07080142 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
BU1LD11• da'J6':GLENVIEW AV WATER QUALITY PLUMBING 07080142
•S — PERMIT ISSUE DATE
OWNER'S NAME:
MR YU 1860 ALMADE
SANITARY NO. CONTROL NO.
(408) 267-9330
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 a 0
? LICENSED CONTRACTOR'S DECLARATION Job Description
i hereby affirm that I am licensed under provisions of Chapter 9(commencing
vrtth Section 7000)of Division 3 of the Business and Professions Code,and my license is RE P I PE MAIN LINE
F ip roll-force and err,
License C tcs LIC.ti
o Datc Contractor
`
.'. ARCHITECTS DECLARATION
- I understand my plans shall he used as public records
J '
F" 'Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
Ca following reason.(Scction 703 1.5,Business and Professions Code:Any city or county
Ii which requires a permit to construct,alter,improve,demolish,or repair any structure
yprior to its issuance,also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq-Ft.Floor Area Valuation
6 (commencing with Scction 7000)of Division 3 of the Business and Professions Codc)or $6900
drat 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 of ANumber Occupancy Type
not more than five hundred dollars($500). 369110'_9 .R
❑1,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(See.7044.Business Required Inspections
and Professions Code:The Contractor's License Law does trot apply to an owner of
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.).
C:)1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's L-
eone Law docs not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a conlractor(s)licensed pursuant to the Contractor's
License Law.
t]I am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Workces Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
*+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 Workers Compensation insursnce carrier and Poli nu�:2W
Carrier�RtC�'�w�s� Policy No.:
CERT/ CAT NEMPTIONFROMWORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I ceniCy 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
Z forthwith comply with such provisions or this permit shall be deemed revoked.
— CONSTRUCTION LENDING AGENCY
V) I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
a Q Lenders Name
Z Lender's Address
C) I certify that i have read this application and state that the above information is
�-" correct.t agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
GTa above-mentioned property for inspection purposes.
y (We)agree to save,indemnify and keep harmless the City of Cupertino against
ti liabilities,judgments,costs and expenses which may in any way accrue against said City
Z inconsequence of the granting of this permi Date
APPLICANT UNDERSTANDS AND W L OMPLY WITH ALL NON-POINT Issued b): _
Caturc
RCEREGULA
Re-roofs
of App i t/Cactor Date Type of Roof
MATERIALSI CLOSURE
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.
0.ycs _4No
ITT" If a roof '�s 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 Arca Air Quality Management all new i laterials for inspection.
District?
O Yes
i have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that i[the building
docs not currently have a tenant,that it is my nsibilily to notify the occupant of the
reyuircmcntswhich mu _ brwissu ce [aCcrtifica fi`Ranty. ^ Signaturc of Applicant Date
V 11 All roof coverings to be Class"B" or better
Owner or atTtho'67zdI.Ont k Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: CathyS
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 36911019 . 00
DATE ISSUED. . . . . . . : 08/15/2007
RECEIPT #. . . . . . . . . : BS000002386
REFERENCE ID # . . . : 07080142
SITE ADDRESS . . . . . : 10430 GLENVIEW AV
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER MR YU
ADDRESS 10430 GLENVIEW AV
CITY/STATE/ZIP CUFERTINO, CA 95014
RECEIVED FROM MARTY SATALING JR
CONTRACTOR SA`I'ALINO, MARTY LIC # 21526
COMPANY . . . . . . . . . . : WATER QUALITY PLUMBING
ADDRESS : 18EO ALMADEN RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408)267-9330
FEE ID UNIT QUANTITY liMOUNT PD-TO-DT THIS REC NEW BAL
__ ------------- ---------- ----
__ ------- ---------- -
BPREPIPE NO OF FIXTURE 8 . 00 72 . 00 0. 00 72 .00 0. 00
BPWSVCS WATER SERVICE 1.00 9 . 00 0. 00 9 . 00 0. 00
PPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38_ ------
37 0_00
----
TOTAL PERMIT
119 .37 0. 00 119 .37 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -----
CREDIT CARD 119 .37 AX
---------------
TOTAL RECEIPT 119 .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 CUPERTINO
alFREPIPE/� � ' Z1_ /MAIN SERVICE
CUPkiNO PERMIT APPLICATION FORM
CPN# D te:
Building Address: `T
O c n e Q .�R
Owner's Name: Phone#:
Contractor: Phone: License#:
u0- -,26 ')- 933 ° _ - dl
Contact: Phone: Cupertino Business License#:
a9 - 2 3 , L
uilding P rmit Inf .
Bldg ❑ Elect ❑ Plumb
Job Desc ion.
Residential W Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gras Piping System Fee PLUMBING
PPERMITFEE Flumbing Permit Issuance PLUMBING
BPREPIPE Repipe of Fixtures PLUMBING
BPFIXTURE Fblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER S ewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC E usiness License BUILDING