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05100182 (2) 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 •