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06100162 CITY OF CUPERTINO BUILDING DIVISION PERMIT ; BUILDING ADDRESS: AMERICAN RESIDENTAIL SERV L1TNO.06100162 10148 PRADO VISTA DR PERMIT LSSUE DATE OWNER'S NAME: JOHN PAUL WALTER 1479 BERGER DR 10/23/2006 SANITARY NO. CONTROL NO. NE: (408) 287-2165 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description U P I hereby affirm that I am licensed under provisions of Chapter 9(commencing 'o with Section 7000)ofDivision 3ofthe Business andPr t u s d,phylicense ix REPLACE MAIN WATER LINE AND INSTALL CLEAN OUT .=y in full force and f�e�t ? License Class Lic.M F rp Datc Contractor HITECTS DECLARA ON 11.4 1 understand my plans shall be used as public records �aU O y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county 8 O O O c,�,(ii which requires a permit to construct.alter,improve,demolish,or repair any structure Z; 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 License law(Chapter 9 Sq Ft.Floor Area =O at–$ (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 of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of r Ou Occupancy Type not more than five hundred dollars(5500). ❑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 forsale(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- cerise 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 OwnerDate WORKER'S COMPENSATION DECLARATION .wt: I hereby affirm under penalty of perjury one of the following declarations: n ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn- 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 arc: Carier.71,7 Policy No. CERTIFICATE OF EXEMPTION FRO WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is far one hundred dollars($100) or 1 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 'O Z 10 UP 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"" CONSTRUCTION LENDING AGENCY Fr r4. 1 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 A Lender'sName az Lender's Address U 0 1 certify that I have read this application and state that the above information is L4 0— correct.I agree to comply with all city and county ordinances and state laws relating to O Ubuilding construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. W (We)agree to save,indemnify and keep harmless the City of Cupertino against rF- 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 ► APPLICFSNT ST S AND WILL COMPLY WITH ALL NON-POINT Issued by: S07. REGULA „I G- Re-roofs Si nature pplicant/Con Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof ill 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 Cote,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or utT urc 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 inspection. District? ❑Yes u 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 docs not currcntl have a tcnan4 that it' my responsibility to notify the occupant of the requirements wh) be met p' issuance of a Certificate of Occupant. 2,� re of Applicant Date w` or Dam All roof coverings to be Class"B" or better authorized agcnl *, Community Development ,.4. 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 anof Fax(408)777-3333 U PEkTIN0 Building Department JOB ADDRESS: PERMIT 11,�� c- '7 (J OWNER'S RAW: ` PHONE # GENERAL CONTRACTOR ` FAX # Ole I am not using any subcontractors: SigurenatDate Please check applicable subcontract d complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets&Millwork Cement Finishing El cal 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 ,m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 34214093 . 00 DATE ISSUED. . . . . . . : 10/23/2006 RECEIPT # . . . . . . . . . : 36527 REFERENCE ID # . . . : 06100162 SITE ADDRESS . . . . . : 10148 PRADO VISTA DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JOHN PAUL WALTER ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM RESCUE ROOTER CONTRACTOR BUREL, MARK T LIC # 21504 COMPANY AMERICAN RESIDENTAIL SERVICES ADDRESS 1479 BERGER DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95112-0845 TELEPHONE (408) 287-2165 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- - - --- - - - - - - ---- ------ ---------- ---------- ------- --- ------ BPERMFEE VALUATION 8 , 000 . 00 147 . 96 0 . 00 147 . 96 0 . 00 BPSEWER SEWER SYSTEM 1 . 00 21 . 58 0 . 00 21 . 58 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 370 . 00 38 . 37 0 . 00 ---------- ---------- - --------- --- --- -- -- TOTAL PERMIT 207 . 91 0 . 00 207 . 91 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -- - - ---- - - ----- -- --- ------ --- ------------------ CHECK 207 . 91 003997 TOTAL RECEIPT 207 . 91 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO 000I00IO2-. REPIPE/S W RS/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # Date: Buildin Ad re Owner'sName: l ` Phone#: Cid/� Contractor: Ph e' License #: Contact: P on --L-Cii"pr6tin Business License#: h(A 9.11 A 2, dl, Building Perm Info: Bldg ❑ Elect ❑ Plumb Job Descriptio (" 'I'teL, f Residential v Commercial ❑ Cost of Project: Qty. if Ap licable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repi e of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING