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10040043 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18911 TUGGLE AVE CONTRACTOR:ALLSTAR PLUMBING PERMIT NO: 10040043 OWNER'S NAME: LOVANN FLAUGHER 326 PHELAN AVE DATE ISSUED:04/07/2010 r"'NER'S PHONE: 4087251372 SAN JOSE,CA 95122 PHONE NO:(408)230-5569 JOB DESCRIPTION: RESIDENTIAL F1 COMMERCIAL El U LICENSED CONTRACTOR'S DECLARATION GAS LINE RELOCATE r} f¢ VL&&C.— S Q-� License Class Lic.# ��/ Contractor ate_ I hereby affirm that I am licensed under the provis�ons 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. Sq.Ft Floor Area: ua n:$1200 I hereby affirm under penalty of perjury one of the following two declarations: t. I have and will maintain a certificate of consent to self-insure for Worker's APN Number:37533064.00 `-:i%, Occupancy Type: Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 2. 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 thisPERMIiF WORK IS NOT STARTED permit is issued. WITHI�O,11XAYS OF PERMIT ISSUANCE OR APPLICANT CERTIFICATION 180 DAYS FRbM LAST CALLED INSPECTION. 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 Issued-bf. Date: 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 y accrue against sai City in consequence of the RE-ROOFS: granting of this permit. ditiopally,the t understands and will comply with All roofs shall be inspected prior to any roofing material being installed.If a roof is all non-point source r ulati s per up o Municipal Code, ection 9.18. installed without first obtaining an inspection,I agree to remove all new materials for Signature Date inspection. Signature of Applicant: Date: I— O ER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I icreby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: HAZARDOUS MATERIALS DISCLOSURE 1. 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 I have read the hazardous materials requirements under Chapter 6.95 of the sale(Sec.7044,Business&Professions Code) California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain 2. I,as owner of the property,am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& construct the project(Sec.7044,Business&Professions Code). Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will 1. 1 have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation,as provided for by Section 3700 of the Labor Code,for the Health&Sa Code,Se '0 5505,25533,and 25534. performance of the work for which this permit is issued. Ow_Or hor' g t: 2. I have and will maintain Worker's Compensation Insurance,as provided for by Date: Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. CONSTRUCTION LENDING AGENCY 3. 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[o become subject to the Worker's I 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.) Compensation laws of California. If,after making this certificate of exemption,I Lender's Name 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 Lender's Address revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I understand my plans shall be used as public records. 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 Licensed Professional 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, c^ and expenses which may accrue against said City in consequence of the ig of this permit.Additionally,the applicapt understands and will comply with an .on-point source regul ns per the upe ' o Municipal Code,Section 9.18. Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37533064. 00 DATE ISSUED. . . . . . . : 04/07/2010 RECEIPT #. . . . . . . . . BS000010118 REFERENCE ID # . . . : 10040043 SITE ADDRESS . . . . . : 18911 TUGGLE AVE SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LOVANN FLAUGHER ADDRESS . . . . . . . . . . : 18911 TUGGLE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DANIEL VENTURA CONTRACTOR . . . . . . . : DUARTE TADEV LIC # 22189 COMPANY . . . . . . . . . . : ALLSTAR PLUMBING ADDRESS . . . . . . . . . . : 326 PHELAN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95122 TELEPHONE . . . . . . . . : (408) 230-5569 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1,200. 00 1. 00 0 .00 1. 00 0. 00 1BSEISMICR VALUATION 1, 200 .00 0 .50 0 .00 0 .50 0.00 1PGASRES OUTLETS 1.00 63 . 00 0 .00 63 . 00 0. 00 1PPERMITFE FLAT RATE 1 .00 42 .00 0 .00 42 .00 0.00 1TRAVDOC FLAT RATE 1.00 42 . 00 0 .00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 148 .50 0 .00 148 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 148.50 VISA --------------- TOTAL RECEIPT 148.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM Date: //--7 Building Address: Owner's Name: Phone 7Z l' Co ac or: Phone / W ��—/—C,C)er L Fax #: ontact Phone#: _X�Ct Fax#: Contractor License#: Cupertino Business License#: Z- Description: Residential Commercial ❑ Valuation. /Ze,-�6---, Project Size: Express Standard Large Major Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1 PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 av-1-1 CITY OF CUPERTINO REPIPUSEWERIMAIN SERVICE CUPEk iNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Grou 1BCBSC Cal Bldg Standard-7 s Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or :::: - 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P IBPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P / 1 PGASRES Residential Gas Piping System P 1-4 Outlets IBPGAS Gas Piping System 5+ Outlets P IPPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P IPLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B 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: PERMIT# OWNER'S NAME: r . PHONES GENERAL CONTRACTOR: cc y BUSINESS LICENSE# ADDRESS: P CITY/ZIPCODE: *Our municipal code requires all businesses w rking in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPAN Y INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR ANDEE NTRACTORS AVE_OBTAINED A;;T ERTINO BUSINESS LICENSE.I am not using any subcontractors: gna re Please check applicable subcontrmplete the following information: 7V ] SUBCONTRA�CTOR � 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