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06050237 CITY OF CUPERTINO �' «zay " • "�� %' BUILDING DIVISION PERMIT .CONTRAG`T,0 INFORMATION BUILDING ADDRESS: SOUTH BAY PLUMBING PERMRNo06050237 11030 VIA SORRENTO OWNER'S NAME: PERMIT ISSUE DATE FARVANEH ABHARI 441 N CENTRAL AVE 05/30/2006 E: SANITARY NO. CONTROL NO. (408) 370-3535 ARCHITECDENGINEER: BUILDING PERMEr INFO BLDG ELJ:R PLUMB MECH 0 0 0 0 +00 LICENSED CONTRACTORS DECLARATION 1 Mrcby.M.that 1 am lived under I.W.ns orChapler 9(commencing Job Description L+ with Section?000)of Division 3 of Ne Basin=and Professions Code,and my lzenmu ±�„ infull roreeand efreet. . ! WATER HEATER REPLACEMENT a Ui z License I R � Lie.N =F0 Da¢ Canuactor ' "t ARCHITECTSDECLARATION l¢< I understand my plans shall Wined as public r¢t.nIs lyU WO In Licensed Professional g OWNER-BUILDER DECLARATION iI I hereby Jr.athat Iain exempt from the Cantrxcum's License Law for the , O O fallowing...(Section 7001.5,Bminess and Prefesvom Code:My city ar county `e m which requires a Permit tocomtruc4 alcor.improve,demolish.nr repair any smeWo $810 °-" prior m its issuance.also requires the applicant for such permit to file a signed smrement -�< that he is licensed pursuant to the provisions of the contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation '50 (commencing with SectionTOD0)of Division 3 of the Business and Professions Code)or y _ that he is eumpt therefrom and the basis for the alleged eumption.Any violation of Section 9031.5 by any applicant for a permit subjects Ne applicant W a civil penally of nm ream man five hundred dollars(3500). r Occupancy Type ❑Lssowmrofti¢pmporty.ormyomployem wirewaguumeir tole compensation, will do the work.and the h,Com u molidrendede Law dd f .1 apply to a/.Btasie.of sod arty who lCodcds& Thr Contractors Lame law docs not apply W rt owner of Requ Inspections Property who builds id impasses thereto,and who does such wort himself or through his Own however.ther;prog or improvement at eh impmvem wthinnod ear of cmpllemG far mame,e. - / Wild r,Ne building orionofpu halt a did oro year or completion,the owner- 1 builder will have the burden of proving that he did not build m improve for Purpose of ssle.). ❑1.as done,of the pmpeny,am eaelosively contracting wire Beaumont conuactom in O/ convict the project(Sec.7Oa4,Besides and Profusions Cade:)The emntraeWrm U. (� cents law does not apply to an owner of property who builds or improves thrmem.and . who contracts for such projects aids a rnnuachor(s)licensed pursuant In do Comneudes License Law. ❑I am eaempl under Sec. ,B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby,a1Bmt under penalty of perjury ane of the following declarations: 1 ham and will maintain a CenfficoW of Cousin,W self-insure for Workers Compcn. smion.as provided for by Secfion 37M of the Lab",Cade,for the ponformanco of the work(or which this permft is issued. ❑1 have and will maintain Workers Compensation Innutana,a required by Section 37M of th.Labor Code,for the perform....or the work for which the permit ire Issued. My Workers Compensation ImL artier and Policy number )(� O' Carriers U•�' In�' �<2Policy No.: CERTIFICATE OF EXEMPTION FROM WORKER COMPENSATION INSURANCE (Thiss.mim need Out be completed Bthe permit IS faro.hundmddallars(3100) ` ar less) I cenifv that id the perform.of But,work for which this pinern u issued.l shall not - employ any person in any manmrao m in become subject o dte WorkosComp.m stion Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making mu Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Libor Coda you must .,O fdMwids comply with such provfuoll e perm or thit shall be tamed revoked. �'� CONSTRUCTION LENDING AGENCY [-t Ithereby s(B,m than mom is a cmumucunn lending agency(o,the pustroman¢"f y, dm work for which Oil$limpid,u utwed sec.3097.Civ.C.) , !sd Q Lenders Name Z:)z Landers Address U C 1 certify Nat I hays rad this application and auto that thc above idfomtatiud u D.F correct.)agree W comply with all city and county ordinances and mute laws relating to 0U building conviction.and hereby amhome mpmscnutiws or his city to color upon the r a shave m.miuned property for impecum,Purposes. (We)agree W all indemnify and keep harmless her City of Cupertino against vE".t rq liabilitiem.judgments,costa and expense which may in any way secret against said City U z to ccm.quenceof the grenung of this permi4 III ^ APPLIC UNDERSTANDS A .WILL CO WITH ALL NON- OI Issued by: Date 3 e/ SOUR GULATI S. sign a fApplian nare Re-roofs - HAZARDOUS S MATERIALS DISCLOSURE Type of Roof Willy t applicant C.prmfMuni building arupanUWm m handle lurardous d Safety a ty u de,Sed by the 32(a)l m Municipal Cade.Chapter 9.11.and the Healds and Safety Cole, my. All roofs shall be inspected nor to an roofing material beim ❑Yds p��. P P Y g g installed. Will the applicant or furore building o pant use cyuipmrnl or devices which If a roof is installed without first obtaining an inspection,I agree to remove .mit hmardom air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. DiahikLy OYa pflu 1 have real the hvardo s materials requirements under Chapherb.95i f the Califor. nu Ficalth&SafelyCode,Sines.15505.15533 snd 75534 I unJcrswd mat ifthc holding dao ml sly hart a um l my WspouiK try W notify dim occupant of the require3nts him..usith,, / otiBcaloorCea g Signature of Applicant Date f - All roof coverings to be Class 'B"or better Owner tar aumarisd ase.. r � Da ,n Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408) 777-3333 �UPEkTINO Building De artment JOB ADDRESS: 11030 V v-i 54rr-en PERMIT # OWNER'SNAME: j rz PHONE # 12- e,-03) c-17-0--('0Z06 GENERAL CONTRACTOR: I am not using any subcontractors: )IA17./YZa, 30 0 Signature bate Please check applicable subcontractors and complete the followinginformation 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 CITY OF CUPERTINO •m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31601038 . 00 DATE ISSUED. . . . . . . : 05/30/2006 RECEIPT # . . . . . . . . . :34597 REFERENCE ID # . . . : 06050237 SITE ADDRESS . . . . . : 11030 VIA SORRENTO SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FARVANEH ABHARI ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : DONALD KELLER CONTRACTOR . . . . . . . : RICK PERKINS LIC # 22605 COMPANY . . . . . . . . . . : SOUTH BAY PLUMBING ADDRESS . . . . . . . . . . : 441 N CENTRAL AVE CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 370-3535 WE 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 ---------- ---------- ---------- ---------- TOTAL PERMIT 45 . 65 0 . 00 45 . 65 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 45 . 65 138 TOTAL RECEIPT 45 . 65 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 103 UFER 106 SEWER & WATER 507 FINAL PLUMBING UIiiiiiMiiiill CITY OF CUPERTINO 0W5 0 237 RNAL WATER HEATER • CUPERINO PERMIT APPLICATION FORM EAPN # '^ —O'" 0?0 Date: �Oress: /V� Z/ J� � lO JLJ w s Owner's Name: f Phoe#: 3 x(26 26(0 Contractor: Pho License#: tt ��., lvw, , `�� �1u�1 , b�3�3 � " v' 6 Contact: Ph ne: Cupertino Business License#: -15(,r\/u Building Permit Info: 1 Bldg ❑ Elect CJ Plumb ©� Mech C Job Description: ZJ Residential Commercial ❑ Cost of ect:lk Strapped On Platform Bonded Er New Location ❑ Replacement �— Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE Plumbing Permit Issuance PLUMBING •BENERGY Energy BUILDING BUSLIC Business License BUILDING