06120003 CITY OF CUPERTINO +• seg
BUILDINt5 DIVISION PERMIT -,CCONTRACTnR�INFORMATION
qs Y%Y x. „�+,;,_.. ,,.a ,o-5"•u"�*'r 9 taw-;::xvc�°�:e
BUILDING ADDRESS: SULLIVAN CONSTRUCTION PERMITNO.06120003
10883 LEAVESLEY PL
OWNER'S NAME: PERMIT ISSUE DATE
DEE MEUNEAI 960 OPAL DR 12/01/2006
E: SANITARY NO. CONTROL NO.
(408) 247-2147
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
o o LICENSED CONTRACTOR'S DECLARATION Job Descriptionm I hemby affirm Nat 1 am licensed under Provisions of Chapter 9(commencing
�Z� with Section]O(IB)of Division 3 ofthc Business and Professions Code,and my liccmc is
!�N in full fame andeffac -vl y5 3 73 REPLACE MAIN WATER SUPPLY PIPE FROM STREET TO H
a�f2 License�T ass Lk.1
1�a Dae J2 y-hr: c tatcthr CvILL.1F'w`�
ARCHTIECrS DECLARATION
I I understand my plans shall be used as public records
5
t, Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm Nu I em exempt from 0e Contra"ors Liccme Law far de
p o following mason.(Section1031.5,Business and Profecvinm Code:Any city or county
i m which rtquirts a Permit to connrucL after.'vnProue.demolish,nr repair any asueture
pdorm its issuance.also mrluirea the applicant for Such permit to rile a signed statement
Er
< that he is luenud pursuant to provision of the Contractor's Liccnu Law(Chapter 9 Sq.Ft. Floor Area Valuation
`t-� (commencing with Section]00()nf Division Sof the Business and!Prafessiasu Code)or
'7$800
Nu at be exempt therefrom and She basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant far a permit Subjem the applicant o a civil penalty of APN Number OccupancyT e
not mote Nan five hundred dollars(35M).
yp
0 1,as owner of the property,ar my employees with wages as der uk compered..,
will do the work and She structure is not intended or offered far ask,(Se..]0/4,Business U V VRequired Inspections
and Pmfessimu an
Cade:The Conuares License law dos col apply a an owner of q p
property who builds or improvesdurcan,and who doessuch workhimselfor Waugh his
awn employees.provided that ouch improvemens am not intended"Offered!far Sale U,
however.the building or improvement is Sold within ane year of completion,the owner-
builder will have the burden of proving that be did not Wild or improte far purynm of
ask I.
❑1.as owner of the property am exclusively contracting with licensed contractors So
construct ths proje"(Sec.7W.Business and Profession Cade:)The Contractor's U. _
come law docs not 3PPIY On an owner of property who Wilds or Improves thereon,and.
who contracts for Such project with a contractor(s)Iicemsed pursuant to thm Contractars
Lkenu law.
l am..crop,under See ,B&P C fa this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby afapm under penalty of perjury me of the following declaration:
1 have and will maintain aCcrtifinm of C.use.I On calf-imum for WorkersCompen-
sadan,as provided far by Sccuun 3700 of the Labor Cods,for the pen(mmance of the + ��
work for which this Permit is issued. I 1
❑1 has aul will andrunt Workoes Compensation Insurance,m matured by Section I
T/110 of the Labor Code,far Ne performance of the work far which this permit is issued.
My Workers Campeau ima Insurance carrier and policy -
y0 cram
Cartier. 5"t-a e f f.kpl of Policy No,; S j 211 qO
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ibis section teed pmt he completed if the permit is foram hundreddollars(SIM)
nr Ices.)
I cervi y that in Ne performance of thm work for which Nis roman is issued,I shall not
employ any person in any mannerao as an become Subject to the Workers Corepenubs,
Laws of QllfaraiL Dau
Applianl ,
NOTICE TO APPLICANT:1f,after making this CcniOrae of EumPtum.you should
become Subic"to the Workers Compensation previsions of the Labor Codc,you must
.J O raMwiN comply with such provisiom of this Permit Shull de dcemed revoked.
Z a-' CONSTRUCTION LENDING AGENCY
'r~+.�. I hereby afRrm Naz Nem is a co nrucuan lending agency far the perform.of
!Yi 7 the work for which this Permit is issued(See 3097,Civ,C.)
1 Q Lender's Name
Z Lenders Address
U C) I runi(y that 1 harm read this application and sate Wt de abase informauun IS
U, correct.l agree to comply with all city and county ordinances and Slate laws relating to
O V building construction.and hereby authorise spresentatives of Nis city to enter upan the
F 0. above mentioned property for inspection purposes.
(Wee)agree(a save,indemnify and keep harmless the City of Cupertino against
Cl) Iiabilidu,judgments.cass mdesperms which may in any way accreagainst said City
U Z in consequence of the granting of this Permit. hl ^
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCES D t
R ULA�IONS, /)- /_O�
Re-roofs
Stgnaldf APPliaapale
HAZARDOUS
MATERIALS DISCLOSURE Type of Roof
Will the applicant or(Muni building aapapt r 9.1 or handle hmardom material
C de0ned by the Cupertino Municipal Code.Chaplet 9.11,and the Health and Safely
code,s"tienzss3z(a>] n^// All roofs shall be inspected prior to any roofing material being installed.
❑Y /®No
Will to applicant ar f��u\ building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
pit hvardnm all essmamimnli as de0ned by She Bay Ama Air Quality Management all new materials for inspection.
DistricO
❑Yes
I have mad the hamrdous materials mquimmens under Chapter 6.95 of the Califon
out Health&SSfctyCode.Swoons 25505.25533 Sod 25534.1 understand that irate building
dao not currently have a tenant.that itis my res,robility m notify the oxupant of the '
mgaircmensw ichmuan� `/,,,gceoraC.111.aeof� Signature of Applicant Date
Owner mmomcdagcm D,te All roof coverings to be Class "B" or better
CITY OF CUPERTINO
loll 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp : Rng : Sub: Blk: Lot :
APN . . . 11 . 11 : 35615025 . 00
DATE ISSUED. . . . . . . : 12/01/2006
RECEIPT # . . . . . . . . . : 36934
REFERENCE ID # . . . : 06120003
SITE ADDRESS . . . . . : 10883 LEAVESLEY PL
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DEE MEUNEAI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JOHN SULLIVAN
CONTRACTOR . . . . . . . : JOHN SULLIVAN LIC # 23091
COMPANY . . . . . . . . . . : SULLIVAN CONSTRUCTION
ADDRESS . . . . . . . . . . : 960 OPAL DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95117
TELEPHONE . . . . . . . . : (408) 247-2147
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FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - - - - - - - - - - - - - - - - - - - - - - - - -------- ----- - - -- - - - - - -- ---- --------- - - - - - - - --- -
BPERMFEE VALUATION 800 . 00 83 . 16 0 . 00 83 . 16 0 . 00
HPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- - --------- ---- - - - - - -
TOTAL PERMIT 197 . 16 0 . 00 197 . 16 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - - - - - - --- ---- -- -- -- --- - - - - - ------------------
OTHER 197 . 16 VISA
TOTAL RECEIPT 197 . 16
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 106 SEWER & WATER
507 FINAL PLUMBING
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-� Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPE(�TINO
Building Department
JOB ADDRESS: PERMIT #
�cYc 3L z'x b(o 9LQ0C)3
OWNER'S NAME: PHONE #
GENERAL CONTRACTOE.A AX ##
2a
am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin 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
Plumbing
Roofing
Septic Tank
Sheet Met
Sheet FA
Til
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Owner/Contractor Signature Date
CITY OF CUPERTINO QIQI l bC�b
REPIPE/SEWERS/MAIN SERVICE 3
OF
CUPERTINO PERMIT APPLICATION FORM
APN # r p_ �e� Date:
Building Address:
,%o �g 3 L,��.��'�5 � X12 Cu ter•].>>,.�
Owner's Name: Phone#:
S-.S—
Contractor: Phone: License#: L
SL, tC ,'�w�n
Contact: Phone: _ Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
1�� R L✓ Iro,v\ Svc 7 SU , / fjjq2t V-eN-Y 7 60- ,
Residential IT Commercial ❑
Cost of Project:
•
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 Repi a of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
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