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CITY OF CUPERTINO
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CCINTRAC"TQIiINFORMATION x
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
GENMOR PLUMBING
PE1M1T N0 06120009
104
OWNER'S NAME:
PERMIT ISSUE DATE
NISHIMURA AKI
3560 HAIG ST, t2
12/04/2006
NE:
SANITARY NO. CONTROL NO.
(408)855-8348
ARCHITECrfENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
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LICENSED CONTRACTORS DECLARATION
IOU Description
1 hereby affirm Nat I am licensed under provisions of Chapter 9 (commencing
with Section 7")af Division 3 ofdte Busi,ses and Pmfessions ,and my license in
in(allf andmIT L
COPPER RE -PIPE
Lieetuc ass Lie. R -
.
Dam —Conpador
� y>7
ARCHr1DECLARATION
�/t
I undersunJ my plans shall W d as public mrnrJn
usen
Licensed Fmfcssional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Comracmes License law for the
following rcuon. (Section 7031.5, Business and Professions Cook: Any city or county
.
which Requires a permit to c.mem c4 ally. improve. demolish, or ¢pair any swttum
$7000
prior W its issuance, also requires the applicant for such permit to Bk a signed summem
this W is licensed pusamenao the Provisions of the Committees Limns, Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000)of Division Sof the Business and Professions Code) at
that he IS axampt stionfousen and ak Rssu for the alleged complains. My violation of
Occupancy Type
Section 703 L5 by any applicant for a permit subjects the applicant to a civil penalty ofr
na mom than five hundred douses (M),
I, as owner of dee property, or my employees with wagon as their sole eomlenudon.
will do the work and We swttum is Mt intended or oflcred for sale (Sec. 7144, Business
Required Inspections
.crt License n m law donot apply an Owner of
and Professions Code: The Comptu
property who bu ilds or i mprevrs therms, and who doessuch work himsrJ f orduougb his
Own employees. provided that such impmvxmenu are Ootintended oroffcred ferule. If.
however. Ne Wilding or improvement k sold within ane year Of compktion. the owner -
builder will have Ne burden of proving Nat M did not Wild or improve for purpose of
side.).
❑ 1, as owner of the property, am enclusivcly contracting with licensed mnoanors In
consmrt Me proim (Sec. 7044. Business mad Professions Code) The Conbactofs U.
cease law does not apply OR in owner of propeny who Wilds or improves Marano. and
who compacts for such projects with a cantranor(s) licenced passuam to the Contractor's
Licenz law.
❑ lameaemp,mcierSec .B&PCIMWismauen
Owner Data
WORKER'S COMPENSATION DECLARATION
1 thereby affma under p reaRy of perjury arc of the following declatatwns:
1 haw and will mainain m Cenifacte of Cement to self-iasum for Warker'sCon,.-
mien, as previded for by Section 3700 of the labor Code, for eche perfam once of the
work for which this permit is issued.
❑ 1 ban atb will maintain Worker's Compensation Insurance, as required by Section
3700 of Ne labor Code. for Ne padofmance orum work for which Nis permit is issued.
My Wor C. e. 6. Inmrartee omn and Poli,
Lamer. Poli, No.:
d
tP...( CERTIFlCA ONFRAN WORK S'
TION INSURANCE
COMPENSATION
(Thu settle need nm uncompleted if the permit is (arose hundred dollars ($IOG)
nr leas)
I cenifv Wet in Ne performance of the work for which Nis permit is Wind, I Wll OR,
employ any person in any manrcerso as p become subject to the Workers' Compensation
Laws of California. Date
Applicata
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
them¢n subim to We Worker's Compensation previsions of Nc IdbW Code. you most
foMwith comply with such pmvisime, or this permit shall W demend tevokcd.
CONSTRUCTION LENDING AGENCY
I ! hereby han that Were is a cpaSum lendivg ages, for tW perfurmastm of
_
work for which this permit is issued (seecc. 70 309], Civ, C.1
Lancer's Name
L<nder's Address
1 certify that I haw read this application and sum Nat We own information is
come(. I agree to comply with all city and county ordinances and sate laws Relating to
Wilding constriction, and hereby authome representatives of this city to enter upon the
ahoy,:-mc
oned
operty
purpo
cuen s.
forinspemses
(We) agree to save, indemnify and keep harmless We City of Cupertino against
judgmnt,emi
judgments, and exp which may in any way accmc .,mm' and City
in coi serpjruce of ispkRmich
inconsequence of DERST nt NOS thisDWIL
grans
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: 1/"
SOURCE REGULATIONS.
�J �i/k/ Date
Re -roofs
-
Re of ApplicurUConuacmr Dao
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicapt or f from Wilding mavpant spm or handle huardous material
as defined by the Cupertino Municipal Code. Chapter 9,12. W the Health and Safety
Code, Scores 25572(a)7
❑Yns ON.
All roofs shall be inspected prior to any roofing material being installed.
Will We applicant or future Wilding =Upon, use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit hanrdons air contaminant u defined by the Bay Area Air Quality Managcmem
all new materials for inspection.
District?
❑Yes ONO
1 have read We hazardous materials requirements under Chapacr6.95 of dm Czlifor.
ria Health&Safety Okk. Smdrns 25505,25577 and x5534. I mucesand MaifNe Wilding
Ones not curtcmly haw a umam. that it a my Reapmisihilily, to notify the =upmt of d¢
requirements which most be mel prior w//I iyum oft CcmrteategOcapanry.
�ignature of Applicant Date
I�u n
All roof coverings to be Class "B" or better
Owner or auWonsd agent Dam '
CITY OF
46UPERTINO
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U
Buildin
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Department
JOB ADDRESS PERMIT #
OWTNEIeS
GENERAL CONTRACT R -5ri n.,,.,v ,, . 4,, tin. I FAX #
I am not using any subcontractors_
Signature
Please check applicable subcontractors and complete the following information
b -_a Lag
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
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature
Date
Om 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31633083.00
DATE ISSUED.......: 12/04/2006
RECEIPT 4.........: 36943
REFERENCE ID # ...: 06120009
SITE ADDRESS .....
SUBDIVISION ......
CITY .............:
IMPACT AREA ......
OWNER ............:
ADDRESS ..........:
CITY/STATE/ZIP ...
RECEIVED FROM ....
CONTRACTOR .......:
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ...
TELEPHONE ........:
10449 PLUM TREE LA
CUPERTINO
NISHIMURA AKI
OPERATOR: amyw
COPY # : 2
GENMOR PLUMBING
GENARO MORALS LIC # 27101
GENMOR PLUMBING.
3560 HAIG ST. 42
SANTA CLARA, CA 95054
(408)855-8348
EE ID UNIT QUANTITY
------------------------ ----------
AMOUNT'
PD -TO -DT
THIS REC NEW
BAL
3PWSVCS WATER SERVICE 1.00
--------------------
9.00
0.00
--------------------
9.00
0.00
PPERMITFEE FLAT RATE 1.00
38.37
0.00
38.37
0.00
TOTAL PERMIT :
---------- ----------
47.37
0.00
---------- ----------
47.37
0.00
METHOD OF PAYMENT AMOUNT
-----------------
NUMBER
------------
CHECK 47.37
------------------
3122
TOTAL RECEIPT 47.37
VOICE ID DESCRIPTION
VOICE
ID
DESCRIPTION
301 ROUGH PLUMBING
502
FINAL PLUMBING
ENERGY
507 FINAL PLUMBING
•
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41 CUPEkTINO
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CITY OF CUPERTINO CLO I 91DCCq
REPIPE/SEWERS/MAIN SERVICE
PERMIT APPLICATION FORM
APN # , — 33"—��3
Bldg. Permit Fees
BUILDING
Date:
Building Address: —�
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Owner's Name"r
PLUMBING
BPFIXTURE
Phone #:
� ��J c
N
BPWSVCS
Main Water Service
'Jlp 65
Vv
PLUMBING
BPSEWAGE
Contractor:
Phone:
License #:
BUSLIC
Business License
BUILDING
Contact:
Phon :
Cupertino Business License #:
Building Permit Info:
Bldg ❑ Elect ❑
Plumb Ef--�
Job Description:
Residential Commercial ❑
Cos of Project:
•
Qty. if
Applicable Fee ID
Fee Descrintion
Fee Gmnn
BPERMFEE
Bldg. Permit Fees
BUILDING
BPGAS
Gas Piping System Fee
PLUMBING
PPERMITFEE
Plumbing Permit Issuance
PLUMBING
BPREPIPE
Re i e of Fixtures
PLUMBING
BPFIXTURE
Pbl . Fixture
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BPSEWER
Sewers
PLUMBING
BPSEWAGE
Sewage Disposal
PLUMBING
BUSLIC
Business License
BUILDING
40