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08100086 CITY OF CUPERTINO BUILDING MVISPON PERMIT CC1NTRACTORINFORMATION-, BUILDING ADDRESS: PERMIT NO. 21921 ALCAZAR AVE SPEEDY ROOTER PLUMBING 08100086 OWNER'S NAME: PERMR ISSUE DATE HESHAM IBRAHIM 701 ALDO AVE STE 43 10/16/2008 �NE: (408) 234-8134 SANITARY NO. CONTROL NO. � ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH rpp LICENSED CONTRACIOR's DECLARATION Job Descri non ur 1 hereby affirm that I am l�tsed under provisions of Clepvl9(commencing P with section 70 I)of Division3of UtcBumnmandProfeuimuCoda.mdmylie..1. SPOT REPAIR ON SWR LATERAL LINE CLEANING i on full force and effem. LKe. ys Le.. 7 3 =F0 Dam Contrazmr fed2l&Ze wwwy ARCHITECT'S DECLARATION < 1 undersunJ my stair shall he used as public recants u g H Licensed!Professional a OWNER-BUILDER DECLARATION ef 1 hereby affirm that I am exempt form the Convector's License Law for the 00 following mason.(Section 7f131.5,Business and Pmfesions Code:Any city or county K m V which mquires a permit to construct,admit,impmwe,demolish,m repair any awmum in Prior 0 is vsuance,sm mquims the applicant forsuch Permit On file a sigocil samment < that he a licensed pumuantto the provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation I­ (c y ommencing with Section 700M of Division 3 of the Business and Professions Cade)or $4000 y;$ that he is exempt therefrom and the basis for the alleged exemption Any vidauon of Section 7031.5 by arty applicant far a permit mbjcas the applicant in a civil penalty of Number Occupancy Type not mom Nita fire hummd dollar(5500). 3 5 715 0 9 9 .'°t�l,N I,as owner of the prolswtY•mmy mvployw with wades as mev sole compcnaation, will do the work,and the structure is not intended or.Rered forme,(Sce.70/6,BUaness Required Inspections and Pmfes am;Code:The Carom's Liana Law dm net apply N an Owner of q P propertywW Wilds crimprow thecem.ti d whodoessuchwarkhimsrlrarduough his awn employees.provided Can stcWmpmwemerms am amtimmndm oroRered forsale If. beramm,the Wilding or impmwenoent is sold within are year of mmpleum,the owner- Wilder will have the When of proving that le did net Wild or improve for peopsase of sale.). 1,as Owner of the property am uclusiway contacting with licensed contrarian in SAN apnatmmthees act (Sec.in a 9unnessandity whose Cade)The Consw:mr'3 rid ��whoa law does wt apply m an owner of Proper(vice Wilds or en,rovo thereon.and wW cantrscs(arsucb pmjeca with aconvactorts)licraad puntiam m the Contractofs 0 1 son==or❑lam aempt under See ,08PCfor this maven Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury me of the fallowing declam0ona: I hsm and will matmm.a Cenifeme,if Consent to self-inaum fa Worter'sCmopen- .,as provn kci for by Sccvon 37M of the labor Code,far the part...of the work for which Nis permit is lattice. 1 haws said will mainNm Worke/a Compeiwuon Irwran¢,ss I gOimd by Section 3700 of the Labor Curie,fOc the performance of the words for which ms perms is issued My WOrrrrrkkkkkaymmmy••• C/a/mp/en's�asan Omer and Polity nr4l�nC(er�am: �•a Cmiar.�2/y � Policy No. }!T"-I (.r O' . S q CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE musseed.need net becompleed if the permit isforone Wndmd add.($100) or loss) I certify that in the terfmmaxc of the work for which this Permit is satned I shall not employ any person in any sooner an as to became subject in the Workrs'Compewtion laws of CadBomiz.De•- Applicant NOTICE TO APPLICANT:If,after making this Ccnifia¢of Exemption,you sbouldi become ambient to the Workch Compeeaadan prevision,of the tapir Code,you mum .,O foMwvth comely with such'inaddna Oc this pamat shall W dremee rtwkcd. 'Z'y CONSTRUCTION LENDING AGENCY [-� 1 hereby aRrna him them is a rnmurcrnn lending agency for the performance of !Yi > me work In,which ths am ml is aimed(sac 3094,Ch,C.) W 0 IandarsNam- 7 z larders Amer• ' U O 1 certify that 1 have mail this application and nom mat me aWm inramudmt is . I2.P C L 1 agree to comP1Y with all city and county ONinanera and a=Ian relating m Q U Wilding conviction,and hereby a thonme represenatims of this city to eater upon the 4 ahowe-men urp tioned Pmpetty far inspection poses (We)agree in save,indemnify and tees hales de City of Cosentino against rfn Imbilimi,judgmenss.cW end emevu which may,.my way Omuta against said City U aZ in consequence of the bmntin6 of 's '--' APPLE ERSTAN AND WILL yyy�.QLY WITH ALL NON-POINT Issued by Date /GAF 5T10N5 10—(7-6V _Q . e Re-roofs Si pphanUCa V pale ---/ S M A s paaosuRE Type of Roof w0y me,Cpe.. Wit rigs.Clasptaomnr NnNC hazaNOmmamrial as defined by to 2(al? unuipal Code.Clasper 9.12,and!the Healm and Safety cme.s«tiansss3z(a)7 ❑YU 6N rN o All roofs shall be inspected prior to any roofing material being installed. will the aPPhaant or revere Wading acompant tier egmpment or aewiroa which If a roof is installed without firs[obtaining an inspection,I agree to remove hvallom nit conumtmns as dcfance by the Bay Ama Air Quality Management all new materials for inspection. ❑Yes fYMo Ilona mail the hvutlws masraaismgmmmems un@r Clop iO6,95 oft he Califor- nia1@ &SafmyCode.Smlwu25%5,25533wW25336.IurWCmuM ifft tutting does net cwmndy ham a aman.thin it is my responsibility m reify me Occupant of the mgmmemen must be ormissnanrcoI Carnal of w^ry Signature of Applicant �� ✓H/l/L� %t 6� Date owner man, t Dam. All roof coverings to be Class'%¢"or better v CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35715099 . 00 DATE ISSUED. . . . . . . : 10/16/2008 RECEIPT # . . . . . . . . . : BS000006363 REFERENCE ID # . . . : 08100086 SITE ADDRESS . . . . . : 21921 ALCAZAR AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HESHAM IBRAHIM ADDRESS . . . . . . . . . . : 21921 ALCAZAR AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SPEEDY ROOTER CONTRACTOR . . . . . . . : SPEEDY ROOTER PLUMBING LIC # 23086 COMPANY . . . . . . . . . . : SPEEDY ROOTER PLUMBING ADDRESS . . . . . . . . . . : 701 ALDO AVE STE 43 CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054 TELEPHONE . . . . . . . . : (408) 234-8134 OFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - -------- ------ - --- -- ----- -------- 1BSEISMICR VALUATION 4, 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 ------- ------- -------------------- CREDIT CARD 102 .48 VISA --------------- TOTAL RECEIPT 102 . 48 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ------------------- - -------- ---- ------ - 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING 4100 v �(o CITY OF CUPERTINO ' REPIPE/SEWER/MAIN SERVICE e CUPEfll PERMIT APPLICATION FORM AP N,# 2S / /,5 D � ( • & Date: � D ` /<—("L Building Address:V l - ( � n Owner's Name: /(� Phone #: Contractor: Phone 5y Phone#: Z (J_o-74 ��(J JY'/51 1 Fax #: Contact: Phone#: 4;46& 7v6—&-9-73 Fax #: Contractor License#: 331 Cupertino Business License#: Job Description: 5; rbT WA UL Residential Commercial El Valuation: T-1 kood �d Project Size: Express Standard ❑ Large ❑ Major ❑ t Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. /�-- _ Green Building Points: V 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 J IPRSEWER Residential building P 1RPSS �' sewer/sanitary sewer CITY OF CUPERTINO REPIPE/SEWERIMAIN SERVICE CITY OF 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 1BPWATER 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 iPPERMITFEE 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 Revised 6-16-08 •