08100076 CITY OF CUPERTINOt
BUItf3LdC DI`1ISION PERMIT CON, NFORMATIO
BUILD 0 FSS: PERMITNO.
TUGGLE AVE ALLSTAR PLUMBING 08100076
OWNER'S NAME: PERMIT SUE DATE
LOVANN FLAUGHER 326 PHELAN AVE .10/14/2008
NE: (408) 230-5569 SANITARY NO. CONTROL NO.
ARCHTIECTYENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
pop LICENSED CONTRACTOR'S DECLARATION Job Description
1 Worthy amrm this,1 not licensed under provfaons of Chapter 9(commencing
with Section 700f)af Division 3afthc NO.and Poofessons Code.soul my Name is MAIN WATER LINE
in full(one arus arcci. 3L 4 /
j n Z License Class
Lic.g
n a• Dat = Contrwm
ARCHITECTS DECLARATION
I understand my plans shall W used as public records
Ru
5 G
l; Licensed Professional
3 OWNER-BUILDER DECLARATION
'�i f I hereby slam Nat I eon exempt room the CunesemarLicense cense Law for the
❑O following mason.(Section 103 1.5,Business send Pmressions Cade:Any city on,aunty
3 21 which require s permit in construct,alms,improve,dcmnlibb.or.pair any imoub m
_iy prior bits issuance,also requires the applicant for such permit to rile a signed statement
< that le isliarucdru inanttotheprovlaansoftheContractorsliecnsolaw(Chap er9 Sq.Ft.Floor Area Valuation
x�$ (commencing with Section 7000)of Division3 of Na Business and professions Codc)ser $4000
Nat I e Is exempt Ih.ficm and the basis for the alleged inscription.Any violation of
Section 7031.5 by any applicant fora permit sub*u the applicant to a civil penalty of p,p Number Occupancy Type
trot mem than five hundred dollars(5500). 3 7 53 3 0 6 4':V l
Q I,uownv of the propmy.ormY wPloym with wags asmle4 tele mmpenastiov,
and do c work.and the he Cum Ia tors Leded or Law
do forsak(Sec.704,Butla..
W Rofwhobu cane:The Canhectoh License Law dam rot apply l in t owner of Required Inspections
mum enY who Wildsoriropmves thamprove who an not in artalcended ma marked
his
mum employees,ft
that suchimpmvemantsart voter a cmoRemd forrbe camLown Ir,
however.tha building or den of pmmt 4 sold within one year of mpro a for be ower.
Wilder MB baste the bmdset of proving dint he did rot Bald or improv for purpose of
nk.)
Q 1,as owner of the property am exclusively contracting with licensed mnusetms In
mmtoom the project(Sac.704.Business and Professions Cade:)The Cmtrsno's U ,
cense law doer not apply to an owner of property who Wilds or improves Merton,and.
who contracts for such pmjecta with aconuacmr(s)licensed pursuant he the Contractors
License law.
Q l sm exempt under See ,B&P C for this mason
Owner nam
WORKERS COMPENSATION DECLARATION
1 Mrcby+Inco must,penalty ar perjury arc of the fallowing M arafimm:
i Wirt and will maintain a Certificate of Consent to self-imine for Wodmrs Compcn.
mean,m provided for by Sceaon 57M of Ne Labor Cade,for the pedi mann of the
wart for which this permit is ivued.
Q I have and will maintain Workers Compensation Insm+nm,as m orcii by Section
37W a Ne labor Cade,for Ne pmfarmance of time weak for which this permit is issued
My Workers C peruaaan 1nsJuan ¢ami.and Policy number am: ,y
Cartier. / Gr Policy Na.: aC j'7 a�/0 7 7003
CERTIFICATE OF EKEMPnON FROM WORKERS
COMPENSATION INSURANCE
(ThisxNw recd mthccmnplemd if Ne Permit Is foranc hundred action($I00)
W Inst)
I cera(y that in the performance of the work for which this permit is issued.1 shal not
[.play any pccam in any W eenc,so as on became subject to the Workers'Compemation
Laws of California.Dam
Applicant .
NOTICE TO APPLICANT:If,after making this Cerdfmak of Exemption,you should
become tubjcm in the Workers Campedinumn previsions of the Labor Cade,you meet
O foMwith comply with seen Provisions or Nrn
is Permit shall Ise damned nevokcd. '
z " CONSTRUCTION LENDING AGENCY
I hereby afflm that Nem is a conautrction lending agency for the performance of
a ate.. dm won for which this permit is issmd(See.3097.Civ.Q
W Lem&rs Num
CL Rodeos Address
M
U O(� 1 anify that 1 have rad Ws application and sum onto thin Ne starve infomtatio s Ir
V, V comets.T agree to comply with all city and county ordinaries and sum laws relating in
C) Wilding construction.and hereby authorize mimuntatives of this city no comm upon lie
W ahave-mentioned poopcdY(a inspection purposes,
(We)agrte to an,indemnify and keep harmless the City of Cupertino against
H Taj) liabilities.judgments.creta andexpemues which may In any way...againstmid City
U in consegwxe of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date
SOURCE REG TIONS. 'f){/1#kV
Date
Re-roofs
Sigmrt tuof Applimu
nVConumDai
—
r '
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or for=Wilding occupant uric or handle hnenkma mamriJ
w defined by tK Cupenmo Municipal Cade,Chapter 9.11,and IW Hmlth and Safety .
Cast.section 155314)+ All roofs shall be inspected prior to any roofing material being installed.
❑yin �Na
Will the applicant or future Wilding oaupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haaANcm air<mtaminsnu u fond by tim Bay Area Air Don ity Management all new materials for inspection.
Dis rico
❑Yin Nu
1 hrvc.wi the becurdous mumcnals.quirements under Chapkr6.95 of d.Califor-
niaHmlth&SafctyCode,Seca=25585,25535seul25534.1andctstaedth ifdmbuilding
does not currently have a mwnl Wt It is my responsibility m maty the occupant of tht
mquiremenu which mem od met pilar to issuance of a Certificate of Occupancy. Signature of Applicant Date
101/-1/if All roof coverings to be Class'N'or better
Owner tie ariz agenm Dok
CITY OF CUPERTINO
e 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37533064 . 00
DATE ISSUED. . . . . . . : 10/14/2008
RECEIPT # . . . . . . . . . : BS000006344
REFERENCE ID # . . . : 08100076
SITE ADDRESS . . . . . : 18911 TUGGLE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LOVANN FLAUGHER
ADDRESS . . . . . . . . . . : 18911 TUGGLE AVE
CITY/STATE/ZIP . . . : CUPERTINO,. CA 95014
RECEIVED FROM . . . . : KYLE MORROW
CONTRACTOR . . . . . . . : DUARTE TADEV LIC # 22189
COMPANY ALLSTAR PLUMBING
ADDRESS . . . . . . . . . . : 326 PHELAN AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (408) 230-5569
• FEE ID UNIT QUANTITY - AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BPWSVCS WATER SERVICE 1 . 00 20 . 40 0 . 00 20 .40 0 . 00
1BSEISMICR VALUATION 4, 000 . 00 0 . 50 0 . 00 0. 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 102 .48 0 . 00 102 .48 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ---------
CREDIT CARD 102 . 48 VISA
---------------
TOTAL RECEIPT 102 . 48
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -----------------------------
106 SEWER & WATER 301 ROUGH PLUMBING
507 FINAL PLUMBING
•
awfl-
CITY
Community Development
10300 Torre Avenue
Cupertino CA 95014Telephone(408) 777-3228
OF Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
bell T� lc loe',060-1 6",
OWNER'S NAME: DUcAr t L T� cle.U PHONE # ZS - Co U`Y 0
GENERAL CONTRACTOR: 115-fr.,,r u ,46,9 FAX #
I am not using any subcontractors: ems `:%' /b �/ G
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
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
• CUPEkTINO PERMIT APPLICATION FORM
APN # 275 2 c3(-,& L/. c'-" Date: 'U ` U�
Building Ad ress:
1 1 To ( 2, oa Ve.
Owner's Name: Phone#: 2 �_
L-ou U-Vl V1 10,V c ( Jo /
Contractor:+1 Phone#: qo rd1 Z sl —GC 0-
+(�� {r UM l Fax #:
Contact: /� Phone #:C'/09J 2-37 -7 l0
1ZX[ I �C�rY� Fax #:
Contractor License #: 7 3 2- (p
Cupertino Business License #: ZZ 19
Job Description:
itil �ih W0.' - c � L ; !tet L
esidential [ti7� Commercial ❑
Valuation: r Jr O v
Project Size: Express ❑ Standard Large Major
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set & the sheet index.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer .
IBPREPIPE Commercial re-pipe per fixture P 1CPRP
1PGASCOM Commercial Gas Piping System P
1-4 Outlets
1BSEISMICOM Seismic Commercial P
113SEISMICR Seismic Residential P
/ 1PRSEWER Residential building P 1RPSS
sewer/sanitary sewer
CITY OF CUPERTINO.
REPIPE/SEWER/MAIN SERVICE
CUPEkTiNO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
IRPWS
IPPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1BPWATER Install/alter Water Pipe P
1BPFIXTURE Plumbing Fixture P
1PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1PLM 3LNCK Plumbing Plan Check P •
1PLMBINSP Other Plumbing/gas Insp. P
1TRAVDOC Travel &Documentation Fee B
1BUSLIC Business License B
Revised 6-16-08
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