09070002 CITY OFC PERTINO �'•�
BUILDING DIVISION PERMIT �1�►TRRl. C?R I� ATI�r.
BUILDING ADDRESS: PERMIT NO.
8067 PRESIDIO DR GENMOR PLUMBI
OWNER'S NAME: PERMIT ISSUE DATE
�
�ME.9H
)NE: s)(NrfAPt8.2009 CONTROL NO.
(408) 855-8348
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 a a a
u p p LICENSED CONTRACTOR'S DECLARATION
m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z. with Section 7000)of Division 3 of The Business and Professions Code,and my license is
'=y in full forceande t COPPER REPIPE & WATER SVC
? Licensc CI a k
p Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
DyU
O Licensed Professional
n y� OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
C 0 O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K$9 which requires a permit to construct,alter,improve,demolish,or repair any structure
y Z prior to its issuance•also requires the applicant for such permit to file a signed statement
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y.t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 6 O O 0
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 APN Number Occupancy Type
not more than five hundred dollars($500). 35611074 . 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
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
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 Comractoes Li.
cense Caw 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.
❑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:
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
Kfor which this permit is issued.
have and will maintain Worker's Compensation Insurance,as required by Section
of the Labor Code,for the performance of the work for which this permit is issued.
My Workee/s��compensation insurance carrier and Poli cy umber am:
Carrier.1ALT J3 laid Policy No. M(I
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.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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
[~a 4 1 hereby affirm that there is a construction lending agency for the performance of
p;> the work for which this permit is issued(Sec.3097,Civ.C.)
0 Lender's Name
Z Lender's Address
U O I certify that 1 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
0V building construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes
(We)agree to save•indemnify and keep harmless the City of Cupertino against
„Pict liabilities,judgments,costs and expenses which may in any way scenic against said City
V Z in consequence of the granting of this permit. y Date
m" APPLICANTNDERSTANDS ANON-POINT Issued by: — '—
REGU N WILL COMPLY WITH ALL
Re-roofs
S' n re of Appli t/ ontractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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
Cede.Section 25532(a)? All roofs::hall be inspected prior to any roofing material being installed.
❑Yeso
Will the applicant or tutu building occupant use equipment or devices which If a roof i:;installed without first obtaining an inspection,I agree to remove
Will the applicant or fu<tu
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection.
.tsirict7
❑Yes No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code. 'ons 25505.25533 and 25534.1 undcrswd that if the building
does not curre2ly have a rant that it is my responsibility to notify the occupant of the
ns whits m t prior to issuance of a Certificate TT k Signature of Applicant Date
Owncrorauthorizcd 1 are All roof coverings to be Class's"or better
CITY OF CUPERTINO
6 ITEMS OF 6 PERMI`[' RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 35611074 . 00
DATE ISSUED. . . . . . . : 07101/2009
RECEIPT #. . . . . . . . . : BS000008090
REFERENCE ID # . . . : 09070002
SITE ADDRESS . . . . . : 8067 PRESIDIO DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER RAMESH MENON
ADDRESS . . . . . . . . . . : 8067 PRESIDIO DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4026
RECEIVED FROM . . . . : GENMOR PLUMBING INC
CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101
COMPANY GENMOR PLUMBING
ADDRESS 2532 SEABOARD AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95131
TELEPHONE . . . . . . . . : (4 )8) 855-8348
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 6, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BPWATER UNIT 1 . 00 42 . 00 0 .00 42 . 00 0 .00
1BSEISMICR VALUATION 6, 000 . 00 0 .60 0 . 00 0 . 60 0 .00
1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 .00
1PRREPIPE NO OF FIXTURE 1 . 00 11 . 00 0 . 00 11 . 00 0 .00
1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 138 . 60 0 . 00 138 . 60 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 138 . 60 #3964
---------------
TOTAL RECEIPT 138 . 60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 507 FINAL PLUMBING
` CITY OF CUPERTINO
REPIPE/SEWEWMAIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN# 5� ( 10 -74 - C7 O Date: I Iocl
.
Building Address: r 001
p re S lO LD D�
Owner's Name: �6JM-C�hl`,l �eNbNPhone #: 40 ' /SContractor: Phone#: `�
C1eM Fax#:
Contact: Phone #:;
S&A101 Z Fax#: "i O
Contractor License#: 3 j
Cupertino Business License #: 1 V
Job Description:
Mme- r�P,p�lae (q. ri ct wa y- &WV1U
Residential Commercial ❑
Valuation: ( V 0 C)
Project Size: Expressly❑ Standard Large [] —Maj or❑
Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the
application or if applicable, include in plan set& 1 he sheet index.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary s.wer
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1 PGASCOM Commercial Ga;;Piping System P
1-4 Outlets
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICOM Seismic Commcrcial P
Revised 01/07/09
CITY OF CUPERTINO
I it REPIPE/SEWE R/MAIN SERVICE
CUPEkTINO FEE S(:HEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Resider tial P
1PRSEWER Residential building P 1RPSS
sewer/sanitary s,-wer
I 1PRREPIPE Residential re-p pe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1PPRSEWG Private Sewage Disposal System P
1 PCESS Cesspool P
` 1BPWATER Install/alter Watl-r Pipe P
( 1BPFIXTURE Plumbing Fixtute P
1 PGASRES Residential Gas Piping System P
1-4 Outlets
1BPGAS Gas Piping Syst,;m 5+Outlets P
1PPERMITFEE Plumbing Permit Fee Issuance P
1 PLMBLNCK Plumbing Plan Check P
1 PLMBINSP Other Plumbing,'gas Insp. P
1TRAVDOC Travel & Documentation Fee B
1 BUSLIC Business Licens,- B
Community Development
10300 Torre Avenue
st Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
7UPEkTINO
Building Department
JOB ADDRESS: �Ob-1 � �y PERMIT #
OWNER'S NAME: PHONE # 4,06-gam` ,3q
GENERAL CONTRACTOR Ie w1010,4 FAX#
l
NU 1 0�
I am not using any subcontractors: ``�
SA, ature Date
Please check applicable subcontractors and com > ete the following information:
SUBCONTRACTOR BUSIrTESS 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
ile
er/Contractor Signature Date