08070005 CITY OF CUPERTINO .iwY-ems
BUILDINDIVISION PERMIT CONTRXOTORINFORMAT
CION,
.� .
PERMIT NO.
Buagl�G_.�tjREs�: BLANEY AVE ALL VALLEY PLUMBING 08070005
NER'S NAME: PERMIT ISSUE DATE
RICHARD MAK 3345 SELDON CT 07/01/2008
PHONE. - SANITARY NO, CONTROL NO.
ARCHr]ECrIENGINEER: BUILDING PERMIT INFO
WTR HEATER REPLACMNT -BLDG ELECT PLUMB MECH
O O O O
�Oa LICENSED CONTRACTOR'S DECLARATION Ib Description
1 hereby.(firs that I am linrtscde
d unr provisions of Chapter 9(roOe$GTIp
mmencing
In with Section 7")of Division 3 of Use Business,and N.F.ssiom Code,and my liccmc is
ec.'n n in full torand of SD
j�,jr z Llcenm C usfic, Lit,
F Dam �7 CanOacrar
ARCHfIECfS DECLARA ON
I understand my plans shall W used u Public records
U
gra
aG Licensed Professional
OWNER-BUIIDER mDECLARATION
'12coc Ihcmby.(Rrm NatIA.1. adoptfromIWfsnons Co U...Lawo far ft
i o o (allowing reason.permit
t ]031.5,Business and Professions Code:Any An err county
S$ which requires issuance.permit re conmua, eller.improve,demrmit t m repair any Rmmom ..
x> primWisensedpalmnt to the that, Cant for mchpctor'to fcmeacle a gadstamment
Oat he ending wit Pursuant to the of Division
of de ConuacmrSliana law(Chapter Sq.Ft. Floor Area Valuation
a�$ that he is a ernp,therefron om
And
of Divisiof r of me Busineuana Professions lAU,a of
that he a<xempt dmrtfmm and Ne bus,for the alleged exemption.Any violation a!
Section 7031.3 by any applicator for a permit subjects de applicant W a civil penalty of APN Number Occupancy Type
not moa the five hundred dollars(5500). P y yp
1,u owner of die property.m my r4.ployeo wins wgn u thck mk eampeuadon,
will lathe woks Code, he C.AsneatsLiWed err oRe d trout(pee.]814,BoiKn
and artyPruffeaim"
bu Cade The Conueeroes rad who Law don or apply lf an awnv of Required Inspections
Property who builds id ed that such
Ih Improvements
and who aressach wort himselfofmmugn his
awn on.thebuipmWded prsuchimprovementsart not inendedoroffered for salon-
Ammon.the buildingorimprovemcntis ghalo within am year ofimpletionthe owv-
.ilea will Nve the burden of proving!hal k did rot WW or improve Ins purpose of
ale.).
❑1.As mvret of rim property am uclusively carousing with licensed nnuanun W
coutmct the project(Sec.7044.Butanes,and professions Code:)The Co araCWes Li-
ceue Law does not apply m an owner of property who Wilds or improves demon,had.
who contracts for such projects with acanmaor(s)licensed pursuant W the Contractor's
Liccnu taw.
❑Iamvemptunder See ,Bk PC fm then nraha.
n Due
WORKERS COMPENSATION DECLARATION
1 hereby alli m under penalty of perjury one of me following declarations:
1 hive and will maintain a CeniOnm ofConmm to W if-insure for Workee,Compeo-
sada.,As provided fm by Salon 3700 of the Labor Code.for the perfmmana of the
some for which Ins,permit is.m~l
Q Tuve and will maintain Wartees Compsmxuon Iruurance,As an uhad by Section
37?()()of the labor Cade.for Ne perfmmanccoftle work forwhich thia permit is issued. '
My Worker's Compensation Insurance artier and Policy number art:
Carrier. PolicyNo.: C
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
Crus section reed notbecomplemd if tie permit is furore hundred dollars(5100)
or less)
1 coldly that in the pvfDam ce of the work For which this permit is issued,l shall not
employ any person in any maamrha as W booms subject to the Workers'Compensation
Law,of Cslifamia.Data
Applicant
NOTICE TO APPLICANT:If,after mating Ins,CeniEnm of Exemption,you abo di
Wnme subject W the Worker's Compensation provisions of me lahm Cade,you mum
.,Q foMwith comply with men provisions or this"it shall W domed mated.
zCONSLRUCTION LENDING AGENCY
(~ IWmbyafrnm that mart iia construction lending Agenry,far the perfuran.of
CYi
the work for which mu Permit s issued(Ser.30Tf.Civ.C.)
Wi 0 Lattices Name
6
1M. Z Lanese,Address
V Q 1 certify mal l have read mi,application And All WI the aWve infamem an is -
gy P cmWCL 1 Alma to comply with all city and county ardinances and also,law reining to
0 V building construction.and hereby aumorira mpm-mttatives of this city to enter upon the
�cri aWvc-me.uanad property,for io,andan purpoal which ms
F G (We)agree to Lee,indemnify end kap harmless me City of Cuperom agdrd,
Z income tauAg rcous,ants.cosine apeumooit. rosy in my wyaorre against said City L
fJ z ePAPPLICANT ofine RSTAN of this pCtWI
.. SOU0. UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /
Su6nuurt or ApplianuContrmmRe-roofs
r Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applicant mfuture Wilding a,Chapter
9.1 m handle n Health And Seely
As defined by the25 Cupertino Municipal Cade.Chapmr 9.12.W Ne Health and Safety
ode,
Section 253J2(a)7
❑Yrs Otho All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building aaupant use cqulpm rL or dcvins which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardoas ser conumioants u defiacd by the Bay Area Air Quality Management all new materials for inspection.
District,
ID Yes C]No
I have read Lite haaa Bars materials requirements under Cluper 6.95 of the Glifor.
.is Health @Safety Code.Sadao 25505,25533 and 25534.1 understud that if the Wilding
does net cuncnit In a means Out it is my rexpaoildlity W notify the recuPWt of me
mqui wknmup meipdorboissurnceofacadfeamatora...y Signature of Applicant Date
Owner or mmoriud qat Data All roof coverings to be Class'/{'or better
' .
CITY OF CUPERTINO
• 4 ITEMS OF 12 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . . 36933004 . 00
DATE ISSUED. . . . . . . : 07/01/2008
RECEIPT # . . . . . . . . . BS000005310
REFERENCE ID # . . . : 08070005
SITE ADDRESS . . . . . : 10591 S BLANEY AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER RICHARD MAK
ADDRESS . . . . . . . . . . : 10591 S BLANEY AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4542
RECEIVED FROM . . . . : ALL VALLEY PLUMBING
CONTRACTOR . . . . . . . : MARY SANDBRINK LIC # 23015
COMPANY . . . . . . . . . . : ALL VALLEY PLUMBING
ADDRESS . . . . . . . . . . : 3345 SELDON CT
CITY/STATE/ZIP . . . : FREMONT, CA 94539
• TELEPHONE . . . . . . . . : (510) 376-4816
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 350 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1PRWHEATR UNITS 1 . 00 24 . 48 0 . 00 24 . 48 0 . 00
ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 106 . 56 0 . 00 106 . 56 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- . ----------------------------
518 WATER HEATER _..
R CITY OF CUPERTINO
oS
WATER BEATER
On OF
• CLIP ERJINO PERMIT APPLICATION FORM
pt Date:
0�
Rl-lild-m, Address:
A-,te,
ne— Nanne:
r)"
onnaLnoi,: C,
Fax 1-1': z—)/
;
cupertipo L3U=i7i e.• R1C en Se # S!aTe I.
'57
Phone =: ;3&i -�Y 6�,' l —76
ontaci:
Fax #:
�,lflldinq t�e nt FT-7,f �
dPiumb i Nfec- '-
------
Commercial
Job Description:
------------
L:�,-
Planomt Bonded. New I-ocat r, Replacement I
a U 2 T 1 C"T 0�5SV�
Green Buildino Check must be completed and attached to this application.
Green Building Points achieved:
CITY OF CUPERTINO
4%F WATER HEATER
WUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCWHEATR Commercial Water B PCWHEATR
HeaterNent
1BSEISMICOM Seismic Commercial B
1PRWHEATR Residential Water B PRWHEATR
HeaterNent
1BSEISMICRE Seismic Residential B
1PPERMITFEE Plumbing Permit P
1TRAVDOC Travel & B
Documentation
1BUSLIC Business License B
I
Community Development
!21
10300 Torre Avenue
Cupertino CA 95014
Telep�tone(408)777-3228
CITY OF Fax(408) 777-3333
fdPEI�TIN0
Building De artment
JOB ADDRE,§S: j ' I�n . ( PERMIT# O�O O� D
(� l�
OWNER'S NAME: Gy- L IPHONE # q O'6 -H(p - �Z
GENERAL CONTRACTOR FAX #
I am not using any subcontractor .
Signature Date
Please check applicable subcontra rs and complete the following , ormation:
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