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07090152 CITY OF CUPERTINO BUILDING DIVISION PERMIT �IRA +C)IZ � �IQN' BUIL ES PERMIT NO. ""INTIbENDERGAST AVE SAS ROOTER & PLUMBING 07090152 OWNER'S NAME: PERMIT ISSUE DATE CAROL MATTSSON 33709 12TH ST 09/24/2007 )NE: SANITARY NO. CONTROL NO. (510) 4( 8-8436 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH op LICENSED CONTRACTOR'S DECLARATION O V — I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description :z with Section 7000)o(Division 3 of the Business and Processions Code,and my license is REPLACE WATER MAIN AND SEWER PIPE. r y in full force and effect. t ? License Class Lic.# F O Date Contractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records ,a O y Licensed Professional H OWNER-BUILDER DECLARATION j a 1 hereby affirm that I am exempt from the Contractor's License Law for the in O following reason.(Section 703 1.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $6400 5 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type not more than five hundred dollars(5500). 3 7 5 3 4 0 4 1 � ❑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 and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections 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.IL 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.). 05/] as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)This Contractor's Li- cense law 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 Contractofs License Law. ❑1 am exempt under Sec. B&P C for this reason Owner_S �/ !t Date I t tl \iut WORKER'S COMPENSATION DECLARATION " I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Workces Compen- sation,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 Compensation Insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' 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;n Sas so as to bccZ subject te Workcrs'Comp nsation Laws of California.Date 44 - Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you shook) 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. CONSTRUCTION LENDING AGENCY E-r rte• I hereby affirm that there is a construction lending agency for the performance of CYi•� the work for which this permit is issued(See.3097,Civ.C.) QLender's Name a Z Lender's Address U Q I certify that 1 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 Cj J building construction,and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA 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 y—Z C,—cam SOURC,)y RE r_ "V9416-1 Re-roofs Signature of Applicant/ContractorDT ate HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 Code, Section 25532(a)? ❑Yes AN. All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.1 agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m�terials for inspection. District? ❑Yes Ko I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant that it is my responsibility to notify the occupant of the requirements w_hic in st et poor to octose of a Ccnificate oorZcupancy. Signature(if Applicant Date Owner o'a Fent /r— /�� All roof coverings to be Class "B"or better CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN . . . . . . . . . 37E34041.00 DATE ISSUED. . . . . . . : 09/24/2007 RECEIPT #. . . . . . . . . : BSC00002727 REFERENCE ID # . . . : 07C90152 SITE ADDRESS . . . . . : 18974 PENDERGAST AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CAFOL MATTSSON ADDRESS . . . . . . . . . . : 18974 PENDERGAST AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CAFOL MATTSSON CONTRACTOR . . . . . . . : SEEASTIAN ALBERTO SARMIENTO LIC # 28153 COMPANY . . . . . . . . . . : SAS ROOTER & PLUMBING ADDRESS . . . . . . . . . . . 33709 12TH ST CITY/STATE/ZIP . . . : UNION CITY, CA 94587 TELEPHONE . . . . . . . . : (510) 468-8436 FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPSEWER SEWER SYSTEM 1. 00 21.58 0. 00 21 .58 0. 00 BPWSVCS WATER SERVICE 1. 00 9 .00 0. 00 9 .00 0. 00 PPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 71.37 0. 00 71 .37 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 71 .37 . #123 : --------------- TOTAL RECEIPT 71 .37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING 11FCITY OF CUPERTINO 0-7e REPIPE/ E WR S/MAIN SERVICE CUFEkTINO PERMIT APPLICATION FORM APN# .-, 4��q� 3� Q Q Date: Building Address: 0 7q p a _n jer QS+ Ave- Owner's Name: Caro 1l n n a4ss ov\ Phone#: ('100 Contractor: '"l Ph ne: � License �#: — --b— SAS Roofer & P�umb�n prone (.5( 0)ga-s93� �73`d Contact: Cupertino Business License#: SebaS ia-n SGtrrnlen+o h moi e. CSI O�Ifg�- a37� cXb 03 Building Permit Info: Bldg ❑ Elect ❑ Plumb l Job Description: re place- waizr mai I-, anSewer p , pe Residential Commercial ❑ Cost of Project: G,/-fo 0.0 O Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pb'.g. Fixture PLUMBING BPWSVCS Win Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 71UPEI�TINO Building Department JOB ADDRESS: i 1p a74 pe-y)� er Q Si iwC, PERMIT#0-70-?o 0 o /T Z OWNER'SNAME: Carol C SS o n PHONE # g S;— 3767 GENERAL CONTRACTOR: R66 e,r FAX # I am not using any subcontractors:_ Q 4�z+ 0 7 Si;;nature Date Please check applicable subcontractors and complete the following information: 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 7 Owner/Contractor Signature Date