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10050150I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 6541 CLIFFORD DR OWNER'S NAME: RONALD WAIBEL ,'R'S PHONE: 4082531244 LICENSED CONTRACTOR'S DECLARATION License Class �J Lic. #/ Contractor �i✓�C P �/ +, �2a4Vte I hereby affirm that I am licensed under the isions er 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. Signature Date (� Ll OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this 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 Compensation laws of California. If, after making this certificate of exempt -.O -r, become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 upon the above mentioned property for inspection purposes. (We) agree to save J unify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the 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. %D CON"'RACTOR: SAN JOSE PLUMBING INC PERMIT NO: 10050150 1732 1JILLSDALE AVE DATE ISSUED: 05/19/2010 SAN .LOSE, CA 95124 PHONE NO: (408)296-1820 BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH F RESIDENTIAL F COMMERCIAL JOB DESCRIPTION: COPPER REPIPE FM FOUNDATION VALE Sq. F: Floor Area: Valuation: $6425 1 APN Number: 36926003.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED INITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAY OM LAST CALLED INSPECTION. Issu(d by: S_/C7_ ` L � Date: RE -ROOFS: All rc ofs shall be inspected prior to any roofing material being installed. if a roof is instal.ed without first obtaining an inspection, I agree to remove all new materials for inspe ;tion. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I ha -,e read the hazardous materials requirements under Chapter 6.95 of the CalilDrnia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain coml liance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safely Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air conts.minants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Heal :h & Safety Code, Sections 25505, 25533, and 25534. !rWauthorized agent: / Datc:��A CONSTRUCTION LENDING AGENCY I herrby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Len( er's Name Len(er's ARCHITECT'S DECLARATION I uncerstand my plans shall be used as public records. Lice ised Professional 5 ITEMS OF 5 CITY OF CUEERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: lot: APN ........: 36926CO3.00 DATE ISSUED.......: 05/19/2010 RECEIPT #......... BSOOOC10441 REFERENCE ID # ...: 10050150 SITE ADDRESS .....: 6541 CLIFFORD DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER RONALD WAIBEL ADDRESS 6541 CLIFFORD DR CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4555 RECEIVED FROM ....: DAVID PLEMONS CONTRACTOR GARZA, KEVIN N LIC # 14200 COMPANY SAN JOSE PLUMBING INC ADDRESS 1732 HILLSDALE AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95124 TELEPHONE (408)296-1820 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 6,425.00 ----------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 6,425.00 0.70 0.00 0.70 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 ----------- 96.70 ---------- 0.00 96.70 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 96.70 --------------- 96.70 REFERENCE NUMBER -------------------- V:_SA VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY Of CUPEI�TINO CITY OF CUPERTINO REPIPE/SEWER04AIN SERVICE PERMIT APPLICATION FORM �, �' `, v ► APN # GojJ Date:�.6-/( Building Address: / � /C Owner's Nam � Phone #: yo 0?53 - a y Contractor: � �� vA Fax Phone #: 3 % #: D T !� (J Contact: ( PWI,� Phone #: IM 7 z vl Zs Fax #: Contract: / (Jl r Cupertino Business License #: Job Description: Residential Commercial ❑ Valuation: Project Size: Express Standard ❑ Large F Major LJ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the iheet index. Green Building Points: Quantity Fee ID Fee Description Fee Group Permit Type 1PCSEWER Commercial building sewer/sanitary sewer P 1CPSS 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Pi Jing System 1-4 Outlets P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES IBSEISMICOM Seismic Commercial P Revised 01/07/09 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: PERMIT # f065—O /J70 OWNER'S NAME: ,,' PHONE # % -- GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: G CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CU ERTINO BUSINESS LICENSE. �7 I am not using an subcontract s: - a ' ' Y Signature Da& Please check applicable subcontractors and complete i he following information: Owner / Contractor Signature Date 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