiot
lou rot c.ncdly bare a,Cunt that ib IS my ma(v,uiNli,y 10 nailY Bo oaupant d Ne
rcytirodcd,which m=to mel*rWi„unl¢or a Canilkne of Occupidicy.- Signature of Applicant Date
/,-- -
Dam All roof coverings to be Class"B"or better
Owar.r..Ood d a ed
CITY OF CUPERTINO
I 1 of 1 PERMIT RECEIPT OPERATOR: kiereaw
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34212074 .00
DATE ISSUED. . . . . . . : 03/08/2006
RECEIPT #. . . . . . . . . : 33494
REFERENCE ID # . . . : 06030036
SITE ADDRESS . . . . . : 10235 ANTHONY PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ILANO MARIA BELEN L AND CARLOS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5646
RECEIVED FROM . . . . : ARIEL BARCIBAL
CONTRACTOR . . . . . . . : SPEEDY ROOTER PLUMBING LIC # 23086
COMPANY . . . . . . . . . . : SPEEDY ROOTER PLUMBING
ADDRESS . . . . . . . . . . : 701 ALDO AVE, STE 43
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054
• TELEPHONE . . . . . . . . : (408) 234-8134
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
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 47.37 0.00 47.37 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ _---______-----_--
CHECK 47.37 2742
TOTAL RECEIPT 47.37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
________ ____________________________ ________ ____________________________
__________________ ________ ____________________________
106 SEWER S WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
•
f Community Development
10300 Torre
Avenue
Cup ertino CA 95014
Telephone(408)777-3228
UkTINO Y CSF Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT #
1Z)235 ANrN�µ� �� 6, �b-T
OWNER'S NAME: Mbr p LR u-4-1 c PHONE # '1 _ L-1 5
GENERAL CONTRACTOR: 50-% o-i V wT-L-� 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
LZ Plumbingvl obi 1� rJ
Roofing
Septic Tank
Sheet Metal
Rock
Til`
3 L,
Owner/Contractor Signature Date
D ` 00E
CITY OF CUPERTINO
i REPIPE/SEWERS/MAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
O l� Date: 3 _ -o 6
Building Address:
.,2 S ANTAt14 L( P�
Owner's Name: Phone#:
Contractor: Phone: License#:
,Puts()`t -1 Qy— I Sf5
Contact: Phone: Cupertino Business License #:
PIC 10- 12�/�� 1 gb� 5ct5 -4coi1�
Building Permit Info: -,Apr
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential R9- Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Pi in _System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Revive of Fixtures PLUMBING
BPFLYTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•