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07080243 CITY OF CUPERTINO BUILDING DIVISION PERMIT c�ac ,eTaR INEQRIVIAT�f�N. PERMIT NO. BUILDING ADDRESS: 10311 PALO VISTA RD WENGER :?LUMBING CO. 07080243 PERMIT ISSUE DATE OWNER'S NAME: PEREIRA RAMON R AND MARLA E 1112 F.iORENCE WAY 08/28/2007 SANITARY NO. CONTROL NO. NE: (408) 37,1-4740 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH °C Z LICENSED CONTRACTOR'S DECLARATION o Job Description cmi F I hereby affirm that I am licensed under provisions of Chapter 9(commencing z W with Section 70(10)of Division 3 of the Business and Professions Code,and my license is REPLACE THE SEWER LINE 7 a. in full force and effect. ;n? License Class Lic.S F p Date Contractor ARCHITECTS DECLARATION ,,-J 1 understand my plans shall be used as public records aU u N Licensed Professional < OWNER-BUILDER DECLARATION t� t 1 hereby alTirm that I am exempt from the Contractors License Law for the 1 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to concoct,alter,improve,demolish,or repair any structure Z 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 Sq $3550 t= (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 ,�l Number Occupancy Type not more than five hundred dollars(S500). 3 5 7 0 3 0 2 .JYU ❑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 docs 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 salO.sl'i.ct owner of the property,am exclusively contracting with licensed contractors to the project(Sec.7144,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon.and. who contracts for such projects with a conlractor(s)• sed pursuant to the contractors License Law. ❑I am exempt Sec _.B&P Cforthis reasonOwner Date 9-4 -017 W K 's M N DECLARATION 1 hereby trm under penalty of perjury one of the following declarations•- L]I have and will maintain a Certificate of Consent to self-insure for Workers 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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars($100) or less.) 1 certify that in the perfonnan c of the work for which this permit is issued.I shall not employ anrkn,any so bcr�p subject to the Workers'Compensation Laws of C Applicant NOTICE after _ g this Certificate of Exemption,you should become ubject the Workces Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z"" CONSTRUCTION LENDING AGENCY [�- 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 Lenders Address U C I certify that I have read this application and state that the above information is Lt. t correct.I agree to comply with all city and county ordinances and state laws relating to U J building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. 1]r (We)agree to save,indemnify and keep harmless the City of Cupertino against ,-q to liabilities,judgments,costs and expenses which may in anyway accrue against said City U Z in consequence oC c granting of this it. Date 2-C"I.4 ►- APPLICANT JADERSTA WI COMPLY WITH ALL NON-POINT Issued b): SOURCE LATIO Re-roofs S' rA tDate' T r HAZARDOUS MATERIALS DISCLOSURE Type of I.00f Will the applicant or future building occupant store or handle hazardous mauxial as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes �No Will the applicant or future building occupant use equipment or devices which If a roof is 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 r iaterials for inspection. District? ❑Yes lin No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1understand that ifthc building docs not currently havc a tenant,that it is my responsibility to notify the occupant of the requirements c ust�norbeoCaCertificate ofOccupanry. Signaturf:ofApplicant4:4 Date gAll roof coverings to be Class"B"or better mer or authorir. agent Date - Community Development 10300 Torre Avenue ; :. Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ':UPEI�TINO Building Department JOB ADDRESS: �� PERMIT� oho Zc( A OWNER'S NAME: PHONE # W o ff' � zI Z GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature 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 /;�, --- X, O ne a r Signature Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMI'' RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35'703022 . 00 DATE ISSUED. . . . . . . : 08.128/2007 RECEIPT #. . . . . . . . . . BS'000002493 REFERENCE ID # . . . : 07080243 SITE ADDRESS . . . . . : 10.311 PALO VISTA RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : PE:2EIRA RAMON R AND MARLA E ADDRESS . . . . . . . . . . : 10311 PALO VISTA RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2714 RECEIVED FROM . . . . : RICHARD MURTAGH CONTRACTOR . . . . . . . : WEVGER, WES LIC # 6454 COMPANY . . . . . . . . . . : WENGER PLUMBING CO. ADDRESS . . . . . . . . . . : 1112 FLORENCE WAY CITY/STATE/ZIP . . . : CAKPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 374-4740 FEE ID UNIT QUANTITY kMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPSEWER SEWER SYSTEM 1. 00 21 .58 0. 00 21.58 0. 00 PPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00 ---------- ---------- ----- --- ---------- TOTAL PERMIT 62 .37 0. 00 62 .37 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 62 .37 1687 --------------- TOTAL RECEIPT 62 .37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWS ESS/MAIN SERVICE %CUPEI�TINO PERMIT APPLICATION FORM -7 g 2 G � APN# Date: 3S -7 (D2,c) 22 c :3 Building Addr ss: /0,3/1 f-a- �� o� c e r Owner's Name: Phone #: ? eLl -t m v r�a L-�- VL -G Contractor: License#: ' e Contact: Cupertino Business License #: k)e 5 LA-) � X08-3 s Building Permit Info ls CG �t ke Bldg ❑ Elect ❑ Plumb Job Description: Residential 0' Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPERMFEE Bldg. Permit Fees BUILDING BPFIXTURE Pbl . Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING