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07030147 CITY OF CUPERTINOACTgR IjIMATIOl BUILDING DIVISION PERMIT PERMIT NO. BUILgZIrj,GeVFSRODRIGUES AV DISCOUNT PLUMBING & ROOTER 07030147 PERMIT nUE DATE OWNER'S NAME: ONER, KARAY 1330 VALOTA RD 03/20/2007 SANITARY NO. CONTROL NO. ef?ONE: BUILDING PERMIT INFO ARCHITECTIENGINEER: REPAIR EXISTING SEWER PIPE BLDG ELECT PLUMB MECH Q D D C7 p O LICENSED CONTRACTOR'S DECLARATION Job Description VF I herebyaffirm 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 r H in full fora and �S( No?? Ltcensc ttss Contractor r = tic.8 Date f2_*L>C W O.t+K%ft t 1 l F'[+ ARCHITECTS DECLARATION j a a I understand my plans shall he used as public records 3wu u.y Licensed Professional C,a OWNER-BUILDER DECLARATION j 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 o"y prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation -?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q r t=• (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L that he is exempt therefrom and the basis for the alleged exemption.Any violation o[ Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number P Y Yp not more than five hundred dollars(5500). ❑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 oroffered 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 We.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 contractor(s)licensed pursuant to the Contractor's License Law. ,B&P C for this reason C3 I am exempt under Sec 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 Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. JI have and will maintain Worker's Compensation Insurance,as required by Section 3r0 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 arc: Carrier. I�Policy No.: CERTIF CATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE A -(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 b 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 ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. Z(A CONSTRUCTION LENDING AGENCY rte-+ 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 jLender's Address U C) 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 U. U building construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way accrue against said City ^ I D U Z in consequence of the granting of this permit. Date (/(� *� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: S LATIONS. wZ�"107 3 - Re-roofs Signa um of pplicant/Contractor Date Type(f Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future but 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 shall be inspected prior to any roofing material being installed. C]Yes tRINe 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 V materials for inspection. District? ❑Yes �o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- 32 a— O 7 nia Health&Safety Code,Sections 25505.25533 and 75534.1 understand that if the building does not currently have a tenant that it is my responsibility to notify the occupant of the Date me is which must be mel prior to issuance of a Certificate of Occupancy. .S Igna1 ULC 0 AppllCant ij aRI-0 7 tTAll roof coverings to be Class"B"or better or authonzcd agent Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITI(OF Fax(408)777-3333 ,UPEkTINO Buildin De arhnent JOB ADDRESS: O 'K *01".%`5`'et {- PERMIT# C_ C 070 OWNER'S NAME: - r PHONE # G- .- GENERAL CONTRACTOR: - I„ I:' 4 FAX # C� — G I am not using any subcontractors: Signature Date Please check applicable subcontractors and cors 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 Tile Owner/Contractor Signature Date CITY OF' CUPERTINO 3 ITEMS OF 3 PERM--:T RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: B'-k: Lot: APN . . . . . . . . : 35911014 . 00 DATE ISSUED. . . . . . . : 0:9/20/2007 RECEIPT #. . . . . . • • • : B:3000000734 REFERENCE ID # . . . : 0'7030147 SITE ADDRESS . . . . . : 20686 RODRIGUES AV SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : O:1ER, KARAY ADDRESS . CITY/STATE/ZIP . . . : CJPERTINO CA, 95014-2965 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : ORCE NAVMOVSKI LIC # 24887 COMPANY . . . . . . . . . . : DISCOUNT PLUMBING & ROOTER ADDRESS . . . . . . . . . . : 1330 VALOTA RD CITY/STATE/ZIP . . . : REDWOOD, CA 94061 TELEPHONE . . . . . . . . : (650) 333-8105 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---------- ----- BPERMFEE VALUATION 3, 000 .00 83 .16 0.00 83 .16 0.00 BPSEWER SEWER SYSTEM 1.00 21.58 0 .00 21.58 0.00 PPERMITFEE FLAT RATE 1.00 38 .37 ------0_00 -----3837 ------0_00 TOTAL PERMIT 143 .11 0 .00 143 .11 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------- CREDIT CARD 143 .11 VISA --------------- TOTAL RECEIPT 143 .11 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- --------------------------- - 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO �,am: -Y /MAIN SERVICE REPIPE/SENN CUPEkTINO PERMIT APPLICATION FORM 070301q--1 APN # Date: 3- 0 -o-7 Building Address: v Owner's Name: Phone#: ,n e.� -3 7 3 Contr ctor: Phone. License#: ` cdvh-! (tSv- 3— f of Contact: hone: Cupertino Business License#: P a�7 Building Permit Info: �4�;, �C i s-1 :►n 5 a4e, S2w e,- S Bldg ❑ Elect ❑ Plumb Job Description: Residential Commercial ❑ Cost of Project: 3 e)�� Qty. if Applicable Fee ID Fee Description Fee;Gtoup BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING ILDING BUSLIC Business License BU