06030008 CITY OF CUPERTINO 3hA+ta»�nn X'h^e im ''`
PERMIT
BUILDING DIVISION 'CONTRACTOR INFORMATION
BUILDINGADDRc9S: GREAT AMERICAN PLUMBING C P'TNC10O6O3OOO8
Y 5923 BOLLINGER RD
WNER'S NAME: FERMTI'ISSUEDATE
TONY NGUYEN 166 GRAHAM AVE- 03/02/2006
ONE SANfrARY N0, CONTROL NO.
(408) 995-6400
ARCHITECT'EIGINEER: BUILDING PERMIT INFO
BLDO E.E0R P0LUMB MECH
0
30Zp LICENSED CONfRACInR'SDKLARATION Job Description
F I IYwy.ffirm thu 1.m liaomil uMer Provision or CTaprtr 9(commcaing
" wlN Section 7ll(10)ofDMnw3of the Busittw.od Prtr C and myliacnteu
9�� imm�rara.neen«t _ PROPERTY LINE CLEANOUT/BACKFLOW DEVICE
AA B �s
�� D,u: —crs�ocrwRAnoN ao. ���r B���®
; U 1Wdvaam my Plvu•hall NctarcupdJlc raaN
Li¢tucd Pmfcuian.l
OW NFA-BUILDER DECLARATION ��p
.� F I berth'.M.Ihm I.m e,emP,nom Jc Cora oa`.I.kwc W for ft MW /e 2006
0 o followingrcamo.(Satan 7031.!.Buri csa am Pnfnaown Code:My city a county $2600
s$ tick t.yuira.P ft to cadrva4 alar.Ntpmrxmd
c, i.n,a rtpatr any urvcturc
pri«to lu lWu.ac.Wo rtqulmi tM,ppli=t for such pcmiit to Sit a sigoN.uumcnt
xy< lbatkhliccnsN,O.m b too panslons of Jc C..',Li,,.Isw(Cluplu 9 Sq.Ft. Floor Area hon
Y I"$ (cammcnclnj with SaJw7000)NDivision 3nf JC Buutuv.od Pa
fcaiau GOx)IX
- thn K h oemp Jcmftam ab the W.h fa do.IIgM e.mtpu°n MY Nal Wim of
BUILDANG
Scaim 703•by any apply tf«a pamh.abjew tbv.ppl Lro.Ciao Po.hy Of -------------5 kPR Mr�ger U U Occupancy Type
eat ware Nn nue hundred xnan eISOB). ,
❑I,n ovtc of Jrt yop.Ty,a toy a IoYcc•vhh wgea as tka,k"cvmpmnJw-
winPticA.Coce:ThuConhn«mleohdaa dofano(Ser_'r Butivry
aw RoreWom tax:rhe convaemr,�taco aa4.a.pWy m n owner of Required Inspections
PrapAtyvhobund.avnpr°wsthetain,.rtdvhodouatrdwmkNnuelforthroughSia ,
awn oc Wn.ahim is WW
tfdn n« a,of aaaerw r«vl�u:
boildlor thexbuilding th «imp a MAthtab wiN'vtoroow Or
foro.Bc ovo of
Ndldv wJl bare the bureo of panni that h eitl nn duW a"vnPrase for ptWvs of
uk.).
❑L u owrcr of tim prWutY•am coral dy canlr.Noi wilb li enud rnnv.nars b
W awn Jc project(Sa.7614.Bulna..ad Cock:)Ta,CoovaaoY.LL
coA'e Law docs va.pply to an o W pr°p'nywho hJitl'or ftr r meow,rod,
wba cwovv fa xb Mjt m with a cmtrcw(')Iimtsd P...ot to the Canal.
license Isco.
C l am esemp unxr See .Bis PCfor this roaw
Dart
WORKERS COMFEI9ATION DE RATION
I bueby aBhu wxr pemlty of Perjury ac N tiat,fano iog dNaNwu:
❑I N.e.ad vN m.inuly.Catifuu of Cavot to a1f-insure fa WarteY'Cwtpn-
s.uon,u provixd fa b,Saban 3700 of tK Isbar Code.fa we puforwrtre of Ih
oat for vhleh Dios paonit is iuuc,l
❑I ban.4 vin m,imain Ward.Camprn W ion Imunn¢,as r,vi by Semon
3700 a toc Labor coca,rm the prformutrrt or IM watt for which mu Permit h'.e.n
My Wo:erACapp aria Btnn u and pal mbcr arc
G.ner: Icy No.: �.
CERTIM TE OF EX ON FROM§W'1 RS
COMPFNSA NINSUItANCE
(ITh aealm reit trot m�pkcd'd Je pumb 4 foot hnhrddol Ws(5100) t
a lea.)
I cuufy Out In me pafarm.nx of me coat ra which this P h u isucd.I altar
vp ofca Pcnw lnany roamer soumbcmmc aubjatta JC Watui'Canpuatiw
Ian MCalifarni,.Dau
NOTICE TO APPLICANT:If,•fur mating Ju'Cettifwe of Esemption,you'hooW
bcc rc lubjat W the Waha'a Compcmtlon pror lWao of tha Lab COdc,you roan
Z roMwi N comply with such praifitcu or thu Permit"I bo iicC dmakrd.
zy CONSTRUCTION LENDING AGENCY
F.,> Ihemhyalid mu Jen u,coi(St 3M.Ci,C-) fa Je perfamarcM
D:> the coat for which Nis permit h lautl(Sec.3047.air.Cl .
0 Lcn a Name
DZ I<ndels Addrtn
U0U. I caufY Jua l hate rod mn appliutian.rtl sur chat Nc,Cott Ivfam.Jw u
;-t. career I.pee u comply ai b all city and cagy adi^.na..nd tote hwa rtlaunli u
building cnn9rt on."beredy.an«ire rtptoenutiYOS&trial city to tour upon the
CLl Wove-Donlon"Pnpeny fa irupnioa PurpnaeL
We).pee W not,indemnify aoe I¢cp IumJot the city a Cupenitroapiml
A nabilitiu,judgnuu,cam,adeapo¢.which coy In any vay.crn aboot"City
ir.
U APPLICwaNeUNDERS_,%hZSwNO WILL COMPLY WITH ALL NON-POINT Issued by: Date �. 2 —9 �-
so /f
' Re-roofs
Sip A pre MATm1ALS DISCLOSURE me Type of Roof
Vlir me appllaM« wort bWldingaapntgae ah.rLk hvudw.ttuurial
u xrrce by the cupettiw Mum ip.1 tact.Outer 9.1;and the Holth W Safety
cox,C ns3u.) -� � All roofs shall be inspected prior to any roofing material being installed.
Will mc.ppllaant«ratan Itling oaaPmn site walpaatt a xvlcc.wltieb If a roof is installed without first obtaining an inspection,I agree to remove
emit lua,N u.ir conuoninnu x0atl by me Bay Arc.Air eaality M. ,=. all new materials for inspection.
Dinrini !'� l .
�Ya No
I have rt.d me hc,S dfi.nweelal.5533%mero wxc Ouptu6.9s of Je Cslifa-
nuHrslNhSaf,Cox.Satlok 25569.7My uW2 Wu,unxmmde oifft
up ,attic
eau not Y haat a teooc It u my rcapottdbnuy m roof'the occupnt M Ne
I n - ma ' rm.a�.,,,.,.or.CmJlkasafOcctgwy. _ Signature of Applicant Dale
r map - Dart All roof coverings to be Class"B"or better
'i CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: suem .
COPY # 2
Sec: Twp: Rug: Sub: Elk: Lot:
APN . . . . . . . . : 37535021.00
DATE ISSUED. . . . . . . : 03/02/2006
RECEIPT #. . . . . . . . . : 33427
REFERENCE ID # . . . : 06030008
SITE ADDRESS . . . . . : 5923 BOLLINGER RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TONY NGUYEN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : GREAT AMER PLMBG CO
CONTRACTOR . . . . . . . : CORPORATION LIC # 18061
COMPANY . . . . . . . . . . : GREAT AMERICAN PLUMBING CO INC
ADDRESS . . . . . . . . . . : 166 GRAHAM AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
TELEPHONE (408) 995-6400
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
BPERMFEE VALUATION 2, 600.00 83 .16 0.00 83.16 0.00
BPSEWER SEWER SYSTEM 1.00 21.58 0.00 21.58 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
__________ __________ __________ ----------
TOTAL PERMIT 143.11 0.00 143.11 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ _____--___________
CHECK 143 .11 94770
------------
TOTAL RECEIPT 143 .11
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
_________ ________ ____________________________
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
•
Community Development
Its,
10300 Torre Avenue
1 Cupertino CA 95014
Telephone(408)777-3228
* CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDR rr PERMIT #
OWNFS N PHONE # Q
GENERAL CONTRACTO FAX #
I am not using any subcon actors:
Si e Date
Please check applicable subcon actors and com ete-the-full information
60 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
er or ature Date
CITY OF CUPERTINO
acoorREPIPE/SEWERS/MAIN SERVICECUEkiNO PERMIT APPLICATION FORM
APN # � �� � b � I Date:
Buildin Addr
O Name Phone#:
ontract : Phone: License#:
ntact: 11 PIQne, Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb [�
Job 1escription:
S C
Residential Commercial ❑
Cost of Projec :
rt
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 Re i e of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
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