07100097 CIT�' OF CUPERTINO ` ` 7�,� T
RUILDIN(:�DIVISION PERMIT �������������
. ,:: . • ;;.. ,; . ,.,. .. _
— PERMIT NO.
BUILD � HAVEN CT GENMOR l�LUMB ING 0 710 0 0 9 7 �
PERMIT LSSUE DATE
OWNER'S NAME: ,
LIU MING S AND GRACE C 3560 HA: ST 10 12 2007
SANITARY NO. CONTROL NO.
NE:
(408) 85`i-8348
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG EI.ECT PLUMB MECH
� � � 0
i p � LICENSED CONTRACTOR'S DECLARATION JOb DeSCiIpLlOi1
i U�j 1 hcrc6y aCfirm that I am liccnscd undcr provisions oC Chaptcr 9<rnmmcncine
; Z� wiih Scction 700U) of Division 3 0( ihc Busincss and Profcssiuns Code and my Iicensc is C O P P ER ] tE P I P E
�� y in full Corcc and eCf c� ��
� v� Z Licensc 1 s �— L�. x
; F �p pa� Contractar
�� ARCHITEC["S DEC ATION
) a 6 1 undcrs�and my pians shall bc used u public rccords
)yU
' w y Lieensed Pro(cssional
: � a OWNER-BUILDER DECLARATION
'r � f hcrc6y affirm ihat 1 am cxcmpt from ihc Camractor's Liccnsc Law far thc
� p O following rcason. (Sccuon 7031.5, Busincss and Profc.csions Catc: Any ciry or counry
�,°, � which rcquires a permit to cnnswct, altcr, improve, dcmolich, ar repair any swcturc
° Z y prior w ils issuancc, also ccquires �hc applicant Cor such permit ta file a signed stalemrnl �' Ft. Floor Area Valuation
< that hc is liccnscd pursuant to thc provisions o[ thc Conuactor's Licensc Law (Chaptcr 9 • � 8 3 O O
,� t- $(commencing wiih Scction 7000) of Division 3 of ihc Busincss and Profcssions Cadc) ur
y�.. that he is exempt therefrom and ihe bssis for the allegcd exemption. Any violaUon o(
Section 7031.5 by a�ry applicant for a permit subjccu Urc applicant w a civil penalty of ,_ p�$1 Number Occupancy Type
not morc than C�vc hundied dollars (5500)• 3 5 6 11 � 4.)
� 1, u owncr oC tt�e property, or my croployces with wagu u their solc compensation,
willdathcwork.and�hesuuctureisnotintcndcdorofferedfarsalc(Sec. Required Inspections
and Pro(essions Code: The Conuacwr's License Law docs not apply to an owner of
property who builds a improva thereon, and who does such work himself or tlwugh his
own employces, provided that such improvemenLC are not in�ended or otLered for sale. If.
however, the building or impmvement is sold within ane year of completion, tlie owner- ,
buildw will have the burden oC proving tAat he did not build or improvc (or pmpose af
�,�,. C�� �. C-C-�
❑ I, as owner of the properiy. am ezciusively conuacting wi�h licensed convactnrs w
conswct the project (Sec. 7044. Business and Pro[cssions Code:) The Ca�trx�wr's Li- �� � �� J�
cense Law does not apply w an owner of propeny who builds or improves IheROn. and ,
who contracu Cor such projecu with a conuactor(s) licensed pursuan[ to the Contrxror's
Q 1 am ezempt under Sec. . B dc P C for �his rcasaa l ��a ' - f
Owner Date ` ''� ....�j �. . , ! G f f ✓ � , � y
WORKER'S COMPENSATION DECLARATION `�_..._ � � ; � s -' � ti _3" �
.. � ,� �,.': . .'..F i �! !
I hereby aCfirtn under penalty ot perjury nne o( �he following declarations: ���� � r � �� �� i � � �;
�] 1 hsve and will maintain a Cenifcatc of Consent to sel(-insure far Workcts Compen-
"..1 �. ��
satian, as provided for by Secuan 3700 of the Labor Code, for the performance af drc ,
woric for which Ihis pertnit is issucd.
�havc and wiU maintain Worker's Compensation Insunnce. az �cquired hy Scction . �� ��i����� �`�j�i//) � ���
3700 of ttic Labor Codc, Cor thc performancc of �he worlc for which this permit is issued• L'
My Worke�s Compensation InsunMe rtier Policy n r a�c:
r�
Carrier. licy No.:
CERTIFlCA OF PI70N FROM WO ERS'
COMPENSATION 1NSURANCE
(fhis section need noc bc completcd i( the pertnit is Ru onc hundred �itazs (5100)
or IcssJ
I cenify ihxt in thc performancc of thc work for which ihis permit is issucd. I shall not
e:aploy any persan in any manner so u to become subject to �he Workers' Compensadon
Laws of Califomia. Datc
Applicant
NOTICE 7'O APPL.ICAM: If, aftcr making this CcniCcatc of ExcmpGan, you shoulJ
become subject to the Worker's Compensation provisions of Ne Lalwr Code, you muu
� O forthwitA comply with such provisions or this pecmit shall bc dccmcd rewkcd.
Z "" CONSTRUCTION LENDING AGENCY
(� � I hcsby alrrm �hat thcre is a conswction Icnding agcnry Cor thc perfortnancc of .
�, � thc wurk fur which this permit is issucd (Sce. 3097, Civ. C.)
W Q Lendcr's Namc
j z Lende�s Address
U � I ccrtiCY iha� I havc rcad this application and stam that thc above inCortnatiu� is
w ►� cortcct. I agrce to comply with all city and county orclinances and sta�e laws rclating �o
O U building conswction, and heteby authori�e reprcsenta�ives of ihis city to enler upon lhe
� W abovc-mcmiuned property (or inspccdon purposes.
a (We) agrce to save, indcmni(y and kecp harmless thc City of Cupcnino against
„F", � liabiliues, judgmcnLS, costs and ezpenscs which may in any way accruc againsl said City
U z in consequenc aC tAe granting of �his permit. Date
►-� APPLICAN'f�JNDERSTANDS AND W1LL COMPLY WITH ALL NON-POINT Issued by:
SOURCE I�GrJLATlONS.
U L ���,, rA l ldl� 6� Re-roofs
Signawre of Appli Conuxtor �°� T e of R�of
HAZARDOUS MATERIALS D[SCLOSURE }�p
Will the applicant ar futurc building occupant storc or handlc ha•rardous matcrial
u dcfincd by the Cupenino Municipal Codc. Chaptcr 9.12, and thc Hcalth and Safcty
c� Scction 25532(a)? � All roofs :�hall be inspected prior to any roofing material being installed.
❑ Y� .
Will thc applicant or futurc building occupant usc eyuipmcnt ar dcvias which
If a roof i:: installed without first obtaining an inspection, I agree to remove
.�nit harardous air coniaminan�s as dcfincd by the Bay Arca Air Qualiry Managcmen� all new m aterials for inspec;ion.
a5u���?
❑ Ycs g�90
1 havc rcad �he ha�ardous maicrials rcyuircmcnts undcrChap�cr 6.95 of �hc Califor-
nia cal�h & Safcry Codc, Secuons 25505.25533 and 25534. I undcrsnnd �hat i[ thc building
d not curren�ly havc a �cnant, at it is my responsibility to notify thc occupant nf thc
yu men�s which musi be mel p or to issuance of a Ccnifica�c of Oc �ry. Signature of Applicant Date
\ � � All roof coverings to be Class "B" or better
Owncr or hori¢cd agcnt Datc
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: suew
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35611045.00
DATE ISSUED.......: 10/12/2007
RECEIPT #•••••••••: BS000002983
REFERENCE ID # •••: 07100097
SITE ADDRESS .....: 925 NEW HAVEN CT
SUBDIVISION .......
CITY .............: CUFERTINO
IMPACT AREA .......
OWNER ............: LIL MING S AND GR.ACE C
ADDRESS ...........
CITY/STATE/ZIP ...: CUFERTINO CA, 95014-4023
RECEIVED FROM ....: GENMOR PLLTMBING
CONTRACTOR .......: GEI�ARO MORALS LIC # 27101
COMPANY ..........: GEnMOR PLUMBING
ADDRESS ..........: 3560 HAIG ST
CITY/STATE/ZIP ...: SAI�TA CLARA, CA 95054
TELEPHONE ........: (4C8)855-8348
FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 8,300.00 158.76 0.00 158.76 0.00
BPFIXTURE LTNITS 13.00 117.00 0.00 117.00 0.00
BPREPIPE NO OF FIXTURE 1.00 9.00 0.00 9.00 0.00
BPWSVCS WATER SERVICE 1.00 9.00 0.00 9.00 0.00
BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00
PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 441.55 0.00 441.55 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 441.55 1157
---------------
TOTAL RECEIPT : 441.55
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
� CITY OF ��UPERTINO
:� ' REPIPE/��;�����`ti�/MAIN SERVICE
CUPEI�TINO PERMIT APPI,ICATION FORM O �/�9I
APN # � JC l // � � Date:
�P
Building Address: � � �, 1
�� � � �
Owner's Name: Phone #:
� � 2 _ . 2��
Contractor: Ph ne: License #:
�' -- �► �3 - �
Contact: Phon : Cupertino Business License #:
��{��8 c�SS � 3
Building Permit Info:
Bldg � Elect ❑ Plumb �
Job Description: �
Residential � Commerc'al
Cost of Project: �
���
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE F ldg. Permit Fees BUILDING
BPGAS C'�as Pi ing System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE R epipe of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS l�iain Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Eusiness License BUILDING