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08050147 (2) CITY OF CUPERTINO �y�ss��sa,,�gTTTxs�iI<�*;1��FnSs�� /'� Cy +��' "` `�`�" BUILDING DIVISION I�ElUYla l CONTRtiCTQR INEC}RMATIN A .'iFsl+fs ti Bu1LDIrvM5 �DEEPROSE PL GENMOR PLUMBING PERMIT08050147 OWNER'S NAME: PERMIT ISSUE DAIS MIKE BRBSALL 2552 SEABOARD AVE 05/19/2008 ONE: SANITARY NO. CONTROL NO. (408) 855-8348 ARCHITER/ENGINEER: BUILDING PERMRINFOIN BLDG F3FC1' PLUMB MEC, 0 0 0 0 30$ LICENSED CONTRACadR'SDECoN Job Description m 1 Mcby affirm Nan I am Hamed under provisions m of or Chapter 9(ammcncing P 4 � wINSeC4o11TOBU)p(DlVlelan)arlM1eHayrlaANdPrakaslamCede,ad�YIICCM1m, HOUSE COPPER RE-PIPE Il sen teres ad eRa c 6 Rg z Limen is Lk.g n s- Dam caetrsem ` ARCHITECTS DEC16AKATION I understand my pedal Audi W usad a public mcorda ;yU 50� Licensed Professional 3 OWNER-BUILDER DECLARATION <i I hereby aria Nn 1 am ucmpt from the Camramors License Law for tie i o O follawin,revue.(Seel an RD 1.5,Busims and Procession Codc:Any city m county S$ which mquha a permit as eoamrueL slur.impmse.demol'uk m repair any Auction prlmm its imiance.Am asinine;Na applicant Chemical Permit to file a Signed summenl mat is,is leered pension,in Ne provisional of the Cmmcurs lxense Law(Chapter 9 Sq.FC Floor Area Valuation z€� (commence,with Section 1000)of Division S of She Business and Prorealinn Cause)or $6000 — that W is eaempt Nenefrom and Ne basis for She alleged uempdan Any vinatien of - Sessions 1031.5 by any applicant fa a permit subjects the applicant m a civil penalty of Number Occas ane e on,more Nan five hundred&It=(S.M 36905022�� P YTYP ❑L.ne of Nepmpmy.mmymploymwiNma uthe wlccampe dw, will Pr fte wank and Ne aYaure lanar's LMed as w dons not apply]061,Business and Pm ashen code Tie Camacmrs n ttme Law dm net apply lf rt owne of Required Inspections PmpcnY was Wildami provided taw Nercon,ad who..at mems himsel(m Nmu,h h, own empbym, ori pr amus i t Is semw t art not ear o c moRmed rmale R. howeverWildn',Ncbuilding mimprovcmmtIcaaid withinoneyen ormprove fa.impose use of builder will haw W burden of proving that Ire did rot build or improve for puryase of 0 1,as owner of the property,am exclusively contracting with licensed smnusema m am ami the pmjeu(Sm.7044.Business and Prefosom Coda)The Coomsetm,Li- mve Law does not apply to an owner of property,who builds or improves thereon,sed who emtracu fee such pajeas with a camacmr(s)Ik<med porno.,in the Oantraemrs IYenz law. ❑lamescmpunder See ,B&I'Cfmds,mmon Owner Dam WORKER'S COMPENSATION DECLARATION 40 I hereby affbm under pmulty of perjury an of Ne following dularadons: 1 hart and wall remains aCmdGnte of Conant to self-inure for WorkersCompo- avim,as provided far by Section 3100 of the Labor Code.for the penfamaa of Ne wart for which Nu Porritt imposed. 0 1 have and will mAmah.Workers Compensation Insurance,as mquimd by Section 3100 of Ne labor Cade,for Ne panromanee ofthe wort rte which this permit is issued. My Workers Cmop mid..Imus¢areim od Policy be numr am: Cam CJ Policy No.: E FICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Min motion need wtWcomplcmd if de Permit Is roan hundred dollars($100) or less) L madly that in Nc po formurcc of the work for which Nis permit is issued.L dd1 not employ any person in any enamor an as in become subject In tic Wmkea'Compemadon Laws of California.Dau Applicant NOTICE TO APPLICANT:If.after making Shia Cenificau of Raccoons.you.Should become subject as the Workch Compensation previsions of Nc labor Code,you muss .J O forthwith comply with Such provision m Nu permit shall be datedvo reked, .Z.v'"-" CONSTRUCTION LENDING AGENCY [-�.N.. 1 hcmby alum Nu share is a mnawaim kndin a for Ue e gem Ierfmma oN Ile dark for which u Permit Js issued(Sm.l ,Civ.C.7 Le N Q Undoes Name �z f<ndeff Address U O l canary 0.11 have and hear application and slam Nan de Asian infomadw is LL,^ cameo.l agme m cmnply with all chy and cowry orris arras aM sum laws miming as O CSJ^ building construction,and hereby initiation mpresualmin,of this city in Sums open She a alma n-m mmused property for impeNaa purposes Wo)agree to ave,indemnify and kap hamlets the City of Cupertino again, E"h liabilidu,Judgments,ants ad espe"m^•which may in any way soma against said City UZ in consequence or the granting of this pemit. J G APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date S OUnano Re-roofs ApplimslCouanor Dau HA DOUSMATERIALS DISCLOSURE Type of ROOF e"heat car famrt wI,Nyg aroupam smrt aho dlehaardom material '. no Munici Cada.Chapter9.13,and du Health and safety zss32(.)1daAll roofs shall be inspected prior[o any roofing material being installed. e applicant car Ormre Wilding repentant e e If a roof is installed without first obtaining an inspection,I agree to remove anall PP g w egaipmat an dnim whim g Dlatrih�nes air conamo nano uRncd by the,Bay Arco Air Quality Managcman, all new materials for inspection. ❑Yu No I have mad NehauNoa masala,requirements umfer Ch ip cr6.95 ofthcUifor- nu Hea]"Safety Cede,Simmons 255.5,25533 and 25534.Iundeuund Nstif Nc building doss set c ndy hew a.k Nu It,my mapomibility m ndfy the acupat of Nc we' wnicgp,aReame, anm ancenira:.maraap Signature of Applicant Date Ower or mthmived agent S� Dam All roof coverings to be Class's"or better CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36905022 . 00 DATE ISSUED. . . . . . . : 05/19/2008 RECEIPT # . . . . . . . . . : BS000004821 REFERENCE ID # . . . : 08050147 SITE ADDRESS . . . . . : 10151 DEEPROSE PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MIKE BRBSALL ADDRESS . . . . . . . . . . : 10151 DEEPROSE PL CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3335 RECEIVED FROM . . . . : GENMOR PLUMBING CO CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101 COMPANY GENMOR PLUMBING ADDRESS . . . . . . . . . . : 2552 SEABOARD AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 855-8348 • FEE ID UNIT . QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BPWATER UNIT 1 . 00 40 .79 0 . 00 40 . 79 0 . 00 1BSEISMICR VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 122 . 97 0 . 00 122 . 97 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------- --------------- -------------------- CHECK 122 . 97 #6591 --------------- TOTAL RECEIPT 122 . 97 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------- ------------------------ ---------------------------- 106 SEWER & WATER ,' 301 ROUGH PLUMBING 507 FINAL PLUMBING • G p :-D- 0 I CITY OF CUPERTINO « ' REPIPE/SEWER/MAIN SERVICE • CUPEk�TINO PERMIT APPLICATION FORM APN # Date: G Building Address: /of s1- toe os�� pL Owner's Name: Phone#: f V1 t`Ke--(3kl3 /9 o 6- 3 3 -o>Ga Contractor: Phone#: �/C 3 1/8 4 A(9 44-/1 Oe-,5;4 AJ)0p_ 13 Fax #: Contact: Phone#: Fax #: Contractor License#:(-'3 6 Cupertino Business License#: a-7 O Job Description: ocv S(�-COa)'C:7� — 0 Pe' Residential Commercial Q Valuation: Do Green Building:-Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets iBSEISMICOM Seismic Commercial P / 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer -� CITY OF CUPERTINO x REPIPE/SEWER/MAIN SERVICE CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1PRREPIPE Residential re-pipe per fixture P 1R-PRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P IPGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+ Outlets P / 1PPERMITFEE Plumbing Permit Fee Issuance P • 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B • Community Development e 10300 Torre Avenue Cupertino CA 95014 " Telephone(408)777-3228 kUPCITY Of EkT�N� Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # �QD s O ` , / lell,rlS L U OWNER'S NAME: , /��U ,(j PHONE # p6'- GENERAL CONTRACTOR: ,,A„L ETr6 . N FAX # I am not using any subcontractors:�:� ,)G&4:�D � s* —/9 —�9 Signature Date 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