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07060259 777777777777777=7­1 1. CITY OF CUPERTINO BUILDING DIVISION PERMITS PERMIT NO. BUILDRIGarDDWESSRODRIGUES AV CUPERTII�O PLUMBING 07060259 G V O 4 V PERMIT ISSUE DATE OWNER'S NAME: SULAVER PETER J AND MARLENE M 1300 DELL AVE 06/28/2007 SANITARY NO. CONTROL NO. )NE: (408) 25?-0618 BUILDING PERMIT INFO ARCHrrECT/ENGINEER: BLDG ELECT PLUMB MECH p Zo LICENSED CONTRACTOR'S DECLARATION Job Description UP I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 70(10)of Division 3 of the Business and Professions Code,and my license is COPPER F-E P I P E/WATER MAIN 1 CIRC. SYSTEM. s y in full force and e(f r v�Z License Class Lic.1 p Date Contractor • e7 _J F ua ARCHITECTS DECLARATI N a< t understand my plans shall he used as public records )dU c w F' Licensed Professional a OWNER-BUILDER DECLARATION aI hereby affirm that I am exempt from the Contractor's License Law for the p 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 prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation -?< that he is licensed pursuant to the provisions of the Contractor's Licensc Law(Chapter 9 s q•Ft.Floor Area $5000 t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 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 3 5 91101 F ��Number Occupancy Type 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 offend 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 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 thereat,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Seo. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]1 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. ave 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 istued My Worker's Compensation Insurance carrier and Policy number arc: 7 Carrier:� -s 14— Policy No.:�f 101^Y0S3 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for ane 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 Oce Workers'Compen-cation 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 I hereby affirm that there is a construction lending agency for the performance of (Y > the work for which this permit is issued(Sec.3097,Civ.C.) [>I Q Lend ci s Name z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is Lt correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against V) liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. A� Re-roofs Signature of Applicant/Contractor Date Type of Roof HAZARDOUS 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. C3 Yes Ne 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 materials for inspg District? El Yes Nu :�' / 1 have read the hazardous materials requirements under Chapter 6.95 of tiro Califor- � trcquircments alth&SafctyC as 5,25533an 534.IundcrsrandthatiCdtcbuilding ot ave t it is my nsihilit to c occupant of dre which priorwi crtificateoGOccu cy.� S1 Ie 3fAp ant cc Date All roof coverings to be Class"B" or better Owner thorized t Date — CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk-: Lot: APN 35511016 . 00 DATE ISSUED. . . . . . . : 06/28/2007 RECEIPT #. . . . . . . . . : BSC00001835 REFERENCE ID # . . . : 07C60259 SITE ADDRESS . . . . . : 20(40 RODRIGUES AV SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SUTAVER PETER J AND MARLENE M ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2965 RECEIVED FROM . . . . : CUPERTINO PLMBG CONTRACTOR . . . . . . . : CALDIA, FRANK L LIC # 612 COMPANY . . . . . . . . . . : CUPERTINO PLUMBING ADDRESS 1300 DELL AVE CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 253-0618 FEE ID UNIT QUANTITY liMOUNT 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 ----------------- --------------- -------------------- CREDIT CARD 56 .37 VISA --------------- TOTAL RECEIPT 56 .37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUP ERTINO � 70 � 02 e REPIPE/ %0 �1V E IWMAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # -135-9110 / (0 , 5-� Date: Building Address: U �s , Owner's Name: Phone#: Photic: Contact: v Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ P.umb Job Descn tion: U Residential &r- Commercial ❑ Cost of Project: (x)v Qty. if Applicable Fee ID Fee Descrip-tibn-= --- Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS GEs Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSWS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC BL-siness License BUILDING