05100182 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTOR INFORMATION d,:,-
a+SUILDINGADDREss: ALLSTAR PLUMBING PERMIT NO.05100182
OWNER'S NAME: PERMIT SUE DATE
LINDA MILLER 656 N KING RE) 1019119005
NE: SANITARY NO, CONTROL NO.
(408) 251-6040
ARCHITEC(ENGINEER: BUILDING PERMITINFO
BLDG ELECT' PLUMB MECH
500 LICENSED CONTRACTOR'S DECLARATION
0
u I le.7 affirm that 1 am 3.f the
Bu under provisions of Chapter 9(Commencingsis Job Descrip l [j
�� wife Scotian 101 effect.Division3of dte Business and Profushms Code,anpmYlicemeu EI H
ilp 6P 8Eu
Lmumrccamer¢a o �l WATER HEATER
n q? License Clara Lk.N ^
�-E-9 Date_tc, frf r— feHII=I SDECLARA (�/�7'
y.K� I undersand my plamshill hemmed as public records tlisl 214 2005
Dwu
i,t; Licensed professional
5 OWNER-BUILDER DECLARATION
+� q 1 hereby affirm that I am exempt from Ne Contractor's License Law for the b
p O following ream..(Sitcom.7131.5,Business and Profcssiou Code:Any city ar county ��L0
K S ff which requires a Permit to mnmmct alter.improve,demolich,or repair any structure S2_100
'siy prior it)is issuance,also toquim the applicant rat such permit in Ole a signed statement
mma that he is licensedpursuanttotheprovisionsofineContractor'sLicensclaw(Chapter9 Sq. Ft. Floor Area Valuation
iF$ (commencing with Section?000)of Division 3 of the Bulinus and Professions CMe)or
—
Oat be is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 1031.5 by arty applicant for a permit subjects fee applicant to a civil Penalty of Occupancy T
.int m.m than five hundred dollars(5500). 0 0 P Y YPe
❑l.uowmr of the property,mmy cmploycu wife wage udev sole compcnsedon,
will do thework,and the structure is nmtinumded uroRcred formic(Seo.1014,Business
and Professions Code:The Contractors License Law does not apply to an owner of Required Inspections
property who bui Ids or improves theme,and who does sue h work himself or tlwugh his
own employees,provided Nat such impmmenena are not intended or offered for nit.1f,
however,the building or improvement is sold within one year of completion.the owner-
builder will have she burden of proving Nat be did not build or improve for purpose of
alt.).
Q 1,as owner of the property.am exclusively Contracting with licensed contractors to
Construct the project(Sac.7044.Business and Profusions Code:)The Cormi ant's Li-
cense Law dos not apply to in owner of property.who builds or improves theme,and.
who contracts for such projects with a eon sactot(s)licensed pursuant he the Contractors
License law.
1 am exempt under Sec. ,B h P C for this osuon
ncr Data
WORKER'S COMPENSATION DECLARATION
T hereby affirm under pewlty of perjury anc of the following declarations: .
[ham and will maintain aCertlfiateof Consent in self-insure for WorkelsCwnpcn-
sation,as provided for by Secret 3100 of the Tabor Code,for the perforreamc of the
work for which this permit is issued.
❑1 ban and will maintain Workers Comptention Insurance,as required by Section
3700 of the Labor Code.for the performance of the work for which our permit is issued.
My Worker's 5morenamorifinsurance Cartier and Policy number are:
Canicr: ' Policy N..: G (I bogill
RTIIICA OFE)(EMPTIONFROM O ERS'
COMPENSATION INSURANCE
(This section need not bemmpleted limit Permit is Intent hundred dollars(510th
or less.)
1 certify that in the performance of fee work for which this Permit is issued,I shall not
employ any person in any manners.M In boort subject o the Workers'Compensdon
Laws of California.Doc
Applicant '
NOTICE TO APPLICANT:IL after making this Cti ificam of Exemption,you should
hecome subject to Nit Wortrr's Compensation provisions of the Labor Code,you most
.JO Forthwith comply with such pmvisines-10.permilsbll be drevolted,
olted.
z h CONSTRUCTION LENDING AGENCY
[-+ I hereby edition Nat thea is a ConmWction lending ageoey lot the performance of
ai M the work for which this permit is issued(Sec.3091.Civ.C.)
V] Landers Name
D z Underi Address
J C) 1 Certify Nat 1 have sad this application and sore thin fec aWw information u
rm
I, can.I agree to comply with ill city and county on inances and more laws relating in
O[, Wilding construction.and hereby someone representatives of this city to enter upon fee
ra above-cu,judncdms.onymom an inspection purposes
(Wit)agree to save,indemnify and keep harmless the City o(Cupenino Agaiul
Hh incoiouComec,or
aang oxpcnvamit. may in any way acerae against mid City
C.3Z in eonsegmmc of the gaming of this Permit.
APPLICANT UNDERSTANDS A D WILL COMPLY WITH ALL NON-POINT Issued by: Date164—,11-04
SOUR E/ TION
9gR�ip(c dfA'6phcant/Combector • Date
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant some or ban dle hvardou macrial
ax defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Sarely
Code,SO53
Ytion 252(e)7 All roofs shall be inspected prior to any roofing material being installed.
es
If a roof is installed without first obtaining an inspection,I agree to remove
Will Ne applicant or(taw building mcupant tae equipment or dcvicu which g P
emit hazardous air co menet ons as dconcd by the Bay Arca Air Quality Management all new materials for inspection
District? P
❑Yu No
Ihavcmadthehaz d mu 'wrialsmquimmentsunder ChaperG95oftheCalifor-
niaHc21NhSafetyCode.Secoas25505.25533ara125534.1undcrse mifthe Wilding oL
dos hot currently haw a tenons this is u my responsibility to moor,tic oceup.,of Nit
requirements which must be sect prior w issuance Cuts CCmfwae tar Occupanry. Signature ant Date
Gwnerorauthmta<dspent D,� 5 O A All roof coverings to be Class"B"or better
r Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY Of Fax(408)777-3333
�UPEkTINO
Building De artment
JOBADDRESS: jL>G63 AA•.jeHe PI&�e PERMIT #
erV.No CA aso t 0Sfla7?'6�-
OWNER'S NAME: (,;N l e� PHONE # '[/v4 9% - 1961 -3
GENERAL CONTRACTOR R 10MB 1M Ce FAX#
I am not using any subcontractors: lm Co S
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
O er/Contractor Signature Date
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: 8uem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 37532040.00
DATE ISSUED. . . . . . . : 10/21/2005
RECEIPT #. . . . . . . . . : 31693
REFERENCE ID # . . . : 05100182
SITE ADDRESS . . . . . : 10683 MINETTE PLACE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LINDA MILLER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JEFFREY NICHOLS
CONTRACTOR . . . . . . . : DUARTE TADEV LIC # 22189
COMPANY . . . . . . . . . . : ALLSTAR PLUMBING
ADDRESS . . . . . . . . . . : 656 N KING RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95133
TELEPHONE . . . . . . . . : (408)251-6040
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ _____________ __________ __________ __________ __________ __________
BENERGY PERMIT FEE 1.00 34 .86 0.00 34.86 0.00
BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
__________ __________ __________ ----------
TOTAL PERMIT 84 .02 0.00 84 .02 0.00
METHOD OF PAYMENT AMOUNT NUMBER
____________ __________________
OTHER 84.02 VISA
TOTAL RECEIPT 84 .02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF CUPERTINO
WATER HEATER
OCITY OF
CU
PEkTINO PERMIT APPLICATION FORM USS/ate/�Id
APN # 3 n,5 3a Q (O Date:
j 7 L/ O Z b
Building Address:
/o6g3 AINe- laCAL
Owner's Name: Phon #: 11 1qq3
/iAI
Contractor: LPhone: License#:
'UM y0$ 772 _I I P o
Contact: J Phone: Cupertino Business License#:
o?�
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Job Description: (
War "rc A! fe ue
Residential Corrbbercial ❑
Cost of Project: Z I co,C ,�>
Strapped i On Platform El Bonded F-1New Location ElReplacement
Qty. if
Applicable Fee ID Fee Description Fee Group
1 BPWHEATER Water Heater/Vent BUILDING
/ PPERMITFEE Plumbing Permit issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING
•