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09070005 CITY OF CUPERTINO f: BUILDING DIVISION PERMIT � TkE, T� BUILDING ADDRESS: PERMIT NO. 22423 RAMONA CT PREMIER PLUMBING OWNER'S NAME: INC PERMIT ISSUE DATE 2009 TONE: S A CONTROL NO. (408) 903-8184 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a 0 0 0 u O p LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z U with Section 7000)of Division 3 of dte Business and Professions ode,and y license is y infunforce and effec M COPPER RE—PIPE FROM HOUSE SHUT OFF THROUGH ENTIRE ? License Lic.g +F DateContractor HOUSE. REPLACE WATER HEATER. ARCHITECTS DFCLMWrIW I understand my plans shall be used as pubic records X06 O Licensed Professional OWN ER-BUILDER DECLARATION H I hereby affirm that 1 'm exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county 429 which requires a permit to convect,alter,improve,demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation yF $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 6 O O 0 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 35701Q90. 00 ❑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 sale(Sec.7044,Business Required Inspections and Professions Code:The Conuactoes License Law does not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). [11.as owner of the property.am exclusively contracting with licensed contractors to convect the project(Sec.7044,Business and Professions Code:)The Contractor's Li- ccnse Caw does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. C]I am exempt under Sec. B&P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- &tion,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's C��iipe�nsation In�su`"ce carrier and Polity�n/y,pther,are: Cartier. �C L�L ce Policy No.y CERTIFICATE OF EXEMPTION FROM WORK RS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 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 Workers'Compensation Laws of California.Dao Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z 2 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.Q (Ll Q Lender's Name aLender's Address U 0 1 certify that I have read this application and state that the above information is LL cored I agree to comply with all city and county ordinances and state laws relating o Vbuilding convection,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. CL (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / (' SOURCE R GULATIONS 7y" Re-roofs Si onuaclor Dao T of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cede,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building occupant use equipment or devices which If a roof i;;installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? 0Yes Q 1 have mad the hazardcws mucrials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building does not current have a tenant that it is my responsibility to notify the occupant of the requiremcn c must be me 'rtoi a tcnrOccupancy. Signature of Applicant Date 0 u lnorizedagent Da,c All roof coverings to be Class'W'or better CITY OF CUPERTINO 7 ITEMS OF 7 PERMI" RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN 35"01090 . 00 DATE ISSUED. . . . . . . : 07/01/2009 RECEIPT #. . . . . . . . . BS000008094 REFERENCE ID # . . . : 09070005 SITE ADDRESS . . . . . : 221:23 RAMONA CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER KULDEEP KARLCUT ADDRESS 22623 RAMONA CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JOSE MENDEZ CONTRACTOR . . . . . . . : JOSE MENDEZ LIC # 30877 COMPANY PREMIER PLUMBING AND REPIPE IN ADDRESS 1725 ROGERS AVE STE C CITY/STATE/ZIP . . . : SAI7 JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 903-8184 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 000 . 00 1 .00 0.00 1. 00 0 . 00 1BPWATER UNIT 1. 00 42 . 00 0. 00 42 . 00 0 . 00 1BSEISMICR VALUATION 6, 000. 00 0 . 60 0 . 00 0 . 60 0 . 00 1PPERMITFE FLAT RATE 1. 00 42 .00 0 . 00 42 . 00 0 .00 1PRREPIPE NO OF FIXTURE 6 . 00 66 . 00 0 . 00 66 . 00 0 . 00 1PRWHEATR UNITS 1. 00 24 .48 0 . 00 24 .48 0 .00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 218 . 08 0. 00 218. 08 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 218 .08 MASTERCARD --------------- TOTAL RECEIPT 218 . 08 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING