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07080057 CITY OF CUPERTINO �.` t��(j IbPMAT ®�1 II BliiLDING DIVSSION PERMIT — PERMIT NO. BUILDITbA SgSSt)ENI SON AV WATER QUALITY PLUMBING 07080057 _ l 3 PERMIT ISSUE DATE OWNER'S NAME: LIM STEVEN H ET AL 1860 ALb[ADEN RD SANITARY NO. CONTROL NO. E: (408) 26; -9330 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH (� L (� Z LICENSED CONTRACTOR'S DECLARATION Job Description t^ I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3ofthe Business and Professions Codt�yndmylicenscis RE—PIPE FROM GALVINZ TO COPPER MAIN LINE in lull force and cffec Lie # l REPLACEMENT z Licens Cl n Date Contractor J ARCHITECTS DECLARATION 1 understand my plans shall he used as Public records Licensed Professional aOWNER-BUILDER DECLARATION S I hereby affirm that I am exempt from the Contractor's License Law for the o following reason.(Section 7031.5•Business and Professions Code:Any city or county tae, which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation yprior Its its issuance,also requires the applicant for such permit to rile a signed statement FC.Floor Area that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $60000 (commencing with Section 70D0)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3162905 1`tEV Number not more than five hundred dollars($500). [ 1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections will do the work.and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or dumugh his own employees,provided that such improvements are not intended or offered for sale.If, nt is sold w however,the building or improvemeithin one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). Q 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractoes 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 Contractofs License Law. B&P C for this reason I am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: c]I have and will maintain a Certificate of Consent to self-insure for Workees 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 Worker's Compensation Insurance carrier and Policy number are• Carri& lry ThC (� CyNo.: CERTIFICATE FEXEMPTION FROM RKERS' 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 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 provisions of the Labor Code,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the perfornancc of > the work for which this permit is issued(Sec.3097,Civ.Q ] Q Lender's Name Z Lender's Address Q 1 certify that 1 have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating 10 Ubuilding construction,and hereby authorise representatives of this city to enter upon the w above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against y lilCodc, biliiudgments,costs and expenses which may in any way accrue against said City r�� nce of the granting of this permit Date 6 NT UNDE ND W MPLY WITH ALL NON-POINT Issued b): EGULA a,-1 Re-roofs C�r Apph ntractor Dare Type of):oaf HAZARDOUS MATERIALS DISCLOSURE yP ll the applicant or future building occupant store or handle hazardous material by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ion 25532(a)? All roofs Shall be inspected prior to any roofing material being installed. Dyes 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 dcfrncd by the Bay Arca Air Quality Management all new materials for inspection. District? L ' [I Yes 0 I have read the hvardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 an 534.1 understand that if the building docs not currently have a tenant,that it is my re ibility to notify the occupant of the Date requirements which m be el (o issuan o a Ccro'-'C-(Zcspe2 cy.A`/ Signatur° of Applicant I -`/ / All roof coverings to be Class"B" or better Owner or authorize Date CITY OF -'UPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31629054.00 DATE ISSUED. . . . . . . : 08/07/2007 RECEIPT #. . . . . . . . . : BS000002284 REFERENCE ID # . . . : 07080057 SITE ADDRESS . . . . . : 10335 DENISON AV SUBDIVISION . . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LIN STEVEN H ET AL ADDRESS 10335 DENISON AVE CITY/STATE/ZIP CUFERTINO, 95014-2428 RECEIVED FROM . . . . : MARTY SATALINO JR CONTRACTOR SATALINO, MARTY LIC # 21526 COMPANY WATER QUALITY PLUMBING ADDRESS . . . . . . . . . . : 18EO ALMADEN RD CITY/STATE/ZIP . . . : SAI JOSE, CA 95123 TELEPHONE . . . . . . . . : (4(,8)267-9330 FEE ID UNIT QUANTITY IdAOUNT PD-TO-DT THIS REC NEW BAL ----------- ---------- ----------- ---------- BPFIXTURE UNITS 8.00 72 . 00 0. 00 72 .00 0.00 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 110.37 0. 00 110.37 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------------- CREDIT CARD 110 .37 AX --------------- TOTAL RECEIPT 110.37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ---------------------------- - 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF C'UPERTINO 11F REPIPENE� RSWMAIN SERVICE CUPkINO PERMIT APPLICATION FORM (176 APN# � � � 21 �l . Date: Buildin Address: � 33 Owner's Name: Phone#: t (,0 �-b ., Contractor: Phone: License )v: Contact: Phone: Cuperno Suz e�ss License#: m G Building P rmit Info: Bldg ❑ Elect ❑ Plumb Job Description: ti-e f e Residential - Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE B:dg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE R,-pipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sowers PLUMBING BPSEWAGE Sowage Disposal PLUMBING BUSLIC B isiness License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIV OF Fax(408)777-3333 `UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # OWNER'S NAME: u PHONE # GENERAL CONTRACTOR: # '`�` I am not using any subcontractors: n <�KK r Si: ature Date Please check applicable subcontractors and com.Mete 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