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07080226 7B�UILDING OF CUPERTINO IA?VISION PERMIT � j' �TflIZ INt} 'MTION •. : PERMIT NO. BUILDING ADDRESS: 6355 ATHERWOOD AVE PLUMBERS ON CALL 07080226 PERMIT ISSUE DATE OWNER'S NAME: FONTENOT COLVIN TRUSTEE 520 E MCGLINCY LN 08/27/2007 SANITARY NO. CONTROL NO. INE: (408) 879-0483 BUILDING PERMIT INFO ARCHITECT/ENGiNEER: BLDG EPLUMB MECH -J 9 ZLICENSED CONTRACTOR'S DECLARATION 0 Job Description m p I hereby affirm that I am licensed under provisions of Chapter 9(commencing i with Section 7000)of Division 3 of the Business and ProfessionnslCode,and my license is RE P I PE/ WATER HEATER y in full force and effete G Lic. n? License Class p Date � Contractor t ARCHITECTS DECLARATION aJ < l understand my plans shall be used as public records taU u.y Licensed Professional 'o a OWNER-BUILDER DECLARATION 3< 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county 8! which requires a permit to construct,alter,improve,demob h,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement `q Ft.Floor Area Valuation Ch FE A that he is licensed pursuant to the provisions oC the Contractor's License Law(Chapter 9 $6050 t- (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of �,l Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 916 0 0 rV not more than five hundred dollars(E500). p 1,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 We(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.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.). ❑I.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 cone actor(s)licensed pursuant to the Contractors 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: J I have and will maintain a certificate of consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ZI have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compens/a/tion 1 rance?mer and Policy number arc: Cartier. V�t/'tee A-� Policy No.: ��/0 G 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,1 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY [~"rC/I-r 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 Namc Z Lender's Address U C) I certify that I have read this application and stale that the above information is ;.,. corect.I agree to comply with all city and county ordinances and state laws relating to O U building construction,and hereby authorizc representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against v) liabilities•judgments,costs and expenses which may in any way accrue against said City r� U Z in consequence of the granting of this permit. Date `", t APPLICANT UNDERSTANDS AND WIL COMPLY WITH ALL NON-POINT Issued by SOURCE REGULATIONS. / v�iS ' '�'/ �/Z 7 Re-roofs Signature of Applicant/Contractor Date Type of R oof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes 2<0' If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which -mit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new rr aterials for inspection. District? ❑Yes [frNo I have read the hazardous materials requirements under Chapicr6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the - rcyuircmcros which mu be met p. r to issuance of a Certificate of Occup �r. Signature of Applicant Date -�-�� 7147 All roof coverings to be Class 'B or better Owner or authorized agent Date Community Development 10300 Torre Avenue . Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPE(�TINO Buildin De artment JOB ADDRESS: !� PERMIT #G—7 2 Z� OWNER'S NAME: PHONE #�'ke' G Ccvl FAX # I am not using any subcontractors Signature Date Please check applicable subcontractors and co m Tete 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 PlumbingL ., Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF C:UPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36916007 .00 DATE ISSUED. . . . . . . . 08/27/2007 RECEIPT #. . . . . . . . . : BSO )0002481 REFERENCE ID # . . . : 07030226 SITE ADDRESS 6355) ATHERWOOD AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FONrENOT COLVIN TRUSTEE ADDRESS . . . . . . . . . . : 6355 ATHERWOOD AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : PLUMBERS ON CALL CONTRACTOR . . . . . . . : ROBIE DOBKINS LIC # 27158 COMPANY . . . . . . . . . . : PLUMBERS ON CALL ADDRESS . . . . . . . . . . : 520 E MCGLINCY LN CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 879-0483 FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ------ ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 .86 0. 00 BPREPIPE NO OF FIXTURE 9 . 00 81.00 0. 00 81 .00 0. 00 BPWHEATER PER HEATER 1. 00 10.79 0. 00 10 .79 0. 00 BSEISMICRE VALUATION 6, 050. 00 0 .70 0. 00 0.70 0. 00 EPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 MPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 PPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 ----- -0. 00 -- -------- ---------- ---------- - TOTAL PERMIT 249 .72 0. 00 249 .72 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------- CHECK 249 .72 151496 --------------- TOTAL RECEIPT 249 .72 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO CITY of PERMIT APPLICATION FORM CUPEkTINO Cj--�go22,C� ' P4 # 2 Date: (0�11��"1 _a6 7/�7 Building Address: 1V1,ailing Address (if different from building address): Owner's Name: Phone#: Contractor: License #: �l� ��" -- - Contact: Phone: ei4 upertino Business License#: `. Fax: Building Perm t Info: �J7L�ow i` S Bldg ❑ Elect ❑ Pl-.imb E Mech ❑ Job Description: Residential )lee-1 711-e t.�-KAr, Ae =� Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Proj ct: Occupancy Group: Type�Contion: Please cheek�tisbox if'the is a ( second-story addition: -oject Size: Standard Large ❑ Majcr ❑ QuWn—tity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boil-,r<= 100,000 Btu MECHANICAL BBOILER2 Boiler > I OOK to 500K Btu MECHANICAL BBOILER3 Boiler-> 500K to IM 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 I[otel and Motel BUILDING BCONSTAXR Con3tax—Resi/Mobile BUILDING BELEC1000 Ele-I 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD E:-iergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 143