The URL can be used to link to this page

07060054CITE' OF CUPERI'ViV BUILDING DIVISION PERMIT BUILD NG DRESS: PERMIT NO. �1�7 ROSARIO AVE ALL VALLEY PLUMBING 07060054 OWNER'S NAME: JAIR FRED C HSIA AND MELODY S 3345 SELDON CT )NE: ARCHITECT/ENGINEER: i 00 LICENSED CONTRACTOR'S DECLARATION ar F- I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z with Section 7000) of Division 3 of the Business and Professions Code, and my license is I a a in full force and ec[. O � n ? License CI — Li H p Date Conlracwr f va ARCHITECTS DECLARATIO j C a I understand my plans shall he used as public records )yU e.N Licensed Professional o a OWNER -BUILDER DECLARATION aI hereby affirm that 1 am exempt from the Contractor's License Law for the no 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 prior w its issuance, also requires the applicant for such permit to file a signed statement - ? a that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 e (commencing with Section 7000) of Division 3 of the Business and Professions Code) or Q 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 not more than five hundred dollars ($500). ❑ 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 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.). ❑ I, 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 - cease 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 Contractofs License Law. ❑ 1 am exempt under Sec. B & P C for this reason Owner Dare WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ] 1 have and will maintain a Certificate of Consent to self -insure for WorkeesCompen- ation, as provided for by Section 3700 of the Labor Code.. for the performance of the Nork for which this permit is issued. ] I have and will maintain Worker's Compensation Insurance, as required by Section 1700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's yCompensation Insurance carrier and Policy number am: , Carrier: —T -PL ZKil IT H Policy No .0 QL9 303 y O CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars (EI00) 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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 (See. 3097, Civ. C.) Lender's Name Lender's Address 1 certify that 1 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 building conswction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspecuon purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabiliues,judgmcnts, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOCE REGULATI NS. 16C -121L J 0_1 Signature of Applicant/Contractor -- t -_JDft HAZARDOUS MATERIALS DISCLOSURE 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)? ❑ Yes )No 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 District? C] Yes NO I 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 does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which must be t pnorjo issuance of a Certificate of QCcupancy._ Owner or authorricd agent Date (510)376-4816 PERMIT ISSUE DATE 06/07/2007 SANITARY NO. CONTROL NO. Job Description REPLACE WATER HEATER 40 GAL. S a. Ft. Floor Area 35619025 AN Issued by: Re -roofs Type of Roof $750 Required Inspections BUILDING PERMIT INFO ELECT PLUMB Occupancy Date All roofs : hall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature AApplicant All roof coverings to be Class "Bt' or better Date 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 356:_9025.00 DATE ISSUED.......: 06/07/2007 RECEIPT #......... BS000001578 REFERENCE ID # ...: 07060054 SITE ADDRESS .....: 21517 ROSARIO AVE SUBDIVISION ....... CITY .............: CUP:ERTINO IMPACT AREA ....... OPERATOR: suew COPY # : 1 OWNER JAI2 FRED C HSIA AND MELODY S ADDRESS .......... CITY/STATE/ZIP CUPERTINO CA, 95014-4756 RECEIVED FROM ALL VALLEY PLUMBING CONTRACTOR MARY SANDBRINK LIC # 23015 COMPANY ALL VALLEY PLUMBING ADDRESS 3345 SELDON CT CITY/STATE/ZIP FREAONT, CA 94539 TELEPHONE (510)376-4816 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT --------- THIS REC NEW BAL ----------------------- BENERGY PERMIT FEE ---------- 1.00 ---------- 34.86 0.00 34.86 0.00 BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 ---------- 38.37 ---------- 0.00 ---------- TOTAL PERMIT ---------- 84.02 0.00 84.02 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 84.02 --------------- 84.02 VOICE ID DESCRIPTION -------- ---------------------------- 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 506 GAS TEST CITY OF +CUPERTINO WATER HEATER PERMIT APPLICATION FORM J7cGa's3� APN # ''05 Date: L -1f � ' U -I7 BUILDING ppE E Building Address: PLUMBING Owner's Name: _ Phone #: z-AV<� - -2- Contractor: P ne License #E Contact: one: r �►��n Cupertino Busies License #: Vii; t.zi� Building Permit o: tl Bldg ❑ Elect Plumb Its-' Mech Job Description: �� J Residential Commercial ❑ Cost of Project: Strapped On Platform Bonded New Location ❑ Replacement Qty. if Fee GrouD A livable ree -LU BPWHEATER Water Heater / Vent BUILDING ppE E Plumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BT,JSLIC Business License BUILDING i tl CITY OF -UPE�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # 7 OWNER'S NAME: 7FreCi Sa r PHONE # 403- - 25-7 - cl 3--1 GENERAL CONTRACTOR: vc� �� ,��_ FAX # I am not using any su Please cherk annlicable su Signature Date and comr)lete the following information: Owner/ Contractor Signature Date 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 ::TPlastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date