06070172 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTR'ACTOR�TNk'ORIVIATIa!N
„"v`fr.. to °?Crn`sw3*� a..,,.t.;rr «,
BUILDING ADDRESS: GENMOR PLUMBING PERMITNo06070172
18725 TILSON AVE
OWNER'S NAME: PERMIT ISSUE DATE
.OF
TERY 3560 HAIG ST. #2 Q7/25/2006
ONE: SANITARY NO. CONTROL NO.
(408) 855-8348
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
lop LICENSED CONTRACTOR'S DECLARATION O O
Job Description
mF I Wreby affirm that 1 un Incomes under provuians of Cha ver 9(cmmencing
i r`3 with Section 70(Ib)ofDivision3 of Ne Business and Professions Code.and my lice=is
<h In lull fo,ccand a REPIPE FROM GALV. TO COPPER PIPE. REPLACE WATER
i�z Liems Clus ,-•� Lie.Y x l� C2_I
a
Data Contractor -ice.- _a HEATER
ARCHITECTS DECLARATION
i 1uMcratold my plans shall W used ss public mb
eon
iC.
°off Licensed Prufesswrial
5 OWNER-BUILDER DECLARATION
iI 1 hereby affirm that I am exempt from Na Conmamm's License Low(or the
:O O following reason.(Section TW 1.5,Business and Professions Conic:Any city or county -
:29 which requires a pmmit to construct,after.improve,demolish,or repair any swam
-iy prior at its issuance,ebaa requires the applicant far such permit to BIC a signed sammcm
that he is licensed purtuenno On provisions of dm Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Value 500
i (commencing with Section 7000)of Division 3 of Na Business and Professions Code)or
a $ that W or exempt Nemfmm and Ne basis for the alleged exemption.Any violation of
Section 7071.5 by airy applicant for a permit subjects Ne applicant m a civil penalty of
her mem than five hundred dellen(M). 3 9N1 PI0° C'0 0 Occupancy Type
01,ss owner of On property,a my emmm
employees with wages u their role cpenution, 11 g=ir,..
will do On wort and the suuctum isnot Wonded oraRered fmsale(Sec.70th,Business ( a'. r=
and Pmfesdons Code:The orruscmfa Lt..Law does Out apply m an owner or RNCgUlred Iflap2etl
Property who builds or improves thereon,andwW deassuch work himolfor through his
own employees,provided Oat men improvements sadot inmaded oroRered for sale If.
builder,Ne Wilding ou improvement uah1C within oro year of cn,reve lee.Noe ewoo f
builder will have the Wmcn of proving that W did w,Wild a improve fur purynse of 3
ssle.l. c AUG/'S u
❑1.as owner of thin property,am exclusively Promoting with:)Maed mnuacloss U.
constmct dpmnota(Sec.innano Business;and Professions Cade:)The Cs thercon, nd
echo taw docs not apply loan owner of property who Wilds rs improves Nemon,and. It��IJIry.._,/JJ�/t/yttt7]t� \V'l t\V77
whocontractsLace for such projects with aeonramar(s)Bcenzd pmuans m Ne Cnnuacmrs
License Caw.
❑1 am exempt under Sec .B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 boo by affirm under posalty of perjury nm of the following declarations:
I baro and will maintain•Certificnm.(Coment In self-Insure for Wor em's Compen.
taboo,as provided for by Secdun 3700 of the Labor Code,far IW perrormance of IW
work for which Nis permit is issued.
have and will mainain Workers Compensation Insurance,an,required by Section
3700 of the Labor Code.for Ne performance of On work for which this permit is issued. '
My Wor escorts mad" Car scatp(_u a�Q pecpoylicy number a re:
Cartier OY(� fQYK r�'C Polrryl9o.: QR21']
CERfIFICATEOFEXEMPION FROMWOPKERS'
COMPENSATION INSURANCE
flTuaemloh oecd am W completed if the permit Is Parona WndrrA dollen(SIM)
m lass.)
I ceniN than in Ne performance of the work for which this Penni,is issued,I shall our
employ any person in any manneran as to Wcome subject in Ne Werke,i Compensation
Taws of Califorrua.Dam
Applicant
NOTICE TO APPLICANT:If.after making Nis Cenifiesen of Exemption,Phu should
Eccomm N
e subject e Worker's Compression provisions of the Low,Code,you ho u
wJ C) forthwith comply with such provisiam or this permit shall W Canted rewked.
CONSTRUCTION LENDING AGENCY
r
[-+ IWrcbycOm Nat thertuaed(Secti30 len ding agemy for the performanc of
6i theLo work for which this permit is issued(Sec.7097,Civ.C.)
a Q Undoes Name
7 Z Lcndefs Address
U C) I certify that I have sed this application and sate WI Ne a Wve information is
(L F correct.I agree to comply with all city and county ordinances and state laws relating to
rJU building eonurvcrion.and hereby authomerepsesenmiveS Of this City 10 enter uPnn the
W move-mentioned pmPcny for insikcuon pu,poses.
Fgy (We)agree m save,indemnify and LOOP harmless IW City of Cupertino against
rq liabilities.judgments.costs and expenses which may in any way acerae against said City
L1 Z in emnegaonec of the granting of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS, r.6
stgrauum•oaf AAppl Pvcontrkw — Data Re-roofs a^�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof - t
Will than applieurt or future Wilding occupant store erhandle hanNo e,material
as,defined by the Cupertino Municipal Code.Chapter 9.12.and to Health and Safety
Code,Section 255320)? All roofs shall be inspected nor to an roofing material being installed.
40 Will the appliaanl o,future Wilding occupant um equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove
emit haxasdnus air conumimmusi in defined by IW Bay Arca Air Quality Management all new materials for inspection.
Drainer'
❑Yet �1&
I have read the haaarNmsmamrials requirements under ChaPm,b.95 o(Ne Califon
nix HcalN&Safe„Code.Secdrns25505,25533 sort Z5534.lundenaod NatifNe Wilding
does not curonthy have•h un4 that it is my responsibility in mdfy Na occupant of On
requirements which must be mel pd.,Io ismanee ofa Cadiricem of aerpaany. Signature of Applicant Date
—` AXW-'r' fn All roof coverings to be Class°B"or better
Owner ur authmrirrd agent Oa¢
CITY OF CUPERTINO
!em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Elk: Lot :
APN . . . . . . . . : 37518001 . 00
DATE ISSUED. . . . . . . : 07/25/2006
RECEIPT # . . . . . . . . . : 35378
REFERENCE ID # . . . : 06070172
SITE ADDRESS . . . . . : 18725 TILSON AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : YUCHI TERY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : GENMOR PLUMBING
CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101
COMPANY . . . . . . . . . . : GENMOR PLUMBING
ADDRESS . . . . . . . . . . : 3560 HAIG 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
-------- -- ------------- ---------- ------ ---- ---------- --------- - ----------
BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BPWHEATER PER HEATER 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BSEISMICRE VALUATION 3 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 ) 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
--------- - - - -- ------ ---------- ----------
TOTAL PERMIT 170 . 26 0 . 00 170 . 26 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - - - - - - - - - -- ---- ------------ -------- - ---------
CHECK 170 . 26 2025
TOTAL RECEIPT 170 . 26
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
•
° Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
46UPEkTINO
Building De artment
JOB ADDRES: T' ��Un PERMIT #
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation
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
•
Owner/Contractor Signature Date
( - CITY OF CUPERTINO W07W2-
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
N# 1 ^16 4_ 001 Date: ��
Building Address: r rJ U Mailing Address (if different from building address):
Y� Q
Owner's Nanle: Phone#:
ontractor: License#: 3 q
Contact: Pon : Pm�g)t� upertino Business License#:
Fax:
Building Permit Info: ��� v,rn
Bldg El �e\QCe Elect C3-- Plumb F�f' Mech G'
Job Description:
Residential V Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancyroup
— 1
Typ o struction: Please check this box if the project is a
Z1W second-story addition: ❑
roject Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
I of 3
i CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interce t6f PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfrn MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform FixtureWELECTRICAL
BREMPOWER Power Device/Apparatus
BREMRECEPT Rc tl, Switch & Outlets
BREMRELOCA Relocation of HoodL
BREMREPALT Re air/Alter HeatingL
BREMRESAPP Remodel Res Appliance
2of3
sp�s CITY OF CUPERTINO
an"oF PERMIT APPLICATION FORM
CUPERTINO
uantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical sq. foot MECHANICAL
MPERMITFEE Mecb Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Faro PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
•
3 of 3