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11010152 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18640 STARRETT CT CONTRACTOR:GENMOR PERMIT NO: 11010152 PLUMBING OWNER'S NAME: SALAM HAFIDI 1 2552 SEABOARD AVE DATE ISSUED:0 1/28/2011 /NER'S PHONE: 5102925331 SAN JOSE,CA 95131 PHONE NO:(408)855-8348 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB, License Class Lic.# W I MECH I— RESIDENTIAL f— COMMERCIAL Contractor Date It JOB DESCRIPTION:REPLACEMENT OF 13-15'OF SEWER LINE AND INSTALLATION OF 4"CITY CLEANOUT 1 hereby affirm that am license under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the Valuation:$1000 performance of the work for which this permit is issued. Sq.Ft Floor Area: I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of die work for which this APN Number:37526026.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 1 AYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: l granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18• RE-ROOFS: Signature Date I �_Cb I U All roofs shall be inspected prior to any rooting material being installed.If a root'is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 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&Professions Code) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations• health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code 505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or:authorized agent: Date ' J permit is issued. 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 Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Name APPLICANT CERTIFICATION Lender's Address I 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 building construction,and hereby authorize representatives of this city to enter -on the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION +unnify and keep harmless the City of Cupertino against liabilities,judgments, ,,,»ts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . . 37526026 . 00 DATE ISSUED. . . . . . . : 01/28/2011 RECEIPT # . . . . . . . . . : BS000012600 REFERENCE ID # . . . : 11010152 SITE ADDRESS . . . . . : 18640 STARRETT CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER SALAM HAFIDI ADDRESS . 18640 STARRETT CT CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM GENMOR PLUMBING CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101 COMPANY . . . . . . . . . . : GENMOR PLUMBING ADDRESS : 2552 SEABOARD AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 855-8348 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 000 . 00 0 . 50 0 .00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 1 .00 42 . 00 0 .00 42 . 00 0 . 00 1PRSEWER UNITS 1 .00 21 . 00 0 . 00 21 . 00 0 .00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 ----- 0 . 00 ---------- ---------- ---------- TOTAL PERMIT 106 . 50 0 . 00 106 .50 0 . 00 METHOD OF PAYMENT AMOUNT --REFERENCE NUMBER ----------------- -------------- CHECK 106 .50 7818 --------------- TOTAL RECEIPT 106 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION --------- -------- ---------------------------- - -------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 18640 Starrett Ct. DATE: 01/28/2011 REVIEWED BY: gs APN: BP#: *VALUATION: $1,000 R�PERMITT`YPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY PENTAMATION 1 RPSS USE: SFD or Duplex PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1 PRSEWER 1 # $21 TOTALS: $21.00 /'?art'lir Plumb.Plan Check 0.0 hrs $0.00 1,is _ f k'W t h'L"k Plumb.Permit Fee: 1PPERMIT OrlrEIF �f 1/�r 1'i. Jrr�`l>. Other Plumb Insp. 0.0 �rs $42-00 0111"'r ta��_�f�,��. FCC, fn�/)' NOTE. These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept for addn'l info, FEE ITEMS (Fee Resolution 09-051 Elf. 7,1/10) FEE QTY/FEE MISC ITEMS Plan C"lurch Fc e: suppl. 1"(,1,ee PME Plan Check: $0.00 Perinit Fee: PME Unit Fee: $21.00 PME Permit Fee: $42.00 (I.1ons/ructi(1n KIN 11<ouslical/&'vivw Vee: Work Without Permit? 0 Yes 0 No $0.00 Planning Fees: Travel Documentation Fee: 1TRA VDOC $42.00 i Stron Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg�Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $106.501 $0.00 TOTAL FEE: $106.50 Revised: 01/15/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 1 PERMIT# If 11C)IO 1 19 OWNER'S NAME: PHONE# 40k QJ2V'-4Q GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: seal bai CITY/ZIPCODE: �ilAc 3 *Our municipal code requires all businesses working in the city to have a City of Cupertino usiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUB C TRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. t �021 CO2 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CITY OF CUPERTINO REPIPE/SEWERMAIN SERVICE PERMIT APPLICATION FORM CUPERTINtO Date: APN # 026 Building Address: /� r f e'� �� v✓� Phone#:�IL?_�y,��j� Owner's Name: c„�!, . ^ �(J[�'VCJ( phone#: S� �. �Vmanoy IVC• Fax#: Contractor: � Phone#: . SAVINS Contact: Fax/e-mail: SOnM Contractor License#: Cu ertino Business License#: �_ Job Description: �� lom-n of 41, C� Ulan Ute' Commercial ❑ Residential , Valuation: I Project Size: Counter Express❑ Standard❑ Large ❑ Major❑ levant portion of the Green Building Checklist & attach it to the Green Building: Please complete re P a lication or if applicable,include in plan set& the sheet index. PP Green Buildin Points: Fee permit Type Quantity Fee ID Fee Description Crop p 1CPSS 1PCSEWER Commercial building sewer/sanitary sewer P 1CPRP 1BPREPIPE Commercial re-pipe per fixture 1PGASCOM Commercial Gas Piping System P 1-4 Outlets B ALL PERMIT 1BCBSC Cal Bldg Standards Commission TYPES Fee p 1BSEISMICOM Seismic Commercial Revised 12/06/10