The URL can be used to link to this page

07020080 CITY OF CUPERTINO BUILDING DIVISION PERMIT C l RAGTCI I CIRMAT Q ' FBADDRESS: PERMIT NO. 21091 TULITA CT R L BRACKETT CONSTRUCTION 07020080 OWNER'S NAME: —IN�— PERMIT ISSUE DATE KAZU YANAGIHARA 3400 DE LA CRUZ BLVD, SANITARY NO. CONTROL NO. _)NE: 1WT (408) 23` -8852 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i p LICENSED CONTRACTOR'S DECLARATION Job Description v F` I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is TEMPORAF.Y POWER POLE y in full force and effect. h n License Class Lic.g 06— Date • I • Contractor F ARCHrfECPS DECLARATION i a< I understand my plans shall be used as public records )19 U m H Licensed Professional OWNER-BUILDER DECLARATION r 1 hereby affirm that I am exempt from the Contractor's License Law for the n o following reason.(Section 7031.5,Business and Professions Code:Any city or county `e$ which requires a permit to construct.alter,improve,demolish,or repair any structure Z 6 prior to its issuance,also requires the applicant for such Permit to file a signed statement c q.Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 r F=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $500 i that he is exempt therefrom and the basis for the alleged exemption.Any violation of qp Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 32628069 :U Number Occupancy Type not more than five hundred dollars(5500). ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work.and the structure is notintended or offered for sate(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors 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 Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: Q f have and will maintain a Certificate of Consent to self-insure for Worker's 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 7 of the Labor Code,for the performance of the work for which this permit is issued. My sC � WorkeeesCommpensation Insurance carrier and Policy number am: Carrier. Fkrd Policy No.:71k a 'Cd M61 10 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for anc 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.Date 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 ,Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY E—h ham• I hereby affirm that there is a construction lending agency for the performance of a!> the work for which this permit is issued(Sec.3097.Civ.C.) W Q Lender's Name Z Lender's Address U 0 1 certify that I 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 rJ U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (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. Date ►+ APPLIC NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUR _ 2- 194-0-7 Re-roofs Signature of Applicam/Contractor Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP 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)? ff��..' All roofs :hall be inspected prior to any roofing material being installed. El Yes o 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes o I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building does not c my have a tenant,that it is my responsibility to notify the occupant of the requircmc tc p' o issuance of a certificate of Occupancy. Signature of Applicant Date 2' `z.NAll roof coverings to be Class"B"or better Owner or utho'zed agent Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . . 32628069 . 00 DATE ISSUED. . . . . . . : 02/14/2007 RECEIPT #. . . . . . . . . : BS000000464 REFERENCE ID # . . . : 07020080 SITE ADDRESS . . . . . : 21091 TULITA CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER KAZU YANAGIHARA ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : RICHARD BRACKETT LIC # 27027 COMPANY . . . . . . . . . . : R L BRACKETT CONSTRUCTION INC ADDRESS . . . . . . . . . . : 3400 DE LA CRUZ BLVD, UNIT M CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054 TELEPHONE . . . . . . . . : (408)235-8852 FEE ID UNIT QUANTITY AMOUNT. PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BTEMP FLAT RATE 1. 00 62 .10 0. 00 62 .10 0. 00 BUSLIC FLAT RATE 1 . 00 107 . 00 0. 00 107 . 00 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 207 .47 0. 00 207 .47 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 207 .47 VISA --------------- TOTAL RECEIPT 207 .47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL Community Development 10300 Torre Avenue ' . Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 DUH TINO Building Department JOB ADDRESS: PERMIT # 91 4 / _ 1.`46- G 60 OWNER'S NAME: ho,,,.. PHONE # Wp[r. Co 90 3 9/ 6 GENERAL CONTRACTOR: c. *4r- FAX # c(of - a.3 S $ S'i I am not using any subcontractors: a - 1 �� 07 Si;mature Date DP Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSIrIESS 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 ' e Owner/Contractor Signature Date CITY OF CUPERTINO cqo ZC)O cS 0 TEMP POWER. ':UPERTINO PERMIT APPLICATION FORM APN# Date: Gck 14 -o7 Building Address: a I -� Owner's Name: Phone#: 40eg7q - aZ>Sa Contractor: Phone: L�D$ d35%4&52 42,License #: R c. 5 rcLcke.+4r- ��. Flo S(p to LI vontact: Phone: Cupertino Business License#: ia,a,j �SMCJUA& $0 3R i S Building Permit Info: Elect ❑ -7:` ?06,tj2 Job Description: Sin 1 e 0=-q*,4 d*ie4.p f Residential ommercial ❑ Soo Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BTEMP T,mporary Power ELECTRICAL EPERMITFEE E ect. Permit Issuance ELECTRICAL L BUSLIC Business License BUILDING