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11110153CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7548 ORANGE BLOSSOM DR CONTRACTOR: ALLSTAR PLUMBING PERMIT NO: 11110153 OWNER'S NAME: YAMASHITA SHIZUHO ET AL 326 PHELAN AVE DATE ISSUED: 11292011 O ER'S PHONE: 4082579551 SAN JOSE, CA 95122 PHONE NO: (408) 230-5569 LICENSED CONTRACTOR'S DECLARATION r "' ELECT PLUMB '" /�/�� License Class G 3 (a Lia M 73 2611 BUILDING PERMIT INFO: BLDG r r r q Contractor /)•I15'M-rt PIUM 6-YI 69 Date 11' 2q • 1 / MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REPLACE WATER QQ SAME LOCATION (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $1200 1 have and will maintain Worker's Compensation Insurance, as provided for by . Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36611064.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating PERMIT EXP SIF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save WITHIN 0 YS OF PERMIT ISSUANCE indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 DAY LAST CALLED INSPEC costs, and expenses which may accme against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Issued by:. .� Date. 9.18. q Signature Date All roofs shell be inspected prior to y roofing material berg installed. If a roof is anREofingm for OWNER-BUILDER DECLARATION installed without first obtaining an inspection, I agree to remove all new materials 1 hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: ' I, as owner of the property, or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE. declarations: 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health & Safety Code, Sections 25505, 255330 and 25534. 1 will maintain Compensation, as provided for by Section 3700 of the Labor Code, for the compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & performance of the work for which this permit is issued. Safety Code, Section 25532(a) should 1 store or handle hazardous material. I have and will maintain Worker's Compensation Insurance, as provided for by Additionally, should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code, for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with (be Cupertino Municipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Sections 25505, 25533, and 25534. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Owner or authorized agent: Compensation laws of California. if, after making this certificate of exemption, I //f/` -- Date://,".// become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued (Sec. 3097, Civ C.) I certify that 1 have read this application and state that the above information is Lender's Name correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, MM and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION ng of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date • 6 ITEMS OF 6 • CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36611064.00 DATE ISSUED.......: 11/29/2011 RECEIPT #.........: BS000015421 REFERENCE ID # ...: 11110153 SITE ADDRESS .....: 7548 ORANGE BLOSSOM DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER ............: YAMASHITA SHIZUHO ET AL ADDRESS ..........: 7548 ORANGE BLOSSOM DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014-5225 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 156.50 --------------- 156.50 VOICE ID DESCRIPTION -------- ---------------------------- 518 WATER HEATER REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION ------------------------------------ RECEIVED FROM ....: JAVIER ESTUDILLO CONTRACTOR .......: DUARTE TADEV LIC # 22189 COMPANY ..........: ALLSTAR PLUMBING ADDRESS ..........: 326 PHELAN AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95122 TELEPHONE ........: (408) 230-5569 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- -ADMIN ------------- HOURS -------------------- ---------- 1.00 41.00 0.00 ---------- 41.00 ---------- 0.00 1BCBSC VALUATION 1,200.00 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 1,200.00 0.50 0.00 0.50 0.00 1PPERMITFE FLAT RATE 1.00 44.00 0.00 44.00 0.00 1PRWHEATR UNITS 1.00 26.00 0.00 26.00 0.00 1TRAVDOC FLAT RATE 1.00 44.00 0.00 44.00 0.00 TOTAL PERMIT ---------- ---------- 156.50 0.00 ---------- 156.50 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 156.50 --------------- 156.50 VOICE ID DESCRIPTION -------- ---------------------------- 518 WATER HEATER REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION ------------------------------------ u I �S3 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION •CUP O 0300 TORRE AVENUE • CU 7-3333 O, CA 9clacup 55 I �p 0 YJI PLUNGING ❑NMCIIANICAL ❑ELECTRICAL ❑NMCMIANEOUS (408) 777.3228 •FAX (408) 777-3333 • buildina(�cuoertinD.or MEPMIscApp I011.dac revised 06/2 PROJECTADDRESS 7,S -L/6 I^'^�, r,C�%'Y/ CI [l/C'W AFNs ?(I ''' — U� s T OWNER NAME C` U,5 I€( �ar�Gsl�� {>^ PtO Off) 2s7 - qss to E-""� STREET ADDRESS /.5 r ® [�C/ .2Sd/'7 ` CITY, STATE, �e q • 9s,U/ � V FAX CONTACT NAME //fC` /JT/lK PIT zs l• 6 yo YOB- O E-MAIL STREcTADDRESS 3u0 J /may iJ"� 1, STA C Z FAX �{ ❑ OWNER ❑ OwNER.BUILDER ❑ OWNERAGENT a+ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARmTECr ❑ ENGINEER ❑ DEVELOPER TENANT CONTRACTOR NAME 1 LICENSE NUMBER 6 II TJCENSE ZYPE36 C.' C�❑ BUS. LIC z I p 1 (� COMPANYNAME �I/Um /_/ n E-MAU. FAX STREET ADDRESS 526 � / . /Q/h, �- /�(/( CITY, STAB pP n'�. Z _( �0�'!� 2,S- 1-6 0 ND ARCHITECTIENGDJEER NAME LICENSE NUMBER BUS. IJCN COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE SE OF ❑m.DUPLEX ❑ MULTI -FAMILY BLIIIDINC. 13 COMMERCIAL PROJECTINWD-DLWD ❑ YES URBAN INTERFACE AREA [3 NO PROJECTOR ❑ YES FLOOD ZONE 0 N MTHEBIDGAN ❑ YES EICHLER HOME? [3 NO DESCRIPTION OF WORK TOTAL VALUATION: /260 RECEIVED BY: By my sigantare below, I certify to each of the following: I am the property owner m authorized agent to act on the property owner's behalf I have read this application and the inf'ormadon I have provided is camctd have road the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws rolatlng to building canstructlon. I authorize reprosrntativea of Cupertino to enter the ebav dpo 2 d ptop7f inspection puf�oses. Signamm ufAppficant/Agrnt' Daze. !j / SUppLENENTAL INFORMATION REQUIRED . _. ... .__. _ OFFICE USE ONLY 6 Y ❑ OVER-THE-COUNTER ❑ EXPRESS U u s ❑ STANDARD U ❑ LARCE 6 ❑ MAJOR • • • �.�� CITY OF CUPERTINO Imo% I FEE ESTIMATOR — BUILDING DIVISION jaADDRESS: DATE: APN: BP#: REVIEWED BY: `VALUATION: $1,200 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Water Heater PRIMARY SFD or Duplex USE: E/ec. Permit Fee: PENTAMATION PRWHEATR PERMIT TYPE: WORK REPLACE WATER HEATER SAME LOCATION SCOPE Pluwh Imp. I "e, APPLIANCE/EQUIP TYPE FEE ID Alumh, Plan Check QTY rl&A Peron'[ Fix BP FEES E/ec. Permit Fee: Water HeaterNent Unit Fee: 1PRWHEATR Othe, 1,-7ee. Imp, 1 Pluwh Imp. I "e, $26 Pc: mit Fce: Sapp/. fnsp,Fee PME Unit Fee: $26.00 PME Permit Fee: $44.00 Collstruction Th.r Adminish-ative Fee., Work Without Permit? © Yes 0 No $0.00 411erncardManW [,ees: _j44.00 ° Travel Documentation Fee: ITRAVDOC S'nong A9aion.P re: I NOTE: This estimate does not Include fees due to other Departments (le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Prelininary Information available and are oniv an estimate. Contact the Dept for addn'l infa FEE ITEMS (/'ee Resohation 11-053 Bf, 71111 1) tt , h 111mr Cho, 'i; Alumh, Plan Check Ele". Pima Chea rl&A Peron'[ Fix Plumb. Permit Fee: IPPERMIT E/ec. Permit Fee: other Ve. h. Insp. Othea. Plumb hup.L_j $44.00 Othe, 1,-7ee. Imp, Insp. Fere: Pluwh Imp. I "e, 8ie<°. Imp. Few: NOTE: This estimate does not Include fees due to other Departments (le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Prelininary Information available and are oniv an estimate. Contact the Dept for addn'l infa FEE ITEMS (/'ee Resohation 11-053 Bf, 71111 1) FEE QTY/FEE MISC ITEMS fl,m (�:larclr ],ac: A Snppl. PC1;,(!,? T77 Pc: mit Fce: Sapp/. fnsp,Fee PME Unit Fee: $26.00 PME Permit Fee: $44.00 Collstruction Th.r Adminish-ative Fee., Work Without Permit? © Yes 0 No $0.00 411erncardManW [,ees: _j44.00 ° Travel Documentation Fee: ITRAVDOC S'nong A9aion.P re: I � (] r �— 0.5 hrs Admin./Clerical Fee $41.00 ]ADMIN Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $115.00 $41.001 TOTAL FEE: 1 $156.00 Revised: 10/01/2011 OUPERTINO r L Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: ,54 0 M"Oe ) C550 Y" cq PERMIT # OWNER'S NAME: '>u:oc Gvv1USh\ i PHONE # C908) 0 23�%SS / GENERAL CONTRACTOR: AI IbT ✓tn. Flu"\ b n BUSINESS LICENSE # 22-18% ADDRESS: "7�`I� � e �p�o� �= CITY/ZIPCODE: �n33o)r cr+� 9s-iiz *Our municipal code requires all businesses working in the city to have a City of Cupertino business neense. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE -SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signature Please check applicable subcontrac /sand complete the following information: Date Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering j/ Plumbing lury, i n Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date