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08010009 (2) CITY OF CUPERTINO taxi BUILDIN G DIVISION PERMIT CONTItAGT�( RTI URMATrON, ,s BUILDING ADDRESS: PERMIT NO. 10145 SCENIC BLVD BELL PLUMBING SOUTH BAY 08010009 OWNER'S NAME: PERMIT ISSUE DATE ESPINOZA RICHARD D AND 3710 YALE WAY 01/02/2008 DNB>,n ni i v SANITARY NO. CONTROL NO. (408) 279-8824 ARCHITECTIENGINEER: BUILDING PERMITINFO -BLDG ELECT PLUMB MECH app LICENSED CONTRACTOR'S DECLARATION - Job Description ea 1 hmcby affirm Nat 1 am licensed under provisions or Chapter 9(commencing P with Section 7")of Division 3 ofdw Bottom and Professions Coda.ked my license is REPLACE WATER LINE FRM METER TO HUSE WIHT POLY e s in full Tome and ef(ceL DM Laananc Lk.X er1i�174(7 PIPE Dam Contractor ARCHITECTS DECLARATION I understand my plana shall he used as public records 9yU k sea Licensed Professional y OWN ER-exemp ERod theC ATION Commences .�a f 1 hereby.(firm then 11. exempt from the Cssimas rs License Law for the oO following censor.(section 70 1.5,Business and Rofesdons Code:Any city Or county m which requires a permit to cmnmmeL alar,improve,demolish,nr repair any structure iy prior m its issuance,also requires the applicant for such permit m file a signed suamenl G that he is licensed pursuant mMcprovisionsoftaeContractor's License Law(Chapter 9 Sq.Ft. Floor Area [�2OOO Valuation Y $ (commencing with Section 700)(1)of Division 3 of the Business and Profession Code)or y Q .. that Its u exempt thomfrom and to basis for the alleged examption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type not mem than five hundred dollar(5300). 35709076q. � ❑1,as owner of the propeny,or my employees with"gm as their into compensation, will do the work sed the structure Is not intended moQered for..le(Sec.7044,B"reau Required Inspections and Profesuons Code The Contractor's Licensee rs Law donot apply m an owner of 9 P properywha builds or improves dumon,and who dausuch work himself or through his own employees,provided that such impmvemenu ue not imported oroQered forson.If. - however.We Wilding orimpmvement is sold within one year of completion,the came, builder will haw the burden of proving that he did not build or improve for purpose of .Is,). ❑1,as owner of the pmpeny,am exclusively contracting with licensed convector m constmct the project(Sec.7044,Business and Profesaions Code:)The Contractors U. come Law does not apply Be an owner of property who builds or improves themon,and who contracts for such projects with a mmrxmr(s)licensed pursuant to We Continuous License Law. ❑1 sort exempt undo See. ,B&P C for this resson Owner Dap WORKER'S COMPENSATION DECLARATION I hereby&Ron under pormy of perjury am of the following declanliom: him and will maintain a Certificate of Consent m self-insum for Warners Common- in, om on-in,a provided for by Sxtion 3700 of tip labor Code,for the performance of the ode for which this permit in issued ❑1 have and will maintain Workers Compensation Insurance,as ne fired by Section 3700 of the labor Code,for the perform.of the work for which this permit is issued. ' My Wor 'sCampenJtion Imus a airier and Policy number aw: Cortise 1\ Policy No.:Ra I . CERTIFICATE OF P170N FROM WORKERS' COMPENSATION INSURANCE (Thusectlon recd Inst W inorpleted Blue permit le foronc hundred 011.($100) or las) 1 unify that in the performance of the work for which this Permit is wood.l Mall not employ any person in any manner so as in become subject to the Worker'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should Wee ne subject to the Workers Compensation previsions of the labor Code,you most .J O forthwith comply with such Provisions m this Permit shall be deemed rewked. zCONSTRUCTION LENDING AGENCY Fa l hereby aRrm that them is a construction lending agency for the performance of E r7 the work for which this permit is issued(Sec.ID9'I,Civ.C.) W�Q Lender's Name , ] z Lenders Address V Q I certify that 1 have mad this application and sup that the above information is coned.I agree to comply with all city and county ordinances and sus laws mixing to Q SC^J building convection,and hereby muonm reprammativrs of this city to Baur upon Ne LT7 abuve-mentioned property for inspection purpoaea. LL (We)agree m save,indemnify mrd kap humkss the City of Cupertino against `ryI tiabilitia,judgmonu.eosu and expenses which may In any way acemeaganst said City A rmit oLICANT UNDERSTANDS ANDor Lh H of WILLWILL COMPLY WITH AL NON-POINT Issued by: Date _�v SO RCE U ATIONS. - Si tureen a Re-roofs . . gn ppli VConuacmr Dau lv HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building necupantetmc or ankle husrdous maprial as defined by the Cupertino Municipal Code,Chapter 9.13,and the Halth and Safety Code,Section25533(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Ycs Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.I agree to remove haaudmus air contaminants at defmcd by the Bay Arcs Air Quality Management all new materials for inspection. ict7 �� ❑Yes ❑No Ihave.v the W.,d.mamriaHmquimmcnuunder Chapur6.95oftheCxlifor- niaHealth&Safcty Ca ,Sccdam2550,25533md25534.lunder dthmifdp building d nal currently hew a mlNl Wet it is my repandolity,to naGly occupant of she reqs me no which noun les met'prior mIssuance of.CcoificaarCo pantyQ. Signature of Applicant Date Owneronulhorirctlsg✓ t �a�L All roof coverings to be Class"B"or better CITY OF CUPERTINO ® 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B1k: Lot: APN . . . . . . . . : 35709076.00 DATE ISSUED. . . . . . . : 01/02/2008 RECEIPT #. . . . . . . . . : BS000003599 REFERENCE ID # . . . : 08010009 SITE ADDRESS . . . . . : 10145 SCENIC BLVD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO - IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ESPINOZA RICHARD D AND CAROLLY ADDRESS . . . . . . . . . . : 10145 SCENIC BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2724 RECEIVED FROM . . . . : BELL PLUMBING S BAY CONTRACTOR . . . . . . . : PETER DUMLAO LIC # 26329 COMPANY . . . . . . . . . . : BELL PLUMBING SOUTH BAY ADDRESS . . . . . . . . . . : 3710 YALE WAY CITY/STATE/ZIP . . . : FREMONT, CA 94538 TELEPHONE . . . . . . . . : (408) 279-8824 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - --------- ------------- -------- --------- --------- ---------- --------- 1BSEISMICR VALUATION 2, 000.00 0:50 0. 00 0 .50 0. 00 1PPERMITFE FLAT RATE 1. 00 "' 40.79 0. 00 40 .79 0. 00 1PRSEWER UNITS 1. 00 20.40 0. 00 20.40 0. 00 1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40.79 0 . 00 ---------- ---------- ---- -------- TOTAL PERMIT 102 .48 0. 00 102 .48 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER -------- --------------- -------------------- CHECK 102 .48 #1948 --------------- TOTAL RECEIPT 102 .48 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------7 -------- ---------------------------- 106 -------------- --- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING OAU ( OOo1 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE OF CUPEkTINO PERMIT APPLICATION FORM APN# 5 0 n,� f ^ Date: Building Address: 'l W Owner's Name: Phone#: Q p �0 9 b Z i0DZA �1 ) 800 4 Contractor: Phone#: Fax #: Contact: Phone#: Yl � (� 43os �68 � Fax #: Contractor License#: Cupertino Business License#: Job Description: Residential Commercial ❑ Valuation: Green Building Check list must be completed and attached to this application. Green Building Points: 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 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BSEISMICOM Seismic Commercial P 1BSEISMICR Seismic Residential P / 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer I acoCITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 113PWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS 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 10300 Torre Avenue 1 It Cupertino CA 95014 SO 4 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 4VPEI�TINO Building Department JOB ADDRESS: 1C714G7 �1 �� PERMIT # 9:0/0002' OWNER'S NAME: — PHONE # Oe - GENERAL CONTRACTO : FAX # '7;:l _ -7 I am not using any subcontractors: Signature bate Please check applicable subcontractors and complete the following information: 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