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09070170CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10204 BRET AVE OWNER'S NAME: URS MADER '.R'S PHONE: 4082537002 ❑ LICENSED CONTRACTOR'S DECLARATION License Class L (o Lic. k kis-A". A.", �--•� Date Contractor 1 hereby affirm that 1 am licensed 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. 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. 1 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 ay accrue against said City in consequence of the granting oft is it. ddi tonally, the applicant understands and will comply with all non- so re lations per the Cupertino Municipal Code, Section 9.18. 7 I hereby affirm that 1 am exempt from the Contractor's License Law for one of 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 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 exemption, I 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 i• iify and keep harmless the City of Cupertino against liabilities, judgments, co 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 CONTRACTOR: ALLSTAR PLUMBING PERMIT NO: 09070170 26 PHELAN AVE DATE ISSUED: 07/27/2009 AN JOSE, CA 95122 PHONE NO: (408) 230-5569 BUILDING PERMIT INFO: BLDG ELECT r— PLUMB MECH r RESIDENTIAL r COMMERCIAL r— .1013 DESCRIPTION: PROPERTY LINE CLEANOUT/SPOT REPAIR `EWER LINE 1�q. Ft Floor Area: I i►PN Number: 3751103 ` * � Occupancy Type: ' t PERMI'1PIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM AST CALLED INSPECTION. Issued by:Z"."y 0'J*2C% Date: 7,2-7,07 RE -ROOFS: ,d] roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. `signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain i ompliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & `safety Code, Section 25532(a) should I store or handle hazardous material. ►dditionally ould I use equipment or devices which emit hazardous air onta in s a defined by the Bay Area Air Quality Management District 1 will i4;1eal iin mph wt h the Cupertino Municipal Code, Chapter 9.12 and the I & feode ections 25505, 25533, and 25534. i ed agent: Date: e CONSTRUCTION LENDING AGENCY 1'5 here affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional 5 ITEMS OF 5 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37511034.01 DATE ISSUED.......: 07/27/2009 RECEIPT #.........: BS000008273 REFERENCE ID # ...: 09070170 SITE ADDRESS .....: 10204 BRET AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER URS MADER ADDRESS 10204 BRET AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: JOSE ALVAREZ CONTRACTOR .......: DUP.RTE TADEV LIC # 22189 COMPANY ..........: ALJ -STAR PLUMBING ADDRESS 326 PHELAN AVE CITY/STATE/ZIP ...: SAE JOSE, CA 95122 TELEPHONE ........: (4C8) 230-5569 FEE ID UNIT QUANTITY PMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 3,600.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 3,600.00 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 ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 106.50 --------------- 106.50 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 507 FINAL PLUMBING REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 202 UNDERFLOOR PLUMBING 400 SEWER/LATERAL CITY OF CUPERTINO __. REPIPE/SEWE_R/MAIN SERVICE CUPEi�TINO PERMIT APPLICATION FORM Quantity Date: :ZelAPN# Z7 �y Building Address: Owner's Name: Phone r O,�,-*_ �c� �7..�3 CCS Contractor: Phone #: oFj 2__ //J 14� fit Fax #: Contact: Phone #: Cion 92-1 1PGASCOM Fax #: Contractor License #: 7,3 2(�, / Cupertino Business License #: Z -2— q 1BCBSC Job Description: .G��c�i/ Z, _/e B ALL PERMIT TYPES Residential P<D Commercial ❑ Valuation: G, ori, Seismic Comm(rcial 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 & ,'he sheet index. Green Building Points: Revised 01/07/09 Quantity Fee ID Fee Description Fee Group Permit Type 1PCSEWER Commercial building sewer/sanitary s -1wer P 11CPSS 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1PGASCOM Commercial Gai Piping System 1-4 Outlets P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICOM Seismic Comm(rcial P Revised 01/07/09 q110 CUPERTINO CITY OF CUPERTINO REPIPE/SEWERRNUIN SERVICE FEE SCHEDULE Quantity Fee ID Fee Description. N, Fee Group Permit Type / 1BCBSC Cal Bldg Standard: Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential P i 1PRSEWER Residential building sewer/sanitary sewer P 1RPSS 1PRREPIPE Residential re -pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Di:>posal System P 1 PCESS Cesspool P 1 BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Pi;:)ing System 1-4 Outlets P 1 BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Chick P 1PLMBINSP Other Plumbing/g�.s Insp. P I j 1TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B