07020064 777777=777777777777777-
CITY OF CUPERTINO '
BUILDING DIVISION PERMIT C� 'R�GI'l�I1URMT1€�lY'
BUILQ11CtAJ�O YPERMIT NO.
ORKSHIRE DR GENMOR PLUMBING 07020064
OWNER'S NAME: PERMIT LSSUE DATE
VINCENT JAMES H AND CAROLE L 13560 HAIG ST. #2 02/12/2007
SNE:
SANITARY NO. CONTROL NO.
(408) 855-8348
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i p C LICENSED CONTRACTOR'S DECLARATION Job Description
U ) I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z) with Section 7(X)0)of Division 3 of the Business and Professions Code,and my license is WATER HEATER REPLACEMENT
"4 0- in full force and a est
j�,Z„ License Class Lic.#
t w Date n7- 'IClIt Contractor
ARCHITECTS DECLARATION
7 I understand my plans shall be used as public records
)aU
H Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5.Business and Professions Code:Any city or county
c^rL which requires a permit to construct,alter.improve,demolish,or repair any structure
Z y prior est its issuance,also requires the applicant for such permit to file a signed statement
=o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1000
t .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type
not more than five hundred dollars(5500). 3 6 2 0 7 018
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
Q I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worke s Compensatin Insurance carrier and Policy number ^^
Carrier. Policy No.: \V—Q
�v
CERTIFICATE OF EXEMPTION FROM WO
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workcrs'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 provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z , CONSTRUCTION LENDING AGENCY
E t C4 I hereby affirm that there is a construction lending agency for the performance of
(Yi> the work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name
a z Lender's Address
U 0 I certify that I have read this application and state that the above information is
LL
0— correct-I agree to comply with all city and county ordinances and state laws relating to
VU building construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
to liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOORCE REGULATIONS.
NYAG A CSG- kl-Or- Re-roofs
Signature of Applicant/Contractor 1J Date
HAZARDOUS MATERIALS DISCLOSURE Type of F oof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ycs ❑lid"
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection.
District?
❑Yes Q No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand thatif the building
docs not currently have a tenant that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy. Signature of Appl leant Date
G he N.+��'( G�'lrL0 1, All roof coverings to be Class"B"or better
Owner or authorized agent Dare
Community Development
o
« 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT # 0-702WLo4
OWNER'S NAME. PHONE L�M5
GENERAL CO CTOR: FAX #
am not using any subcontractors• h-e� /
Sj gnature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSI14ESS 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
,--l—Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
3 ITEMS OF 8 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 36207018.00
DATE ISSUED. . . . . . . : 02/12/2007
RECEIPT #. . . . . . . . . : BS000000440
REFERENCE ID # . . . : 07020064
SITE ADDRESS . . . . . : 1139 YORKSHIRE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VIMCENT JAMES H AND CAROLE L
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4916
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101
COMPANY . . . . . . . . . . : GENMOR PLUMBING
ADDRESS . . . . . . . . . . . 3560 HAIG ST. #2
CITY/STATE/ZIP . . . : SA%7TA CLARA, CA 95054
TELEPHONE . . . . . . . . : (408) 855-8348
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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------ ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
TINO 07c��O CP4
CITY OF CUPER
WATER HEATER
CITY OF
CUPERTINO PERMIT APPLICATION FORM
Date:
APN# 32.4
rildin Addres
Owner's Name: Phone#:
Contractor: ` Phon(.: License#: I
C nta t: hone: Cupertino Business License#:
e\ � ( �
Building Permit Info:
Bldg ❑ Elect ❑ Plumb D Mech ❑
Job Description:
Residential a . Commercial ❑
Cost of Project:
c_
Strapped ❑ On Platform ❑ Bonded ❑
New Location ❑ Replacement'
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERNIITFEE Plumbin Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING