06070165 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CUI�ITRt�. "T�(1Ii��INE0 TIU.�1
B [WING ADDRESS: � BAY AREA REPIPES PERMrrNo06O7O166
2190 LINDY TA
OW NER'S NAME: PERMIT ISSUE DATE
SARA ARZENO 1861 ORANGE GRQVR DR 07 /25/2006
NE: SANITARY NO. CONTROL NO.
(408) 371-5763
ARCHTIECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� 0
p0 LICENSEDCONRACIURSDECLARATION . Job Description
1 G+ I hereby alarm Nal 1 am licensed under previsions of Chapter 9(commencing
with Sadon7040ofDivWOA3.fft Businessud Pmicati a and myl'aenseis
j N inFull run.and a 4 REPIPE ENTIRE HOUSE .AND REPLACE WATER HEATER
It32Lice CI , G-3(v Lle.a d
Date Conuacmr
RcxlTEcrs DECu O 1
i 1 understand my plans shall k used u public record,
iU
'0 LKCOSCd PmfallanBl /nom ®® �rrr��-�
t 3 OWNER-BUILDER DECLARATION
Comm ON f/iy �',
:00 1 hominy aso .Ince that I I. exempt from the Cessions o :An claw for Ne A .
C o following seta(Saito 71f3L5,Business and w.dogma Code:Any city or county
$� which acquiros•permit m<nmwcL siren improve,dmm�ikh,or repair my structure $5000
- j prior m its issuarue e.also requirtin applicant forsuch pewit m file a signed ststemat
,�< that he is licensed pursuant to the povisloaafthc Communes License Law(Chapter 9 Sq.Ft. Floor Area �y q 006 Valuation
(eorannowng with Section 7000)of Division 7 of the Business end Pmf°uloe,Code)or ,tT
..
that Its In exempt tkaclrom and the buds for site alleged exemption.Any violation of
Section 70"by any applicant fee a permit subjects dse applicanu m a civil ictally of I Occupancy Type
nut mom than ave hundred dollars(SSW).
❑i,u Avner of the psvpeny,or my wplayeu with sages u Heir rein etmpewthon,
rd
will do thewark and tbeumcmm is.,intended aroReteA fmsate(Sec.7ot4,Business Required Inspections
abortpmfasi°°a Code The Contractors Ueeae Law duce,ret apply m an owner of q p
property who kllds a improv therms and wbo dace such work leimvlf m tlntugh his
Own empkym,provided thaeaueh improvemrau are trot Intended aralTeted for cele.If,
however,the building°r improvement 4soM within does year ofcompletrae,the ower-
builder will have the burden Of proving that k did not build or Improve fa purpose of
tale.).
❑1,as Owner of tin prepany eco exclusively contracting with Ilcrsumd centracmrs to
coestmct the project(Sec 7044.Business and Profmsions Code:)Tk Conusct res Lt.
boom law does not apply m an owner of property who builds at imprem thereon.and.
who contracts for sets projects with a conuanm(s)seemed pursuant in the Cormaemh
License Law.
❑l un acmpt under See ,B d PC for this memo
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury One of the fallowing dalwion:
I have end will maintain a Corollate of Cogent m self-iaum for Workel,Cattpm-
.He..as provided for by Section 7700 of the labor Coda,far the perform,of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Inumnob ,u acquired by Section
7700 of the Labor
Cod.,fa N° O"mcut "tin woh for which this permit is issued. '
My WO l f'f!(i A11Fl amiaPoi cy ha°,Z9e 7.
Cart er.,
CERTIFICATEOF IXMPRON
EFROM WORKERS'
COOMPENSATION INSURANCE
(ThisseNon need net k completed Ifft permit is ferOe hundredd°Ilan($1011
Or lose)
I«Nfy that in the perform,of the work for which this permit is issued,l shall not
employ any person many manner m m to become abject to the Workers'Compcaation
laws Of Califomie Gate
Applicant
NOTICE TO APPLICANT:If,after making this Certificates of Exemption.you should
haeme subject to the Worker's Compensation provisimts of the Labor Code,you mute
Q forthwith Comply with such provisiorts or this permit shall be domed waked.
z CONSTRUCTION LENDING AGENCY
[r 1 krohyafOw Lou fm is.construction lending agency for the,performanee of
�i> tiro work for which this permit is issued(Sec.3097,CN.C.)
131
91�O Until Nurse
i7- Lender's Address
U O I certify that I haw read this apptiado t aced sum than site akve information is
I7.f•' cows.I time to comply with all city and county ordlanm and sum laws relating to
OU Wilding construction,and hmacbyaalvn.tepmmnutim upon,ft
this city to cum,up
W alwve-mentioned property for inspection purposes.
gy (We)agree to save.indemnify and kap harm].tie City of Cupertino against
ti N1 liabiliva,judgm°nu,cau Andespeaawhichmeyinmywy.,c.agaiat mid Chy
UZ In conmqu,of thegan I'Of thispe mlL
s'+ APPLICANT UNE NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date // L
SOUR H/' ``
c 7� DG Re-roofs
Signuurt OrApp Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applkeat a future Wilding ac rpautom Or handle haardoa materiel
u defied by the Cupsu no Municipal Code.Chapter 9.13,and the Health and Safety .
Cork.Section 75532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya
WIII tin applicant or future building Occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardous air contaminants U dcaned by the Bay Area Air Quality Management all new materAfor' pection.
District?
❑Yes u
I have mad the hvarduosmamdalsmquimmbna undorChapmr6.95 of dm Celifor.
nk HalthBSaktyCods M 5505,25x33 ux1254J4.1 undcreand dtateft building
does ami curmntly haenL that it u my ro,poaihiBty m notify tin aacupmt Of the
tfaCentric tom"p'ncy' Sign re of Applicant '-- Date
owner r,"thmiaadegent ---"-'-"- Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
J Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
IOUPERTINO
Building De artment
JOB ADDRESS: PERMIT #
2.l aL G,n� �N� ee
OWNER'S NAME: PHONE # 37( -5--763
GENERAL CONTRACTOR Av A c a Pides FAX # --
I am not using any subcontractors: — L S �G
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 f
Owner/Contractor Signature Date
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35624016 . 00
DATE ISSUED. . . . . . . : 07/25/2006
RECEIPT # . . . . . . . . . : 35372
REFERENCE ID # . . . : 06070166
SITE ADDRESS . . . . . : 21902 LINDY LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SARA ARZENO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : BAY AREA REPIPES
CONTRACTOR . . . . . . . : JOHN SWANSON LIC # 23773
COMPANY . . . . . . . . . . : BAY AREA REPIPES
ADDRESS . . . . . . . . . . : 1861 ORANGE GROVE DR
CITY/STATE/ZIP . . . : SAN JOSE, CA . 95124
TELEPHONE . . . . . . . . : (408) 371-5763
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- - -- ------- ---------- ---------- ---------- ----------
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
BPERMFEE VALUATION 5, 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00
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
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 250 .46 0 . 00 250 .46 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 250 .46 3511
TOTAL RECEIPT 250 .46
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
oW-70 1 �U
CITY OF CUPERTINO
+ A REPIPE/SEWERS/MAIN SERVICE
• CUPERTINO PERMIT APPLICATION FORM
APN# 35j_ —Q1(.0 1
Datel J` z
Building Address: J
2 qoz L;n� L
Owner's Name: Phone#:
Sara. Ay- zeno 257- //3
Con actor: Phone: License#: 90/ 3
Ac,-6- c ' 3� 1 . 5"7 G 3
Co�topt: Phone: Cupertino Business License #:
Dh S)4.ngu✓I 3a -0 c)q 23 -73
Building Permit Info:
Bldg ❑ Elect ❑ PlumbPn.
Job Description: nI- I
Kl ' 2q-�, ' buk,04.J Oft), j2 btu upr? r 14 r
Residential Commercial ❑
Cost of Projec
000 .d0
•
Qty. if
Applicable. Fee ID Fee Description Fee Group
BPERMFEE Bld . Permit Fees BUILDING
BPGAS Gas Pi ing System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Repipe of Fixtures PLUMBING
BPFDCTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
lj 1-1Q r. er
BUSLIC Business License BUILDING
EPERA--lIT- Pr- =
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