06100148 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � '
BUILDING ADDRESS: GENITOR PLUMBING PERMIT NO. 06100148
10420 MIT,T,RR AVE PERMIT ISSUE DATE
OWNER'S NAME:
JOY CHEN 3560
SANITARY NO. CONTROL NO.
)NE:
408 .855-8348
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0
p p DECLARATION LICENSED CONTRAJob Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the smcss and Professions Codc,and m license is
!=y infullforeean cf ec{. ^Lic.# ' � qui RE-PIPE GALVANIZED TO COPPER, INCLUDES MAIN
en? License Clas
3 F„m Date Contractor WATER LINE
ARCHITECTS DECLARATION
< 1 understand my plans shall be used as public records
e�U
,a
'u H Licensed Professional
y OWNER-BUILDER DECLARATION
} 1 hereby affirm that I am exempt from the Contractor's License Law for the
3 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
Z} prior tat its issuance,also requires the applicant for such permit to file a signed statement Ft. Floor Area Valuati 5 0 0 0
r= that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq
t—$ (commencing with Section 7000)of Division 3 of thc Business and Professions Code)or
.. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars WW). 37505041 . 00
❑1,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.).
❑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-
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.
❑1 am exempt under Sea B&P C for this reason
Owner Date
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 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 WorkerklCompensation Insurance carrier and Policy number are:
Carrier. (��C Policy No.: &.Q��2\
CERTIFI TE 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.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
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
Er ear I hereby alarm that there is a constntctirn lending agency for the performance of _
pC> the work for which this permit is issued(Sec.3097,Civ.C.)
6fa QLender's Name
0 z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
[f.►� correct.1 agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction.and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
nWi (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,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: C
SOURCE REGULATIO
�roc-� Y �: �U-%O Re-roofs
Signature of Applicant/Contractor Dae T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle ha72rdous 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.
❑Yes O No
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 Managcmcnl all new materials for inspection.
District?
❑Yes N-Ne—
I have read the ha72rdous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.I understated 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 met prior r issuance of a Certificate of occupancy. Slgnatllre Of Applicant
Date
0^yq5.C. All roof coverings to be Class"B"or better
Owner or authorized agent Date
CITY OF CUPERTINO
2m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN 37505041 . 00
DATE ISSUED. . . . . . . : 10/19/2006
RECEIPT # . . . . . . . . . : 36498
REFERENCE ID # . . . : 06100148
SITE ADDRESS . . . . . : 10420 MILLER AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JOY CHEN
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : GENMOR PLUMBING
CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101
COMPANY . . . . . . . . . . : GENMOR PLUMBING
ADDRESS . . . . . . . . . . : 3560 HAIG ST. #2
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054
TELEPHONE . . . . . . . . : (408) 855-8348
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - - - --- - - - -- ----- - ----- - - ----- --- ------- --- ---------- ----- ----- --- -------
BPERMFEE VALUATION 5, 000 . 00 115 . 56 0 . 00 115 . 56 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 162 . 93 0 . 00 162 . 93 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - -- -- - ---- - ---- ---- -------- - ---------- -------
CHECK 162 . 93 2716
TOTAL RECEIPT 162 . 93
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
9 CITY OF CUPERTINO oto �oO t 4s
REPIPE/SEWERS/MAIN
SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
wilding Address-
A7
ddress: -�
Lk��C' [\J\ cz- I\\' '\
Owner's Name: Phone#:
q o 4va- 8a►-373,)--
Contractor:
37 ,)--
Contractor: Phone: License #:
Contact: Phone: Cupertino Busi ess License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential EQ-- Commercial ❑
Cost of Project:
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 Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING