06040072 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON�?TRACTORIN�NF0RMATI0N ,
M1Y,33! ,t<eID+%ufr'Yh �LS.e�*Caa.,15..WRT..d'J-mY k
BUILDING ADDRESS: GENMOR PLUMBING PEAMff N006040072
878 BLAZINGWOOD AV
0 W NERS NAME: PERMIT ISSUE DATE
PING YANG 3560 HAIG ST. 42 04 /1 -1 /2006
ONE
SANITARY NO. CONTROL NO.
(408) 855-8348
ARCHITECT/ENGINEER: BUILDING PPA IMINfO
BLDG ELECT PLUMB MECH
0 0 0
+O� LICENSED CON(RACIORS DECIMATION Job Description
u I hc,cby to m til 1 W 1i under Pro W.a!m,Prr+9(Cam z P
Zx" riN Seelig WM of Dlvlma 3afYC Bum.uq Prarc,vanr Code.W my lkc i,
<� Mir todcH jt COOPER REPIPE FROM FALYyE I E&®TING
C.:�qqq� IJu<vd Cru -- - ,8
i2 ARCHITECTS DECLARATION
^
ICU Nun ooi mypW..hJl be urcd.public raortl,
o x n ed P (oro.F OWNER-BUILDER DMAY 115' 20U�
DECLARATION MAY
trmby.11itm N.I 1 un eacmp form tM CmvcraY,Lkmto Taw(at Nc
00 following2 (Salm 70313,Bod�W Pmfeadam Code:Any coy of mmuy
3 a E which r trim,pump to minmz Jkt iotjw w,dctnN'G u repair any+u'cmrtAil $5000
2_Y tb,m k iicc nc pu r to r pordskiO111 fM C otmwl W rlle. Lt. Chw=l
< Nu hculiamN puaUNllo the pmvisbm of Ck Conuatoru l.i¢ns law(Qupu9 Sq.Ft.Floor Area aluation
�� (caomendng WNSutim 7000)ol Divitlon Sar NCBmrru,.nd Profcalau Cadc)a
Yc u•^mpt Ibucfrao and me W W far Ne 9fted 111-pd—My Wal,lim of
alt
Son 70315 by•n1',ppBavt fu,p.il wbjlxu dk,pPBaot to.ci.B pwltf ol C Occupancy Type
.m more tlm nw buodred doll.,,(55011).
0 L.owee,oft Pmpary.m my mvploym"h wags u Cteh MLC core* W'
*Bol°Imw°tk'ndthe'rr"°' btMwwndedWoffedlo,Uk(ke.7 .11rd" RequiredIns Inspections
W Ptof .Code Ile CnC.noft I.3u t,e lav doer not.ppty to,n o r of P
propmr wbo hold,mime t,u to,,,vho dac,ush wink hkWC]fm tbmugb bu
ovv emplayrc,ProWded ow and impro,ervam.m vm in„_.
or ofreW for W�If.
bawac.rhe building m impowaenl u tNd wWN arc yar a—Ploioa.the a mu-
bWbawiBba<ox buten apmint Cut he did not hoMI a knp for gcpo¢of
.k.4
0 L u owmer ol IIY Pmp Y. mnvuing wiN liccavd aaux7m to
mnnmcl Cv po}ct(5a.70ta,Bu.Jnea W Plot=—Code)The Covvalm',(
ceo.law dou vm.pply ban owner ar popeny wha buAl,or iot ow tb m Nd
wbocmv.0 fm wcb pojcw w tbacmvvom(t)1¢ d purra.nt m the Camr el
0 ime lay.
O vonwPt mdu See .Bk PCfm Nu rcuao
Owrc Due
WORKERS COMPENSATION OECUAATION
1 bcmby Corm oo&r Pm Ly a perjury ary a!Ne following&CWxbnt
grim,u p t
NiN,fu by Salim 7700 ol Ne(abar Code,far Ne pCarm.em of the
tort far whkA prmll u umsd
0 I Ww ad w1 mWwbt Wo ,Comp.vWmInw.rau,u o,w dby Sanm .
37m a Ne tabor Code,rm Ne puf000,.aft w for whcll Nu permit u m.—I
My Work e%Campn.dm lafur.va mrtic,nd Policy rumhc,T.
C.. L [�Y(1 Pd'ay No.:0101127 Ir1A I-02
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION WSUILkNCE
I
Ceti,mlm nag nm he camp1m t 0 We ix.u I..bmdmd da.a($100)
or ut)
1 arrifr Wt h We prfmm,va of Nc wort far whlG Nu parch u laced.I Jail vm
cmplmy mYPcaon io.y vuom,to.a berme wbjal m Ne Wark.V Compwom
lm of CJIfOmi,.D,k
NOTICE
NOTICE TO APPLICANT:B,coo nuking W,C ociau of Eaer.pl od ym t,
become,W MP, Ne Wahef.C or dean i%t1u of Ne labor Code.ym mml
.,O farNwiN comply wiN tueh prori,iuru m Nu pamlt trot be dumeE mvakeE.
z2 CONSIR(ICf1ON LENDING AGENCY
I-.14 1 bercby"Ir.m.t dkre u,..arum.kedi-,woc,,,for Cs paformtmee ar
a> IW work rorb tlws mh wt uo. n(Sc 3(777,Ch.C)
Wer A Larddt Nuoc
z • ..N,Ad*rm
UQ itt ry N.,IWwrcW Nu,pp kl nW tbk Nu the Wow b(muomu
II. H corm.I.Fa b comply wiN JI aly ab County ooll.too u cwt mWin(b
OU Willing cmttrmtlan,.rJ hemby.uthmir<mptexautila of Nu 61Y m==upon Ne
r4 ,ho� ou,000ncd pmprty ror impemloo PuRuct
(ft).pee to.w.iroicovu Y aJ Yap bwnt a the City M C.,000.gw=
F'f�j lubilwq,jodtrvcnu,tato uqupa.m wbW ary lo.nynyaarm,gJ.tvid Gly .
U 2 iacroscgterucaroegrmti.ga(Nupennit
APPLICANT UNDERSTANDS AND.WILL COMPLY WITH ALL NON-POINT Issued by: Date
- SOURCE REGULATIONS. ( '
Il (rc1Mr��n A �oez `/�i¢�Jb Re-roofs
Sig..of AppliunUCo.1or IJ D.k
HAURDOUS MAIER3AIS DISCLOSURE Type of Roof
Will Ce,ppliaa or rrmuh
c btt op oavPW sac m btto t ha,Am,m.rri,i
L
deBrrd by Cc Copnim Mu ,l Code.CL.pu 9.12,M 1K H aJ Sfety
Codc.Sc 25531(07” All roofs shall be inspected prior to any roofing material being installed.
[]Y. �.- _I?Na
Wul ft .forma baimint oo a ,. yJpmem or dc. w h If a roof is installed without firs[obtaining an inspection,I agree to remove
cmh h..Nma sur conumlowu a moots by Nc Bay Aru Air Qu,lily M,n.gcmcnl all new materials for inspection.
Ouukt'
❑Yu � biro .
Ilonerrd thehoodoo 255.. 55331 23534.1ofNeGfifm-
nuHOIN&Saf1 Cade.Snvoru U.103.23533a h11i.1urldvaIY 0=W taft
door nrtcffft
mly Ww,roan.mu ilv my tupmmhlily b vodfY Ov aanpmlof Nc
rcyai mtwncbmasbemmy�rm`p�man Card 0170x, .. . Signature of Applicant Date
t rc�tntct
0.or <d.T� All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
F Telephone(408) 777-3228
CfTy OF Fax(408)777-3333
OUPEI,TINO
Building Department
JOB ADDRESS: PERMIT #
vooc� 060`7 007
OWNER'S NAME: cnC, PHONE #
GENERAL CONTRACTOR )en FAX #
I am not using any subcontractors: � k cN n in L—Oct
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
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
Tile
1 k
Owner/Contra for Signature Date
i
CITY OF CUPERTINO
06m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36917020 . 00
DATE ISSUED. . . . . . . : 04/13/2006
RECEIPT # . . . . . . . . . : 33976
REFERENCE ID # . . . 06040072
SITE ADDRESS . . . . . : 878 BLAZINGWOOD AV
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PING YANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : SAN JOSE CA, CA 95129
RECEIVED FROM . . . . : GENARO MORALES
CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101
COMPANY . . . . . . . . . . : GENMOR PLUMBING
ADDRESS . . . . . . . . . . .. 3560 HAIr ST. #2
CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054
TELEPHONE . . . . . . . . : (408) 855-8348
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------- ---------- ---------- ------- ------- ----------
BPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
TOTAL PERMIT 47 . 37 0 . 00 47 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-- - -------------- ------------ ------ -----
CHECK 47 . 37 1268
TOTAL RECEIPT 47 . 37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
______----------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
-
CITY OF CUPERTINO
PREPIPE/SEWERS/1VIAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
APN# �)� 1-1
-1— 11x7— Date:
Building Address: e q� �� 0
c ( Ca C? 4 r
Owner's Name: Phone #:
�iW lk 4 4 - 26
Contractor: 1i Phone: License#:
o g�'�T61
Contact: Phone: p Cupertino Business License #:
C., e
Building Permit Info: . f
Bldg ❑ Elect ❑ Plumb lJ
Job Description:
Residential _ Comme is ❑
Cost of Project: �o
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Ga:Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS ?Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•