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07080238 CITY OF CUPERTINO BUILDING DIVISION PERMIT][ GTI�R IYFE) Mt�TI�N. • PERMIT NO. BUILD NG4,D ESS: 0399 SCENIC BLVD ALLSTAR PLUMBING 07080238 PERMIT ISSUE DATE OWNER'S NAME: ROMO SALVADOR F AND ANDREA M 326 PHEI,AN AVE 08/28/2007 SANITARY NO. CONTROL NO. N . (408) 2: 0-5569 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MEC14 0 0 x Z LICENSED CONTRACTOR'S DECLARATION Job DOSCTIptIOn 0 vP I hereby affirm that I am licensed under provisions of Chapter 9(commencing UZ 8 with Section 7000)of Division 3 of the Business and Professions Code,and y license is PROPERTY LINE CLEANOUT �H in full force and effect se Class I Vic•fl 1Z Licen F p Date_ _Contractor w ARCHITECCS DECLARATI za I understand my plans shall be used as public records iy0 U.H Licensed Professional t a OWNER-BUILDER DECLARATION 3 a 1 hereby affirm that I am exempt from the Contractor's License Law for the a0 following reason.(Section 7031.5,Business and Professions Code:Any city or county %$ which requires a permit to construct,alter,improve.demolish,or repair any structure i—y prior to its issuance.also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q C $3337 (commencing with Section 7000)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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ,N Number Occupancy Type not more than rive hundred dollars(5500). 357020 3 . V ❑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 forsale(Sec.7044,Business Required Inspections 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 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.). ❑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- cause 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 contractors License Law. ❑i 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: ,J I have and will maintain a Certificate of Consent to self-insure for Workefs Compen. sation,as provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as mquired by Section 3700 of the Labor Code,for the performance f the work for which this permit is issued. My Worke�s4?a �pensai insurance carni and Polity num r :� O Carrier. Policy No.: CERTIFICR OF EXEMPTION FROM WORKERS' 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 Fr CA 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-) W Q Lender's Name =z Lender's Address U C) I certify that I have read this application and state that the above information is G> �" correct.1 agree to comply with all city and county ordinances and state laws relating to rJ- Jbuilding 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 rA liabilities,judgments,costs and expenses which may in any way accrue against said City U Z to consequence of the granting of this permit. Date S.Z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL No -POINT Issued by: SOURCE RE Re-roofs Sig rc of Applicant/C r DareOf I.00f HAZARDOUS MATERIALS DISCLOSURE Type 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. ❑ Will the applicant r future building occupant use equipment or devices which Yes No If a roof s installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes 00 1 have read the hazar ms materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently h ve a tenant,that it is my responsibility to notify the occupant f the requirement,w mel prior to issuance of a Certificate an /7 Signature.of Applicant Date All roof coverings to be Class"B"or better Own authorized agent - AMC CITE' OF CUPERTINO `CITY OF PERMIT APPLICATION FORM CUPEkTINO 'CPN # Date: Building Address: ]Mailing Address (if d fferent trom building address): Owner's Name: �- Phone#: (/ �j r,1 a V0,5 C�) --� a> - c, Contract License #: Cont t: / Phon Cupertino Business License#: 7-) Fax: 2 -2— Building Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: Residential F251 ?jZrp72 /h Z a Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a El �( -�- second-story addition: roject Size: Standard ❑ Large ❑ Maj:)r ❑ Quantity Fee ID l+ee 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 Boile:-> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX IncJOff/Comm/Quasi BUILDING BCONSTAXBQ Coil. Tax for BQ Zone BUILDING BCONSTAXH -Intel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC 1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD ]Energy Add Multi BUILDING BINVESTIGA -nvestigation fee BUILDING 1 of 3 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Bl-,r,: Lot: APN . . . . . . . . . 35"702013 . 00 DATE ISSUED. . . . . . . : 08.128/2007 RECEIPT #. . . . . . . . . : BS000002490 REFERENCE ID # 07080238 SITE ADDRESS . . . . . : 10:399 SCENIC BLVD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ROIZO SALVADOR F AND ANDREA M T ADDRESS . . . . . . . . . . : 10:399 SCENIC BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2719 RECEIVED FROM . . . . : ALLSTAR PLUMBING CONTRACTOR . . . . . . . : DUrRTE TADEV LIC # 22189 COMPANY . . . . . . . . . . : ALLSTAR PLUMBING ADDRESS . . . . . . . . . . : 326 PHELAN AVE CITY/STATE/ZIP . . . : SAIT JOSE, CA 95122 TELEPHONE . . . . . . . . : (408) 230-5569 FEE ID UNIT QUANTITY ;MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- --•-------- ---------- ---------- ---------- BPSEWER SEWER SYSTEM 1. 00 21.58 0. 00 21.58 0. 00 BSEISMICRE VALUATION 3, 337 . 00 0.50 0. 00 0.50 0. 00 --•-------- ---------- ---------- ---------- TOTAL PERMIT 22 . 08 0. 00 22 . 08 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 22 . 08 VS --------------- TOTAL RECEIPT 22 . 08 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 *TPEkTINO Building Department JOB ADDRESS: / 4 PERMIT#G .7 O Q �Z� c ( �c-C . OWNER'S NAME: PHONE # GENERAL CONTRACTOR: / -�, FAX # I am not using any subcontractors: �� Si;nature Date Please check applicable subcontractors and complete 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 �er/Contractor Signature Dat-e-''