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07050044 CITY OF CUPERTINO BUILDING DIVISION PERMIT ` PERMIT NO. BUILDjTfT1"bHAR LAP DR GENMOR =?LUMB ING 07050044 l�J l y PERMIT ISSUE DATE OWNER'S NAME: BONICELLI, LYNN 3560 HAIG ST. #2 05/07/2007 SANITARY NO. CONTROL NO. .ONE: (408) 85. -8348 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH L 0 r� i p C LICENSED CONTRACTOR'S DECLARATION Job Description U1 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 RE-PIPE HOUSE, GALVANIZED TO COPPER t=y in full force and effect. vM Z License Class Lk•# F p Date Contractor ARCHITECTS DECLARATION Z a< I understand my plans shall he used as public records )yU U.F- Licensed Professional `y OWNER-BUILDER DECLARATION q 1 hereby affirm that I am exempt from the Contractors License Law for the 2 COO following reason.(Section 7031.5,Business and Professions Code:Any city or county < Pi which requires a permit to convect,alter,improve,demolish,or repair any structure Ll'H prior to its issuance.also requires the applicant for such permit to file a signed statement r .Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq. $4000 r t- (commencing with Section 701)0)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 3263905 3 �Number Occupancy Type not more than five hundred dollars($500). ❑1,as owner of the property,or my employees with wages as their sale compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors 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 arc 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 Contractors u- Law does not I to an owner of property who builds or improves thereon,and. cense apply P oPert for such projects with a conlractar(s)licensed pursuant to the Convaclor s who contractsP K License Law. ❑I 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: 09 r ❑1 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. ❑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 Workers Compensation Insurance carrier and Policy number are: Cartier. Policy No.: 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 must 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z 0-.4 CONSTRUCTION LENDING AGENCY (~-�►�-� I hereby affirm that there is a construction lending agency for the performance of (1! ' the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 0Z Lender's Address U 0 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 U above-mentioned property for inspection purposes. f]. (We)agree to save,indemnify and keep harmless the City of Cupertino against o.q.t c.4) liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date �. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. 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. ❑Yes ❑No Will the applicant or future building occupant use equipment or devices which If a roof i;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 inspection. District? ❑Yes ❑Nu 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 does not currently have a tenant,that it is my responsibility to notify the occupant M the requirements which must be met prior to issuance of a certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class"B"or better Owner or authorized agent Dare CITY OF CUPERTINO ITEM 1 OF 1 PERMIT' RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Bll:. Lot: APN . . . . . . . . : 32639053 .00 DATE ISSUED. . . . . . . : 05,07/2007 RECEIPT #. . . . . . . . . BS000001226 REFERENCE ID # . . . : 07()50044 SITE ADDRESS . . . . . : 10:.91 PHAR LAP DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BONICELLI, LYNN ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1113 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR GEITARO MORALS LIC # 27101 COMPANY . . . . . . . . . . : GEITMOR PLUMBING ADDRESS . . . . . . . . . . : 3560 HAIG ST. #2 CITY/STATE/ZIP . . . : SAITTA CLARA, CA 95054 TELEPHONE . . . . . . . . : (4()8) 855-8348 FEE ID UNIT QUANTITY 1�MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- PPERMITFEE FLAT RATE 1.00 38 .37 0 .00 38 .37 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 38 .37 0 .00 38 .37 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 38 .37 4288 --------------- TOTAL RECEIPT 38.37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/S ` VIS/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM D?o5oo� APN # D_a�e� 34 - 3°�- 053 Building Address: Owner's Name: Phone#: Co tractor: Phone: License#: '7ennn�i bLt]sass 4��U 43 3�� Contact: Phone: Cupertino Business License#: AsC;k VSs - 9 01 Building Permit Info: Bldg ❑ Elect ❑ Plumb 12 Job Description: CJ def Q,� �r�+i,-� Y► x,-2 Residential ❑ Commercial ❑ Cost of Project: �4 e leuc, Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE l'blg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER ;Sewers PLUMBING BPSEWAGE :Sewage Disposal PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 fXPEi�TINO Building Department JOB ADDRESS: PERMIT# 0.10500 41t i O Ici I QIAO✓ Dv OWNER'S NAME: L-q✓i ri I3ori c e I i PHONE # qo vss 3 GENERAL CONTRACTOR: ,.x,,.10✓ ) FAX# �) 02,1101 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete 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