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07060134 CITY OF CUPERTINO BUILDING DIVISI,014 PERMIT =dlrRACfiC3R PERMIT NO. BUILD N ADDRESS: ��132 LOREE AVE SILICON VALLEY PLUMBING 07060134 PERMIT ISSUE DATE OWNER'S NAME: ROBERTO VALEZ 287 SAN JOSE AVE 06/15/2007 SANITARY NO. CONTROL NO. NE: (408) 29,-3975 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH nt Z LICENSED CONTRACTOR'S DECLARATION o Job Description W P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z W with Section 7 )of Division 3 of the Business and Professions Code,and my license is SEWER REPLACEMENT AND PROPERTY LINE CLEANOUT. <y in full(o and ffec 't r2 Z License ass Lam• I w Date Contractor ARCHITECTS DECLARATION •�li�f� i a< f understand my plans shall he used as puhlic records r i4V U.y Licensed Professional a OWNER-BUILDER DECLARATION aI hereby affirm that 1 am exempt from the Contractor's License Law for the :n o following reason.(Section 7031.5,Business and Professions Code:Any city or county m which requires a permit to construct,alter,improve,demolish,or repair any structure z r prier to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation =ao that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 `'q $4500 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 Number Occupancy Type not more than five hundred dollars($500). 37508003 ❑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 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 Li- cense Law does not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a contractors)licensed pursuant to the Contractor's SANITARY License Law. ❑1 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: IM I have and will maintain a Certificate of Consent to self-insure for Workers Compen- non,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 Worker's Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars($100) or less.) I certify that in the performance o the rk for which this permit is issued,I shall not employ any person in any man r ct to the Workers'Compensation Laws of Califo ate .D Applicant NOTICE TOA CANT:If,alter making this Celairicatc 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. Z O CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of fYi> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name az Lenders Address V C) I certify that I have read this application and state that the above information is v — correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this City to enter upon the ahovc-mentioned property for inspection purposes. a (We)agree to save,indemn'y and keep harmless the City of Cupertino against ,may liabilities,judgments,costs and ex nses which may in anyway accrue ag'nst said City U`Z in consequence oC c gra ting of is permit. r AP NT U ER AND AND WILL COMPLY WITH ALL ON OINT Issued by: Date J �� SO CE G TI S. Re-roofs Sign ure o can onua-to Dare Type of Roof 'HAZARDO MATERIALS DISCLOSURE yp 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 ;hall be inspected prior to any roofing material being installed. ❑Yes Irtr If a roof i;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 Area Air Quality Management all new materials for inspection. District? ❑Yesfo I have read the hazard us materials requirements under Chapter 6.95 of the Califor- nia Hcalth&Safety ,Sc ons 25505.25533 and 25534.1 undo d th iC the building d t currently a to n4 that it is my responsibility to no y the cupant of the reyu m whic us( tpriortoissuanceofaCcrtificate foe Signature of Applicant Date All roof coverings to be Class"B"or better Owner or authorized agent ate CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37508003 . 00 DATE ISSUED. . . . . . . : 06/15/2007 RECEIPT #. . . . . . . . . . BS000001671 REFERENCE ID # . . . : 07060134 SITE ADDRESS . . . . . : 19132 LOREE AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ROBERTO VALEZ ADDRESS CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : SILICON VALLEY PLMB CONTRACTOR . . . . . . . : ROBERT SANTOS LIC # 25993 COMPANY . . . . . . . . . . : SILICON VALLEY PLUMBING ADDRESS . . . . . . . . . . : 287 SAN JOSE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408)292-3975 FEE ID UNIT QUANTITY AMOUNT 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 38.37 0. 00 38 .37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 59 .95 0. 00 59 .95 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 59 .95 VISA --------------- TOTAL RECEIPT 59 .95 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ------------------------ --- -------- ---------------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING CITE' OF C'UPERTINO 0-76(o 013q REPIPE/ ' /MAIN SERVICE CUPEkTINO PERMIT APPUCATION FORINT APN # Date: Building Address: Z- o er's Name: . 11 Phone#: ►3�►2,712— _ 40 7_ ------ --- —---- - — ------- )ntractor. Phone'. l-icellse t`: Z - 37o C on ct: Phone: Cupertino Business License #: �2a - S7a 57q9 3 Building Permit Info: Bldg ❑ Elect ❑ F lumb Job escription: � w ( ,a-LL h-7 rel. Residential Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Descriptibn-- Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Pl imbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pt lg. Fixture PLUMBING BPWSVCS . Mein Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING Community Development r 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ^UPEkTINO Building Department JOB ADDRESS: PERMIT # g13z �V-<,-- `?O bat Li OWNER'S NAME: �t�o ?Qr- PHONE 2 70 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: t D Signature Date Please check applicable subcontractors and co,m lete 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 Til _ ..T, ),,� /�� V &I I b Owner/Con actor Signature Date