06070205 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT ONTRAC� R T OItMATION .#`;
BUILDING ADDRESS: c GENMOR PLUMBING PERMIT N006070205
1136 SCOTLAND D
OWNER'S NAME: PERMIT ISSUE DATE
DE MARCOS MOIRA 3560 HAIG ST. #2 07/28/2006
NE:
SANITARY NO. CONTROL NO.
(408) 855-8348
ARCHITECTIENGINEER: BUILDING PERMIT INFO
131,100 ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION
z
C 1 hereby affirm Nat 1 am licensed umhr provisions of Chapter 9(commencing Job Description
� with Section 70)(1)of Division 3of the Business and Profcasiom Code.md my It..is
in full force and efface ///- COPPER RE-PIPE 7 FIXTURES
;�? License ClusLk.N
Dates Commcur ry
�j ARCHITECTSDECLA ATI N J`
i a I understand my plans shall he used u public meords
;WU
off Licensed Professional
g OWNER-BUILDER DECLARATION
if I hereby a1Lrm that I am exempt from Ne Contractor's License law for the
:C O following mason.(Section 703 1.5,Business and Professions Codc:Any city or county
which mquims a permit to cmor 1.alter,improve,demolish.or repair any auwtuhe 4 O O O
.i< prior m its issuance.also requires the applicant forsuch permit to file a signed statement
•xx that lue islicurowd pursuant to the provisions;of the Contoutur's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
l (commencing withSection 70](Y)of Division 3 o(the Business and Professions Code)or
Nat he is exempt therefrom and tits basis for the alleged exemption.Any violation of
Section 7031.5 by M applicant for a permit subjects the applicant 10 a civil penalty of er Occupancy Type
not mom than five hundred dollars(5500).
El I,mowtmrof Neproperty,armyemploycowithwagesmtheholecompet on,
will Clotho work and theammture is notinuMed orafcered forsals(Sec.7014,Business
and Professions Code:The Cum gimes License Law dors rot apply m an Cramer of Required Inspections
property who Wildaorimproves thereon,andwM Ocesawhworkhimulf or Wough his
awn employers,provided that such improvements arc not intended woRered formic.If. /
however,the Wilding or impmwment uuld within oro year of completion,the owner
builder will have the burden of proving Nat M did net build or improve for purpose of
sale.).
❑1,as ower of the property,70,4,B exclusively contracting with licensed Comminute.
to
Construct La the es not (sec.toad,Business add Profaowm Cade:)Thews then oro,Li-
Fs-
come Taw does not apply jo e,with
a of property ecce Wilds p or imProva Comon,and /
whence Lace for such pmlecm with aeontrxtogs)Iicenud pursuanlmtW Contrumr's - O
License law.
❑1 am exempt under Sce ,B k P C for this reawn
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby aRsm under penalty of perjury one of the following declarations:
1 have and will maintain a CeniBcau of Consent to self-insure for WorkeYsCompen-
sation.as provided for by Sccuon 3700 of IW labor Code,for the perPormance of the
work for which this Permit is issued.
[31fharw and will maintain Workses Compematien Insurance.as mquitod by Se.Om
37W of the Labor Code,for the performance of the work for which this permit is instant.
My Wort1 e'CompmaatioVm neec!onrrie•r'r__yy�hh�dd_Policy umber an,
CartierY:,dCERTIFICATE
"P licy No.:I nP -�
C- FI OF E:EMPTION FROM WRKER
COMPENSATION INSURANCE .
(Thu section need not W completed if the permit is Income hundred dollars(SIM)
or less.)
1 cenify Nat in the performance of to work for which Itis permit Is issued,l shall not
employ anypi rson in any manner so as m became subject m the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:if,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of the Labor Code,you most
�O forthwith comply with suchpmvisimts or this permit shall W deemed rewind.
? 71 CONSTRUCTION LENDING AGENCY
IberehyaR'm that Neto iso construction lending agenry for the performance of
Ix 7 Ne work for which this Permit Is issued(See.3097,Civ.C.) _
W Letulk"s Name
z Lender's Address '
V Q 1 certify Nat 1 have mad Nis application and stats That the above information is
I, f^ correct.I agree to comply with all city and county ordinances and sum laws totaling to
C U building construction,and hereby authorise mprescntativa of this city to enter upon Oc
ahow-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cuper into against
sFa fn liabilities,judgments,costs and expenses which may in any way accuse against said City
fjz in consequence of the granting of this permit.
m+ APPLICANT UNDERSTAND ANO WILL COMPLY WITH ALL NON-POINT Issued by: /
SOURCE REGULATIONS. Dale
Signature of AppliamOCOmxcm' Date'2e-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building arupentstorc or handle ban'tlous maurial
as darned by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code.Section 35532(a)? /
❑Ya W" All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment w devices which If a roof is installed without first obtaining an inspection,I agree to remove
,.mit havardous air contaminants m dcOncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes 8u
1 have mad the harallous materials requircmencs under Chapter 6.95 of the Califor-
McHealth S,Safely Cade,Sections MM5,25533 ant 35534.1 undcniand that if the Wilding
does not currently has a tenant,Nat it is my rcspmisibility to notify the occupant of the
myuimmcnts whichm emetprierm;smancenfa ccruBcam ofoccapaacy. Signature of Applicant Date
Tse n� � �6All roof coverings to be Class "B" or better
Owner or mftfted agent Dau g
Community Development
10300 Torre Avenue
J1 Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
IOUPERTINO
Building De artment
OB ADDRES : c1501PERMIT#
S o?7
OWNER'S NAME: e PHONE #
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors:
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/ ontractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36228015 . 00
DATE ISSUED. . . . . . . : 07/28/2006
RECEIPT # . . . . . . . . . : 35434
REFERENCE ID # • : 06070205
SITE ADDRESS . . . . . : 1136 SCOTLAND DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DE MARCOS MOIRA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : GENMOR PLUMBING
CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101
COMPANY . . . . . . . . . . : GENMOR PLUMBING
ADDRESS . . . . . . . . . . : 3560 HAIG ST. #2
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054
TELEPHONE . . . . . . . . : (408) 855-8348
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPREPIPE NO OF FIXTURE 7 . 00 63 . 00 0 . 00 63 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ----- - -- - - --- ------- ----------
TOTAL PERMIT 101 . 37 0 . 00 101 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
------------- -- -- ------------ ------------------
CHECK 101 . 37 2099
TOTAL RECEIPT 101 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
CITY OF CUPERTINO u'V02C5
��' REPIPE/SEWERS/MAIN SERVICE
•CUPEIIiTINO PERMIT APPLICATION FORM
APN # Date:
uilding Address:
5�1
Ow er'sCName: 1 Phone#:
Ctractor: a Phone: License#:
b,
Contact: Pho e: Cupertino Business License#:
S-
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ,gam
Job Descri tion: `
e C
Residential Commercial ❑ ! jt•pWer �_ 1��kcsne
h Seams
Cost of Project:
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance . PLUMBING
BPREPIPE Repipe of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•