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06070172 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTR'ACTOR�TNk'ORIVIATIa!N „"v`fr.. to °?Crn`sw3*� a..,,.t.;rr «, BUILDING ADDRESS: GENMOR PLUMBING PERMITNo06070172 18725 TILSON AVE OWNER'S NAME: PERMIT ISSUE DATE .OF TERY 3560 HAIG ST. #2 Q7/25/2006 ONE: SANITARY NO. CONTROL NO. (408) 855-8348 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH lop LICENSED CONTRACTOR'S DECLARATION O O Job Description mF I Wreby affirm that 1 un Incomes under provuians of Cha ver 9(cmmencing i r`3 with Section 70(Ib)ofDivision3 of Ne Business and Professions Code.and my lice=is <h In lull fo,ccand a REPIPE FROM GALV. TO COPPER PIPE. REPLACE WATER i�z Liems Clus ,-•� Lie.Y x l� C2_I a Data Contractor -ice.- _a HEATER ARCHITECTS DECLARATION i 1uMcratold my plans shall W used ss public mb eon iC. °off Licensed Prufesswrial 5 OWNER-BUILDER DECLARATION iI 1 hereby affirm that I am exempt from Na Conmamm's License Low(or the :O O following reason.(Section TW 1.5,Business and Professions Conic:Any city or county - :29 which requires a pmmit to construct,after.improve,demolish,or repair any swam -iy prior at its issuance,ebaa requires the applicant far such permit to BIC a signed sammcm that he is licensed purtuenno On provisions of dm Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Value 500 i (commencing with Section 7000)of Division 3 of Na Business and Professions Code)or a $ that W or exempt Nemfmm and Ne basis for the alleged exemption.Any violation of Section 7071.5 by airy applicant for a permit subjects Ne applicant m a civil penalty of her mem than five hundred dellen(M). 3 9N1 PI0° C'0 0 Occupancy Type 01,ss owner of On property,a my emmm employees with wages u their role cpenution, 11 g=ir,.. will do On wort and the suuctum isnot Wonded oraRered fmsale(Sec.70th,Business ( a'. r= and Pmfesdons Code:The orruscmfa Lt..Law does Out apply m an owner or RNCgUlred Iflap2etl Property who builds or improves thereon,andwW deassuch work himolfor through his own employees,provided Oat men improvements sadot inmaded oroRered for sale If. builder,Ne Wilding ou improvement uah1C within oro year of cn,reve lee.Noe ewoo f builder will have the Wmcn of proving that W did w,Wild a improve fur purynse of 3 ssle.l. c AUG/'S u ❑1.as owner of thin property,am exclusively Promoting with:)Maed mnuacloss U. constmct dpmnota(Sec.innano Business;and Professions Cade:)The Cs thercon, nd echo taw docs not apply loan owner of property who Wilds rs improves Nemon,and. It��IJIry.._,/JJ�/t/yttt7]t� \V'l t\V77 whocontractsLace for such projects with aeonramar(s)Bcenzd pmuans m Ne Cnnuacmrs License Caw. ❑1 am exempt under Sec .B&P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION 1 boo by affirm under posalty of perjury nm of the following declarations: I baro and will maintain•Certificnm.(Coment In self-Insure for Wor em's Compen. taboo,as provided for by Secdun 3700 of the Labor Code,far IW perrormance of IW work for which Nis permit is issued. have and will mainain Workers Compensation Insurance,an,required by Section 3700 of the Labor Code.for Ne performance of On work for which this permit is issued. ' My Wor escorts mad" Car scatp(_u a�Q pecpoylicy number a re: Cartier OY(� fQYK r�'C Polrryl9o.: QR21'] CERfIFICATEOFEXEMPION FROMWOPKERS' COMPENSATION INSURANCE flTuaemloh oecd am W completed if the permit Is Parona WndrrA dollen(SIM) m lass.) I ceniN than in Ne performance of the work for which this Penni,is issued,I shall our employ any person in any manneran as to Wcome subject in Ne Werke,i Compensation Taws of Califorrua.Dam Applicant NOTICE TO APPLICANT:If.after making Nis Cenifiesen of Exemption,Phu should Eccomm N e subject e Worker's Compression provisions of the Low,Code,you ho u wJ C) forthwith comply with such provisiam or this permit shall W Canted rewked. CONSTRUCTION LENDING AGENCY r [-+ IWrcbycOm Nat thertuaed(Secti30 len ding agemy for the performanc of 6i theLo work for which this permit is issued(Sec.7097,Civ.C.) a Q Undoes Name 7 Z Lcndefs Address U C) I certify that I have sed this application and sate WI Ne a Wve information is (L F correct.I agree to comply with all city and county ordinances and state laws relating to rJU building eonurvcrion.and hereby authomerepsesenmiveS Of this City 10 enter uPnn the W move-mentioned pmPcny for insikcuon pu,poses. Fgy (We)agree m save,indemnify and LOOP harmless IW City of Cupertino against rq liabilities.judgments.costs and expenses which may in any way acerae against said City L1 Z in emnegaonec of the granting of this Permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS, r.6 stgrauum•oaf AAppl Pvcontrkw — Data Re-roofs a^� HAZARDOUS MATERIALS DISCLOSURE Type of Roof - t Will than applieurt or future Wilding occupant store erhandle hanNo e,material as,defined by the Cupertino Municipal Code.Chapter 9.12.and to Health and Safety Code,Section 255320)? All roofs shall be inspected nor to an roofing material being installed. 40 Will the appliaanl o,future Wilding occupant um equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove emit haxasdnus air conumimmusi in defined by IW Bay Arca Air Quality Management all new materials for inspection. Drainer' ❑Yet �1& I have read the haaarNmsmamrials requirements under ChaPm,b.95 o(Ne Califon nix HcalN&Safe„Code.Secdrns25505,25533 sort Z5534.lundenaod NatifNe Wilding does not curonthy have•h un4 that it is my responsibility in mdfy Na occupant of On requirements which must be mel pd.,Io ismanee ofa Cadiricem of aerpaany. Signature of Applicant Date —` AXW-'r' fn All roof coverings to be Class°B"or better Owner ur authmrirrd agent Oa¢ CITY OF CUPERTINO !em 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Elk: Lot : APN . . . . . . . . : 37518001 . 00 DATE ISSUED. . . . . . . : 07/25/2006 RECEIPT # . . . . . . . . . : 35378 REFERENCE ID # . . . : 06070172 SITE ADDRESS . . . . . : 18725 TILSON AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : YUCHI TERY 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 -------- -- ------------- ---------- ------ ---- ---------- --------- - ---------- BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00 BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00 BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BSEISMICRE VALUATION 3 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 ) 38 . 37 0 . 00 MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 --------- - - - -- ------ ---------- ---------- TOTAL PERMIT 170 . 26 0 . 00 170 . 26 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - - - - - - - - - - -- ---- ------------ -------- - --------- CHECK 170 . 26 2025 TOTAL RECEIPT 170 . 26 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING • ° Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 46UPEkTINO Building De artment JOB ADDRES: T' ��Un PERMIT # OWNER'S NAME: 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/Contractor Signature Date ( - CITY OF CUPERTINO W07W2- CITY OF PERMIT APPLICATION FORM CUPEkTINO N# 1 ^16 4_ 001 Date: �� Building Address: r rJ U Mailing Address (if different from building address): Y� Q Owner's Nanle: Phone#: ontractor: License#: 3 q Contact: Pon : Pm�g)t� upertino Business License#: Fax: Building Permit Info: ��� v,rn Bldg El �e\QCe Elect C3-- Plumb F�f' Mech G' Job Description: Residential V Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancyroup — 1 Typ o struction: Please check this box if the project is a Z1W second-story addition: ❑ roject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I of 3 i CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interce t6f PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform FixtureWELECTRICAL BREMPOWER Power Device/Apparatus BREMRECEPT Rc tl, Switch & Outlets BREMRELOCA Relocation of HoodL BREMREPALT Re air/Alter HeatingL BREMRESAPP Remodel Res Appliance 2of3 sp�s CITY OF CUPERTINO an"oF PERMIT APPLICATION FORM CUPERTINO uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mecb Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Faro PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3