05100208 CITY OF CUPERTINO
BUILDING DIVISION PERMITC�NTRAGTE)R�INFORM.r�TIQN '
BUILDING ADDRESS: - n PERMIT N0.05100208
10310 MORETTI DR
ER'S NAME: FlBUvm ISSUE DATE
AMIR A VETRY 1012r,12(0) 5
PHONE: SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 I=
u000 - LICENSED CONTRACTOR'S DECLARATION Job Descri LOn
1 hereby afrom that l am licerm d under provision of Chapter 9(commencing p
Oztil- withScmc,mmo)ofDivisionJofthcBusiness arWProfrssiunCode.andmylicenuis RELOCATE GAS METER TO FRONT OF HOUSE
d
in fe.farce and crcem.
I-, Date Class Lk.a
I-, Dao: Contractor
e ARCHITECTS DECLARATION
Y s< 1 understand my plans shall he used as public rernrds
JyU
o G Littnud Pmfcssional
OWNER-BUILDER DECLARATION
ct
P 1 hereby affirm tha I em exempt s an the ConfeaaCo e:An u law for the
0o which following reason.Permit
]113L5,Business and Profcsmoli Co dc:Any city Or County
5 m tn which requires a permit m chat the alms improve,h Permit t fie pair any sfeuawm $4000
_z y prior m its issuarec,also require du applicant o for such Permit m RIC a signed snumcm
< that he is licensed pursuant tothsprovisiovnfmcContvcmr'sLiecnxlaw(CMpur9 Sq.Ft. Floor Area Valuation
of (commencing with Section 7000)of Division 3 of the Business and Professions Crvle)or
that be u eserept therefrom and the basis for Or alleged exemption.Any violation of
Section 7031.5 by any applicant for s permit subjects the applicant m a civil penalty of A Cr Occupancy Type
not more than Ove hundred dation(5500).
the
we of the prosaic,structure is emplendedwith wages r ale(ole eompewness
will do fework,endo:Th.Cisnm.License offered dobrise(Sec.]Oaa, .,of
..arts professions;code:rhe Canyacmra License Law does Out apply an,an owner of -.__ ------ —. RegUlied Inspections....------ —--'----._ _.—
progeny ho Euldarm ion,"theiwn,and whodcessuch work himselfofNmughhu y-
I awn cprploycesprovided thasuch improvcmenu are not intended of olrered for vie If 7 A I' '.j'lit,atj
however.the building or improvement is old within one year of<dmpletion.the owner-j
liuildcr wiBhFx Hie burden of PmNng that k did wt tivild w improa fm purpz of; �- -� -�
1. �d'.asawe project
Sec.7W,
Y•am Business
and confessions wM:)The dconmces -! ;-1..______.._.
cmimmm the n apply
to an owner of prod rtywh Professions CaorJ The Cmuacmfs rad! i'ii.11`!'iJIF th1 P:
censelawdoesnotchp1r mon owneropmpcuy.whobuildsor improve thereon,and!,
L who contracts for such projects wi0raconvacmr(s)licensed pursuama the Cenwcxre'
[)'I am exempt under Sec. B&PCror/ a
oil�'al.., WOiData /� .._._"_.....—_._`---_—__. _.._._._._._._ I.. ,..:.•.';.
a! RKER'S PENSATION DECLARATION 1 ' t ..' u I
1 hembY anon under penalty of perjury ore of the(.1lowmg dulmt orae
1 hive and will mor by eCcNfiwmof ik Lab mCod..fum for W forma ce of
..
* Jmoon,as provNetl for by Section 7700 of Bre labor Code:far Ore perfamarce of Net .,rasa L
.vorktorwhch this Puma itissued.r r ri
m 'I Aave t d RI maims W kers Cornpe.stalcm Imuran¢,as required by Section, "
z770Jafthc labor COM.ra Oc peRonnaac of the work for which this permit u iuried,� rA /
My Workers Corefamm don Insurance comer and.Pally number an --
t
-
5 Cartier + rr,,% s- t-u.
a. Na
CERTIFICATE
nONFR .:WORKERS .
COMPENSATIONINSURANCE
V
I
P if t ed
[ITuucuon eded rwt eeranplyuJif the perm tufpore hundreddollsrstg 100) /rs ynI
cly
.:_� I ceNf Nat m the perfnrmar!cc of thd'work
cmpiny arrypcndn inanY her suhs�tW
Laws fC 1 f inn Omc /.p/fir^.,(Lm 1"" - I
'Applival ¢�/� 1•r'7�C/ -.T' r t at r
_I NOTICE b LI ANf If.afteromiki.'medf this is truncate Of Esc pion yov'shmuld:_.,_..___. ... _. ..__ _.._ __.. __._ ___ __ __ __ _._ ____----------
b ray Ni Work raCum iNumi,s 07'n sol fide rahn'Cn"d you must
.J'.2.' fuilliw th comply w di such pr s n M N pc t shall be deemed remkcd '
Zn iisst f I' CQNSTRVCfIQN LENDING AGENCY sn ,r 1,. _ _. ..._._. ____. _........ .. _.
1--, _I rA lY, lherebY oRmm Na there uacpnswct krW ase:Yfor the perfumame of) _ _ -,_ _._ .. _ t t.klL 1J-il l lt. .,.1 ".._ _.
C9 th. kfur hchflus gum tis ssuGd_($ec,709]0
W '� Lcndcls Name _ - v,n
6, Lenllers Address . . . ...,... 1 .. _ .. ,...'
D z
CJ Q �'� 1 ttn fy dr r 1'hla mad N saPpliciuon orad ser¢Nit OI abdvc Infamidiiun'u 1
V. (~ cpricet1 agree to comply with all city and county ordinances and sou laws misting to
O V building egwge,un and bouts,authlore prex uyvmofrhsyty toe lur,pon me __ __ __. 1 11 ------ .—.
[T-1 iAove punu0nyd props-ry rorrmpectlan wToxs. . .t r: Ire r s _.. . .1 r' ? -r
(Wc)agree to save indemnifys d Peep harmless the City of Cupcn no ago ret
y Isabllitim3udgmcnts.eosua de pcmeawbich maymanywayacemc.gal ssmdcuy-
V'� olconsequrncc of me grueling of this perms . .._ _ .. .....
11 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL,NON-POINT Issued by: ' Date 0. ��-,:,d—
SOURCE REGULATIONS
l _. r B.�2h /� _ to/?d/If7/ f ' Re-roofs .. . .. _ . _ ._. ....... _
11 Sgmmr1ofAppl.m1/C....0& ' " - Dare
i. y sf HAZARDOUS MATERIALS DISCLOSURE r 1 I n.. I Type of Roof I
1I a W111hc PPIc mor fdome building oes p l r handle hastro s u il� _... .. ,. _
�'v de06cd by sr♦:Cubenlno M ntopefy ode Chahar 9'12 and the H a1N Ind'$afetyl -- '_...._ __ ._. .._ ...-.
Am Co'dh,sectidn 25532(a)? a J - ^Q I P re anA l ✓..' f
v'i, xflNpc, 1•a t_ 1, All roofs shall be inspected priorto any roofing material being installed.
-r, _., 'l If a roof is installed without first obtaining an inspection,I agree to remove
7.yf.-Will the spPlaam or lotus _building o<.,ant use equip t o rkvura which
c u harardous av conumuun+s,u'der;cN by the Bay Area Air f mthly ManSgcmcnl all new materials for inspection.
D lricst - "
rl 1 ,I f 1 : S.
Ida "
ad the lb.rauddsua macrlals ne,dindrents under Chapur6.95ofdu Califon-'
nia Health&SafelYCo ,Ssuuu255B5;2S533, y2553a IundcrsuN Na fdu building
docamot n,hat's 1 r,tharit s my csyom m1 ty m'Duty dre bcc panfnf del
Feyuirements which must the Ovc,6nar mssuancc oft Cemfdac of Oce Paley ^` '
AMf� 7 PlvrSignature of Applicant Date
Owneru path recd age t -i. C'bIAll roof coverings to be Class"B"or better
CITY OF CUPERTINO
I 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37515010.00
DATE ISSUED. . . . . . . : 10/26/2005
RECEIPT #. . . . . . . . . : 31742
REFERENCE ID # . . . : 05100208
SITE ADDRESS . . . . . : 10310 MORETTI DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : AMIR A VETRY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AMIR VETRY
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
• TELEPHONE . . . . . . . . : -
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ _____________ __________ __________ __________ __________ __________
BPGAS OULETS 1.00 5.40 0.00 5.40 0.00
PPERMITFEE FLAT'RATE 1.00 38.37 0.00 38.37 0.00
__________ __________ __________ ----------
TOTAL PERMIT 43.77 0.00 43.77 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ --------____-_--_-
OTHER 43.77 VISA
TOTAL RECEIPT 43.77
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
w Community Development
c 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
UPEI�TINO Fax(408)777-3333
Building De artment
JOB ADDRESS: PERMIT #
1031n MOPE777 -D4e-,lVL- 0S/6 eSa
OWNER'SNAME: A/Ly/K A . VjE:-71ey PHONE # ¢off of 6
GENERAL CONTRACTOR: FAX #
'" - GOC .
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
66 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 ignature Date
• OCTOBER 26, 2005
GAS METER RELOCATION OF CURRENT
RESIDENT PROPOSAL
10310 MORETTI DRIVE
CUPERTINO,CA 95014
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HOMEOWNER: AMIRVETRY /
HOME ADDRESS: 10310 MORETTI DRIVE
CUPERTINO,CA 95014
PHONE NUMBER: (408)865-0567
JOB SITE: 10310 MORETTI DRIVE
CUPERTINO,CA 95014
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Owner's Name: A. VETRY
Address: 10310 MORETTI DRIVE
CUPERTINO, CA 95014
PHONE#: (40$) $65-0567
APN#: 37515010.00
Su,
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
�CUPEkTINO PERMIT APPLICATION FORM
APN # 3 2s 1j-016
0 Date: 0 C7 A6 /�VD
Building Address: /03/0 cll��INP Cf If-?)/
Owner's Name: AlUIR A , ✓E�7RY Phone
#f`fCT)&65-0514
Contractor: PGJ-F- Phone: License#:
/
Contact: �M�R 14 . VRA Phone: Cupertino Business License #:
08 f2
6s0 S6�"
Building Permit Info: Reloevi &A1 q IOU f)(OK) o- how
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential Commercial ❑
Cost of Project: 4
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 e of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING