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07060122 CITY OF CUPERTINO7 BUILDING DIVISIONATj��t PERMIT PERMIT NO. BUILDING ADDRESS: 10161 PHAR LAP DR GENMOR PLUMBING 07060122 PERMIT ISSUE DATE OWNER'S NAME: DANIEL MEYER 3560 H7,IG ST 7 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: COPPER RE—PIPE; PARTIAL HOME BLDG EO PLUMB ME�CH Z LICENSED CONTRACTOR'S DECLARATION r Job Description O - ... W� I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is !=H in full force and ecLg License 1 5 LK•# F Dale ( Contractor ARCHiTELTS DECLA I < I understand my plans shall be used as public records ryU rLy Licensed Professional io OWNER-BUILDER DECLARATION 1 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 which requires a permit to construct,alter.improve,demolish,or repair any structure i "N prior to its issuance,also requires the applicant for such permit to file a signed statement 3q,Ft.Floor Area Valuation ?a that he is licensed pursuant to the provisions o( the Contractor's License Law(Chapter 9 tx- (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 PN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). 0 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.). 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- cerise Law does not apply to an owner of property who builds or improves thereat.and, who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. 0 I am exempt under Sec. B&P C for this reason SANITARY Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: �]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. 0 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 WorkerC�ommppensation Insurance carrier and Policy number are: CartQ Carrier: 7 `'` Q Policy No.; 14t' CERTIFICATE 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,1 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 mast Oforthwith comply with such provisions or this permit shall be deemed revoked. Z'— CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of x r7 the work for which this permit is issued(Sec.3097,Civ.C.) L4 Q Lender's Name Z LcndersAddress U O 1 certify that I 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 to Ubuilding construction.and hereby authorise representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against HCo) liabilities,judgments,costs and expenses which may in any way accrue against said City /f / U Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b): SOURC Re-roofs Sigg App licant/Comractor Dale Type of Roof 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)? -�Ne All roofs shall be inspected prior to any roofing material being installed. CYes 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 defined by the Bay Area Air Quality Management all new r laterials for inspection. District? 0 Yes two 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not curently have a Want,that it is my responsibility to notify the occupant of the requirements vL nor issuance of a Certificate of Occupancy. Signature:of Applicant Date �f �`'� All roof coverings to be Class"B"or better Owner or authorized agent Dare CITY OF CUPERTINO 3 ITEMS OF 3 PERMI`[' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl-.c: Lot: APN 32 539056. 00 DATE ISSUED. . . . . . . : 06 /14/2007 RECEIPT #. . . . . . . . . : BS)00001658 REFERENCE ID # . . . : 07 )60122 SITE ADDRESS . . . . . : 10161 PHAR LAP DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER DAVIEL MEYER ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1113 RECEIVED FROM . . . . : GE\TMOR PLUMBING CO. CONTRACTOR GEVARO MORALS LIC # 27101 COMPANY GE\TMOR PLUMBING ADDRESS 3560 HAIG ST CITY/STATE/ZIP . . . : SAVTA CLARA, CA 95054 TELEPHONE (408) 855-8348 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPREPIPE NO OF FIXTURE 1. 00 9 .00 0. 00 9 .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 56 .37 0. 00 56 .37 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 56 .37 #4651 --------------- TOTAL RECEIPT 56 .37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING CITY OF CUPERTINO �Z- REPIPE/ r /MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORINT APN# Date: �/ ? Building Address: 01 SP1 VNa►' L-C� 1' Dr Owner's Name: Phone#: �.of�tractar: Plonc;: Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ 3lumb Job Description: a-,f-A C O?i?e� F2E' �e VAI -^2 a-�e4 rr►-�q �'_, 1► Residential ® Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Descrig�ibn- Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE P.umbing Permit Issuance PLUMBING BPREPIPE Repi e of Fixtures PLUMBING BPFIXTURE P:)Ig. Fixture PLUMBING 1 BPWSVCS Main Water Service PLUMBING BPSEWER S-wers PLUMBING BPSEWAGE S,-wage Disposal PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue o Cupertino CA 95014 Telephone(408)777-3228 CITY Of Fax(408)777-3333 -UPERTINO Building Department JOB ADDRESS: PERMIT # 10 1tGr OWNER'S NAME: �'�� t-AC0 er PHONE # (,JN) �`�3~ GENERAL CONTRACTOR: , FAX # I am not using any subcontractors: Sig nature Date Please check applicable subcontractors and co m Tete 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