06030084CITY OF CUPERTINO
CONTRACTCQR,INFOORM.4TION
BUILDING DIVISION PERMIT
i'fi
BUILDING ADDRESS:
PERMIT NO.
WATER QUALITY PLUMBING
06030084
oQJjg 2AMS TAF FORD DR
PERMIT ISSUE DATE
NE:
SANITARY NO3/1 LNO.
ARCHITECfyEf4GINEER:
4 0 8 2 —33 U
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Jb Description
o
at 1 am limnd under provisions of Chapter 9 (commencing'
I hereby affirm Nm
with Smdon7M))of Division3ofthe B.s..n and PuofessionsC de.anderylicenteis
in full forte and `
Lieenm claza Lle.g -INSTALLING
A SEISMIC G
D.Was Contrm
O
ARCHIT6Cr$OECLARA IN
I understand my plans shall b, used as public mmrds
MAR 2006
Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 exempt from the Convenors License Law fou the
1. mu Code: Any city or county
Business and nerd
following moron. (Section 1 on
em impmse, de fie sig any structure
isa a permit m coca
h permit t a
prior to its issuance, also requites the applicant for such permit m Glc a signed suumcm
poorM1 its thel, appllun.icant
Sq. Ft. Floor Area 'o
that m pursuanttoN) Nc Contmmr'sndPoofemonme, Law (ChapterCode)
or Division(
recomencinnwit
B Code) or
exeand
(hat xe with genion 7")orDivision 3 of
al ed
Nat he u exempt Nemfrom and dW bunt for the alleged exemption. Any violation of
he is on. Any
Type
Section 1031.5 by Wry applicant for a permit subjects the applicant to a civil Penalty of
not
not mom Nanfsmhundred dollars (3300>
3�P�NW?Ir. 00
❑ 1, es owner Of Ne propcdy, m my employers with wages as Nee sole wmpenution,
Required Inspections
will do dW work. and Ne suss pure is not intended or offered for sale(Sec. 1044, Business
and Proimal. u Code: The Comma,mrs License Law dm.[ not apply a an owner of
property who builds or imprnves themen, and whodoessuch work himself erthrough his
own employes, provided that such improvements am not imitated moffemd forsele If.
however, the building or improvement is mid within one year of completion, du momr-
builder will have the burden of proving that he did not build or improve for purpose of
talc.).
❑ 1. as owner of the property, am exclusively contracting with licensed contractors to
construct the pmject (Sec.1044, Business and Profusions Code:) The Contractors U
.
mom Law does not apply he an Owner Of property who Wilds or improves BCmM. and.
who contracts for such projects with a eonuactm(s) licensed pursuant to the ConeMcml.
License law.
❑ I am exempt under Sm. . B & P C for this mason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Nulty of perjury one of the following tleclamelor :
h.mandwillmai.WnaC,r r,.Mofconventmself"imumfmwort scompem
.un, as provided for by Section 37W of the Lmm Codi for the perfmmene of the
work for which this permit is issued
1 have and will malnNln Worker. Compensation Imam., as acquired by Section
37M of the labor Code. for the performance of Ne work for which this Permit is issued.
My Woheri Compenutian lmurance artier entl Polity��nu//m��ber tor: —, �.-�'.'Y
Cartier. Policy No.W��3 �L�1
'
CERTIFICATE OF EXEMPTION FROM WORKERS'
/
COMPENSATION INSURANCE
"
(This section need not hecempleted if the permit Is forma hundred dollars IgIQO
at less)
1 certify that in the performance of the work far which this permit is issued, I shall not
employ any Perron in any manner so as to become subject to the Workers Compensation
Laws of CaiiAna x Dat
Applicant
NOTICE TO APPLICANT: IL after making this Cenifcam Or Exemption, you should
become subject to the Workers Compensation provisions of the Law Code. you mrut
forthwith comply with such provisions .,,his permit shall M deemed mated.
CONSTRUCTION LENDING AGENCY
I hereby aRvm that then is a construction lending agency for the performance of
she work for which this permit Is issued (Sec. 3097, Civ. C.)
looter's Name
4nder's Address
I certify that 1 have read this application arta sure that the above information u
WMCL 1 agree m comply with All City and county ordinanns and sure laws muting in
Wilding construction, and hereby authorim rep esenutises of this city to carer upon the
move-mentioned property for Waremion purposes.
(We) agme mum, Indemnify and keep haemleas tM City Of Cupertino against
liabilities,judgmenu, costs and expenses which may in any way accrue against said City
in NT WILL
consequcnec of the granting of this Permit.�/
APPLICAUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
^— `
Issued by:
OURCE
Date J U
REG-4ATION n n
2 r�,
f I �l\Dare
Re-roofs �1Z�
Type of Roof
Sign... of Appfs m
ontmr
HAZARDOUS MATERIALS DISCLOSURE
Will she applicant or future building occupant store crup lk, Iuurdous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
erode.El Yes 25532(.)?ple All
Ye
roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building =upon( use equipment or devices which
If a roof is installed without first obtaining an inspection, l agree to remove
hem dow air mnuminmts as dchncd by the Bay Area Air Quality Management
all new materials for inspection.
ict9 /
0y Q O
Hove mad the hvardnusmarerialirtquimments under Chmkxr6.95 of the Califor-
nia Hcalth is Sele yCode, Sections 25505,25533 and 25534.1 understand that if the building
dors not commily have a Want. Nat it u my, P..oil. dy W notify Ne Occupant Of she
mgvirements which mum met 'orNiss of. ceulifW.0 or Occupancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Ownermamhod dagc DaW
1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rug: Sub: Elk: Lot:
APN ....... .: 36211022.00
DATE ISSUED.......: 03/16/2006
RECEIPT #.........: 33595
REFERENCE ID # ...: 06030084
SITE ADDRESS .....: 1182 STAFFORD DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: kiersaw
COPY # : 3
OWNER ............: VICTOR LY
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4952
C J
RECEIVED FROM ....:
WATER QUALITY PLUMB
CONTRACTOR .......:
SATALINO, MARTY LIC #
21526
COMPANY ..........:
WATER QUALITY PLUMBING
ADDRESS ..........:
1860 ALMADEN RD
CITY/STATE/ZIP ...:
SAN JOSE, CA 95123
TELEPHONE ........:
(408)267-9330
•EE
----------
ID
-------------
UNIT QUANTITY
----------
AMOUNT PD -TO -DT
THIS REC
NEW BAL
PPERMITFEE FLAT RATE 1.00
---------- --------------------
38.37 0.00
----------
38.37
0.00
TOTAL
PERMIT
---------- ---------- ----------
38.37 0.00
----------
38.37
0.00
METHOD OF PAYMENT AMOUNT
-----------------
NUMBER
OTHER
------------
38.37
---_---------_-__-
VISA
TOTAL
RECEIPT
38.37
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
C J
It W110%0
CITY OF
WUPERTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: S\ ` �DQ1�
PERMIT #f2 1-7
d0
OWNER'S NAME:
PHONE # `� _9
GENERAL CONTRACTOR
# �C
I am not using any subcontractors: 6c,
Sign tune Date
Please check applicable subcontractors and complete the following information:
bwi�ie# Contracto ignature
Date
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
bwi�ie# Contracto ignature
Date
awt�mg,
an of
CUPERTINO
pc.Po 30D3`+
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN #� t Z
Bldg. Permit Fees
Dat( ` (0 -C__)C
Building Address:
Gas Piping System Fee
PLUMBING
Q
Plumbing Permit Issuance
PLUMBING
Owner's Name:
Re i eofFixtures
PLUMBING
Phone #:
l (
)S)
BPWSVCS
-
Contractor:
Pho e:
-4 - 9
33 0`��JSvI
License #: 3
Contact
-
Phone:
PLUMBING
Cupertino Business License #:
BUSLIC
Business License
Building Permit Info:
�( �.�� L �I C� (� SL�S(1 C
5 5 MA7—C�r-
Bldg ❑
Elect ❑ Plumb
Job Description:
Residential
Commercial ❑
Cost of Project:
,S2[]�
•
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 eofFixtures
PLUMBING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING