06010045 CITY OF CUPERTINO
n BUILDING DIVISION PERMIT CQN'�g,A.CTURINF 10T 4
BUILDING ADDRESS: THOMAS PLUMBING INC PERMIT No.06010045
0297 S DE ANZA BLVD
OWNER'S NAME: PERMIT ISSUE DATE
BOB ALLARIO 8862 MURAOKA DR 01/09/2006
NE: SANITARY N0, CONTROL NO.
(408) 736-3050
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
=
3 o z LICENSED CONTRACTORS DECLARATION Job Description
1 hereby aOlrm that 1 am licensed under provisions or Chapter 9(commencing p
with Section 70110)of Division 3 of the Business and Profeniom Code,and my license is
n umnmmeandeBet —� pNO PARTIAL SEWER REPLACEMENT (180 ' )
j Z License CI Lk.g g
Da¢ ConuacO N
A
ARCHITECTS shall DECLA iATIO
I undenund my Plem W used u Public records \
:.0 Licensed Professional
OWNER-BUILDER DE Ce CanurON \ C
<I I hereby Maso .(Tian Nm I nm exempt from the Cnnlncmf3 License Law for the
o O following moon.(Section 703[.5,ct. ban. and bereave.
de io demolish.
Code:Any city m county
$ which requires a pmmh re enres t eL plop W prow,demolish,co n A Ci any 3lrucmna 950 0 0
prior er Ise I u ceasedIssuance.also requires DmvisionApplicant of foo suchCon fermi'm ccmc gac(Chmwr t
< dommencaveJ pursuant 7or 0e of Division
of of the B uacmr'slianm6wrC Code)
Sq. Ft.Floor Area Valuation
$ (cat he Is xe pt Section 70nd the
a upon r the
al eged exeandmpt Prookeson.Anyon3Cnde)of
Nat he u exempt them(mm and the buts for dm otic{cd exemption.Any violation of
Section 7031,3 by any applicant for a permit subjects the applicant to a civil penalty of
Out mon than JIM hundred dollars(5300). r Occupancy Type
❑L u ownerk.the proprsry,many otmmt wdwith wee{ forsawv mk compensation,
will do the wah,end the he Com ts nm s Licand,Law w for t apply 70/1,Business
and pnywh ons Cade:The Conhmror'a and who
Law uses rot apply lf rt rwner of Required Inspections
Own cre whobulldamimpmwa thereon,andwho Me nawhwork Mmffemd foczamhrough hip
ownem,smWipingOr Nu3uesImprowmantsseeancunf cara0kred foae IC
however,dm building serImpmwmantgthat is within coo Year ofc improve
rthe purpose
or
Wilder will have dm WNm of proving this he did not Wild or improve fm puryom of
sale.).
O 1,as owner of the propeny,am exclusively contracting with licensed tomiacun in
construct the project(Sec.70th,Business and Profession Cade:)The Contractor's Lt.
cause law does not apply to an oases of propenty.who builds or improves decrease.and,
who comnew,for such projctla with a contractors)licensed pursuant In the Conu woor's
License Law.
❑I am exempt under Sec ,B k P C for this recon
owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of the following declarations:
1 have and will maintain•Certificate ofComent to self-Imum for Warkeb Comfort-
no
un,u provided for by Section 3700 of the Labor Cade,for the performance of dm
k for which It,permit is issued.
1 have and will maintain Worker's Compensation Insurance,u requind by Section
of the labor Cade.for the performance of the work for which this permit Is isaued,Worker' a}}��pe�°Oat/vfns��n1x matt and Polity nu am:rrier. _ fO l i. /Z 7; Polity No.: 7
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need cot W completed lithe permit is foram hundred dollars($100)
or less.) .
1 arffy that in the performance of the work fm which this Permit Is issued.l Nall not
employ any person in any manner an u in bocome mbjecl to the Workers'Compemadan
Laws of California.Data
APplkant
NOTICE TO APPLICANT:If.aur making this Cenine&m of Exemption,you should
become subject to the Worker's Compensation provisions of dm labor Cade,you most
.J O foMwith comply with such previmens or this permit still he doomed revoked.
Z 55 CONSTRUCTION LENDING AGENCY
F+.N+ I hereby afumdat there this construction lending&gamy for the performance of
Gi the work for which this permit is issued(See.3099,Civ.C.)
WQ Lender's Name
�
7 z Lender's Address
U Q 1 caNfy that 1 haw reed this application and sum this the show Infommiun Is
Iy E+ coned.1 agree to comply with all city and county callousness and some lava slating to
pU Wilding construction.and hereby ambodn nPmsentatiwe of this city m color upon the
I37 &how-nowarted property for Inspection purposes.
(We)pgme to save,indemnify and keep harmless the City of Cupertino against
cn liabilities.judgments.costs and expenses which may In any wry accrue against said City
U 4 in consequence of 0m{waning of this rearms -
F7 APPLICANT UNDE STANDS AND WILL COMPLY WITH ALL NO POINT Issued by: Date
SO EGULt\Tl NS.,/ /^(n
or Dm: Re-roofs
Signature of ApplicanVCon m Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WTII the applicant or(Muni Wilding e.Chapter
Ram ser handle Health
material
sa defined by the CupeNno Municipal Cade.CTapkr 9.13.and the Hedth and Safety
ode,SeNoa us3x(a)7 y All roofs shall be inspected prior to any roofing material being installed.
❑Yea �tla
Will du appOtmt o//forum Wilding oaupam um equipment At devices whish If a roof is installed without first obtaining an inspection,I agree to remove
it hasallom air tonuminants As dclined by dm Bay Awa Air Quality Mmagcmcnt all new materials for inspection.
imict9
Yea /AX)
I have read nyCodknNouamucrialare 33 and nu under Chapter6.95tut arae Gldi n
nu Health BSafMYCade,Setiom333u3,7S3JJ and233Jd.IurrdemmM thuifthe Wilding t,�-//�
does at currently have a count,that It u my reapomibillly m notify the occupml M ao _
coq rt nuwlric seat a car to intima nice CcNOcamafQ'pu mry Signature of Applicant Dat6
/
r m mmorivcd&gen
All roof coverings to be Class"B" or better
O
wnesm
Community Development
10300 Torre Avenue
i' ; _✓ Cupertino CA 95014
` Telephone(408)777-3228
CITY OF Fax(408)777-3333
r.' UPERTINO
Building De artment
JOB ADDRESS: lon? S Up A-29 &Ud PERMITGo /
OWNER'S NAME: bdo fflart'o PHONE #
GENERAL CONTRACTOR: 1 FAX #
I am not using any subcontractors: y
Signature ate
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 ate
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
CUPEfaOINO PERMIT APPLICATION FORM
APN # -�S?17001 Date: ? OL
Building Address:? 10317 S �P �q 7 941 )
Owner's Name: Ba Phone#:
�ar�o
Contractor: Phone:( License#: S ��
(1(0.9) 7�f�''`t3�1
Contact: 13.4, Phone:(�o�) Cupertino Business License#:
—l�a�ias
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description: p
I lir-h'G I S2cJ?y r 4(e, ew7t. -fee�,
Residential ❑ Commercial
11
Cost of Project: 5
•
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 .Pixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
# -3z7z�
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