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10010043 I CITY OF CUP ERTINO BUILDING PERMIT 010043 CONTRACTOR:SAS ROOTER&PLUMBING PERMIT NO. 10 SS: 10010 SCENIC BLVD DATE ISSUED:01/11/2010 BUILDING ADDRESS: 33709 12TH ST PHONE NO:(510)468-8436 0,"ER'S NAME: CHERYL&WALTER SHEPARD UNION CITY,CA 94587 NER'S PHONE: 4082552765 G ELECT� PLUMB ONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLD •, CIAL 0 LICENSED C COMMER (p Lic.# �- � MEC RESIDENTIAL License Class � 4t , JOB DDate � ESCRIPTION:WATER LINES,1tEpIPE&WATER MAIN LIN Contractor ter 9 REPLACEMENT I hereby affirm that I am licensed under the provisions3 of the Bus Hess&Professions of (commencing with Section 7000)of Division Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: and will maintain a certificate of consent to self-insure Code,for the for Worker's I have Section 3700 of the Lab Compensation,as provided for by Valuation:$6000 performance of the work for which this permat.is Insurance,as provided for by Sq.Ft Floor Area: I have and will maintain Worker's Compensation of the work for which this Occupancy Type: Section 3700 of the Labor Code,for hep APN Number:35709052.00 permit is issued. APPLICANT CERTIFICATION STARTED I have read this application and state that theaboveand state laws relating WORK IS NOT I certify that with all city and county ordinancesto enter PERMIT EXPIRES IF correct.I agree to complyand hereby authorize representatives of this city YS OF PERMIT ISSUANCE OR to building construction, We agree to save .WITHIN 180 DA for inspection purposes. ( ). g upon the above mentioned property ertino against liabilities,judgments, NI LAST CALLED INSPECTIO • p harmless the City of Cup 180 DAYS FROM indemnify and keep in consequence of the costs,and expenses which may accrue against said City is pe"it. Additionally,the applicant understands a Code,Sectpon Date: granting of h p " per the Cupertino Municipal with all non-poin 'sburce regulati s p Issued by: 9.18. Date 1 Signature RE-ROOFS: installed.If a roof is cted prior to any roofing material being OWN DECLARATION All roofs shall be inspObtain ng an inspection,I agree to remove all new materials for rn t from the Contractor's License Law for one of inspection.alled ithout firs I hereby affirm that I am exempt two reasons, Date: the following or my employees with wages as their sole compensation, Applicant: 1,as owner of the property, Signature of will do the work,and he structure is not intended or offered for sale(Sec.7044, All R BETTER Business&Professions Code) con with licensed contractors to ALL ROOF COVERINGS TO BE CLASS��A 1,as owner of the property,am exclusively co g construct the project(Sec.70445 Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE three penalty of perjury one of the following 6.95 of the I hereby affirm under p , Sections 25505,25533,and 25534. I will maintain Worker's I have read the hazardous materialsrequirementsunderChapter declarations: California Health&Safety Code,S Chapter 9.12 and the Health and will maintain a Certificate ti Consent f self-insure borCode,for he with the Cupertino Municipal Code, zardous material. I have Section 3700 of he La compliance wit Compensation,as provided for by should I store or handle a Safety Code,Section 25532(a) provided for by should I use equipment or devices which emit hazardous air performance of the work for which this pensation Insurance,is issued. as p Additionally, Ba Area Air Quality Management District I will I have and will maintain Worker s Compe contaminants as defined by the y ter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this maintain compliance with the Cupertino Municipal and 25534e'Chap permit is issued. this permit is issued,I shall Health&Safety Code,Sections 25505,25 I certify that in the performance of the work oast for subject to the Worker's wn r authorized a I I I U not employ any person in any manner O Date: laws of California. If,after making this certificate Labor Code, must Compensationf ex provisions of th become subject to the Worker's Compensation p CONSTRUCTION LENDING AGENCY 1 with such provisions or this permit shall be deemed revoked. a enc for the performance of work', forthwith comply I hereby affirm that there is a construction issued(Sec. 097,Clending g APPLICANT CERTIFICAThOa above information is for which his permit is application and state that Lender's Name I certify that I have read this all city and county ordinances and state laws relating correct.I agree to comply authorize representatives of this city to enter and hereby agree to save Lender's Address to building construction, for inspection purposes.(We) upon the above mentioned property of Cupertino against liabilities,judgments, and keep harmless the City consequence of the ARCHITECT'S DECLARATION unify a p accrue against said City in q and expenses which may laps shall be used as public records. his pe source Additionally,the applicant understands and will comply granting of p regulations per the Cupertino Municipal Code,Section I understand my p with all non-poi i source reg Licensed Professional 9.18. Date� Signature CITY OF CUPERTINO atg OPERATOR: P PERMIT RECEIPT COPY # 1 7 ITEMS OF 7 Sub: Blk: Lot: Sec: Twp: Rng: • • . • , 35709052 .00 APN • 01/11/2010 DATE ISSUED. • • • • " BS000009530 RECEIPT #• ID' #' � � � ; 10010043 REFERENCE 10010 SCENIC BLVD SITE ADDRESS SUBDIVISION • : : : : : : : CUpERTINO CITY • • • • IMPACT AREA • • • • • • • • „ ; CHERYL & WALTER SHEPARD OWNER • • • " ' ; 10010 SCENIC BLVD ADDRESS • • " " • CUPERTINO CA, CA 95014-2725 CITY/STATE/ZIP • • • - SAS ROOTER & P R,.I,�B SARMI ENTO LIC # 28153 RECEIVED FROM SEBASTIAN ALBS CONTRACTOR SAS ROOTER & PLUMBING COMPANY ; 33709 12TH ST 94587 ADDRESS • • • " ' ; UNION CITY, CA CITY/STATE/ZIP • : ; (510) 468-8436 TELEPHONE THIS REC NEW BAL - IT QUANTITY -AMOUNT--- ---------PD-TO-DT- --------oo ----- 0 . 00 FEE ID ---------- 1 . ------- 1.00 0 .00 0 . 00 _-------- --- 6, 000 .00 0 .00 42 .00 0 . 00 1BCBSC VALUATION 1 ,00 42 . 00 0 .00 21 . 00 0 . 00 UNIT 21. 00 0 .60 iBPWATER 1. 00 0 .00 0 .00 iBPWSVCS WATER SERVICE 6 0 .00 000 .00 0 .60 42 ,00 42 . 00 0 .00 1BSEISMICR VALUATION 1 .00 0 .00 11 . 00 0 ,00 1PPERMITFE FLAT RATE 1.00 11. 00 0 .00 42 , 00 1PRREPIPE NO OF FIXTURE 1.00 42 .00 0 . 00 159 .60 0 .00-_-_ ------- FLAT RATE _ _------- ------ 159 .60 1TRAVDOC TOTAL PERMIT : �,I, REFERENCE-NUMBER METHOD OF PAYMENT __--AMO-_____-_ -------- 159 .60 CASH --------------- TOTAL RECEIPT : 159 . 60 VOICE ID DESCRIPTION__- DESCRIPTION PLUMBING VOICE ID ---------------------------- 507 FINAL PL 301 ROUGH PLUMBING CITY O F CUPERTINO AIN SERVICE REP IPE/SEWER/M C,I-,T OF PERMIT APPLICATION FORM CU E TINO Date: APN # T Building ddress: 100ko Phone#: z2r--)� Owner's Name: ti CHC-�?--YL- Phone#: 01�)500-( SCOG Af Fax# Contractor:,5,,, Phone ti(04; (0 Contact: Fax#: Contractor License Cupertino Business License ............. C-- Job escription: Commercial ElResidential Valuation: ....... ...... .......................... MayorStandaj�:]� ii�i Large Pro ❑ ject Size : Express 1,�levant portion of the Green Building Checklist & attach it tothe Green Building: Please complete re the sheet index. application or if applicable, in in plan set & Green Buildin Points: Fee Description Fee Permit Type I Quantity Fee ID Grou 1CPSS 1pcSEWER Commercial building P sewer/sanitarY sewer P 1CPRP IBPREPIPE commercial re-pipe per fixture IPGASCOM Commercial Gas Piping System P 1-4 outlets B L PERMIT IBCBSC Cal Bldg Standards Commission TYPES Fee P SMICOM Seismic Commercial Revised 01/07/09 CITY OF CUPERTINO REPIPEISEWE IN SERVICE clofFEE SCHEDULE n CUPERTINO Fee Permit Type Quantity Fee ID Fee Description Grou • B ALL PERMIT 1BCBS C Cal Bldg Standards Commission TYPES Fee P 1BSEISMICR Seismic Residential P 1RPSS 1 PRSEWER Residential building sewer/sanitary sewer P 1RPRP 1 PRR EpIpE Residential re-pipe per fixture � p 1CPWS or 1BPWSVCS Water Service 1RPWS SEWG Private Sewage Disposal System P IPPR P 1PCESS Cesspool 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets P 1BPGA S Gas Piping System 5+ Outlets PERMITFEE Plumbing Permit Fee Issuance P 1P LMBLNCK Plumbing Plan Check P 1P 1 PLMBINSP Other Plumbing/gas Insp. P VDOC Travel &Documentation Fee B / 1 TRA B 1BUSLIC Business License Community Development 10300 Torre Avenue .` Cupertino CA 9501 408 777 3 : Telephone( ) Yr 777 33 ��. -33 �°� Yom,: Fax(408) w CIT1f OF ..'4,UPE TING �. uildin artment D e ��- � PERMIT # C. JOB ADDRESS. � )o1 0 1-(- :� 0 o�� ,� PHONE # �� OWNERS NAME:�;�-�..�JL, Pr N-�' L- � _ FAX# S i `� `a9 " CTOR CONTRA :�� .'�'-�� .,vM�31= GENERAL �� \1 10 subcontractors: Date I am not using any i afore om lete the f ollowin information: licable subcontractors and c BUSINESS LICENSE # Please check a BUSINESS NAME SUBCONTRACTOR Cabinets &Mi1lwork 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 T' i Date O r Contractor Signature