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07010123 CITY DI CUPERTINO BUILDI,lG DIVISION PERMITR I� RM�TI�N PERMIT NO. BUILDING ADDRESS: 939 BUBB EDt0201 ni 03 PERMIT LSSUE DATE OWNER'S NAME: HEATHER SIMMONS 283 E. .AIRWAY BLVD. 01/19/2007 SANITARY NO. CONTROL NO. )NE: (925) 243-2000 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH J p z0 LICENSED CONTRACTOR'S DECLARATION Job Description C m l 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 2 0 0 AMP JPGRADE a=y in full force and effect / j,t2? License Class�—Lic.M t w Date — Contracw ARCHITECTS D A ON a< l understand my plans shall be used as public records DaU 4 U.yt Licensed Professional 0..1 OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the C O following reason.(Section 7031.5,Business and Professions Code:Any city or county K m 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 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation 3 0 0 Ey II-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y 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 of 35611005 . Number Occupancy Type not more than five hundred dollars(5500). ❑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 Contractor's License Law does not apply to an owner of q 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 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 contractors)licensed pursuant to the Contractor's License Law. ❑1 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: 1 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. ❑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 Worrknkces Compensation insutan, airier and Policy number are: CarierAC.E AA 1109 PolicyNO� dS95� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z " CONSTRUCTION LENDING AGENCY Coll E~-t I hereby affirm that there is a construction lending agency for the perfornan, of fy� > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 4Z Lenders Address U C) I certify that 1 have read this application and state that the above information is L>~ ' correct.1 agree to comply with all city and county ordinances and state laws relating to O U building construction,and hereby authorize representatives of this city to enter upon the U ahove-mentioned property for inspection purposes. Rr (We)agree to save,indemnify and keep harmless the City of Cupertino against ►�-t 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 t" APPLICANT UNDERSTAND AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REAULATIONS. Re-roofs Signature of Applicant/Contram Date HAZARDOUS MATERIALS DISCLOSURE Type of Loof 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 Cotte,Section 25532(a)? All roofs shall 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:s 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 Nu 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 does not currently have a tenant t it is my responsibility to notify the occupant of the require which st r to is ee ora C nifieatc or Oceapaney. Signature of Applicant Date D All roof coverings to be Class"B"or better Owner or authorized agent Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ':UPEkTINO Building Department JOB ADDRESS: PERMIT # 3 OWNER'S NAME: 2 c, PHONE # - --!;;Z - -3 GENERAL CONTRACTOR. ,/ # I am not using any subcontractors: 242--� 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 Owner/Contractor Signature Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blh: Lot: APN 35611006. 00 DATE ISSUED. . . . . . . : 01, 19/2007 RECEIPT #. . . . . . . . . : BS000000267 REFERENCE ID # 07010123 SITE ADDRESS . . . . . : 9311 BUBB RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER HEATHER SIMMONS ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR MARK C GOOD LIC # 23097 COMPANY S&iRS HOME IMPROVEMENT ADDRESS 28:3 E. AIRWAY BLVD. CITY/STATE/ZIP . . . : LIVERMORE, CA 94550 TELEPHONE (925) 245-2000 FEE ID UNIT QUANTITY kMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- BELEC200 METERS 1. 00 29 .43 0. 00 29 .43 0. 00 BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 . 86 0. 00 BSEISMICRE VALUATION 300. 00 0.50 0. 00 0 .50 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38 .37 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 103 .16 0. 00 103 .16 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 103 .16 1272 --------------- TOTAL RECEIPT 103 .16 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF CUPERTINO 0101019-:3 MY OF PERMIT APPLICATION FORM CUPEkTINO 40 CPN# Date: o ,6 - o Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: klEaMZAs - S� 51 tS Contractor: License#: Contact: Phone: Cupertino Business License#: f� Fax - Building Permit Info: Bldg ❑* Elect X F lumb ❑ Mech ❑ Job Description: U pG pAD a &-L.cx-Ti,,.e AC.. 5 ea ve a 7-M AC-G Jq n,,P 5 Residential Commercial ❑ Sq.Ft. Floor Area.-- rea. -� Sq.Ft.: Cost of Project: �_ a-0Occupancy Group: � S 1�� Type of Construction: Please check this box if the project is a 1<17- second-story addition: ❑ _'roject Size: StandardA 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 Boilf;r> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1 M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX In(VOff/Comm/Quasi BUILDING BCONSTAXBQ Cosi. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 Elec 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA -nvestigation fee BUILDING 1 of 3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rm,il Signs Add Branch ELECTRICAL BREMSIGNS Rerr odel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD 5cb Specific Plan BUILDING F 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 Eke Permit Issuance ELECTRICAL MPERMFEE N echanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Lone Range Residential PLANNING ZADDCHG .Address Change BUILDING 3 )f3