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07010152 -777777777777777 CITY OF CUPERTINO BUILDING DIVISION PERMIT (-U INFORIATIflN� PERMIT NO. BUILDING ADDRESS: I OWNER'S NAME: SCOTT HUGHES 01/24/2007 SANITARY NO. CONTROL NO. ZONE: BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH Q � 0 Ll 0 a LICENSED CONTRACTOR'S DECLARATION Job Description v C I hereby affirm that I am licensed under provisions of Chapter 9(commencing =Z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is S ERV I C T UPGRADE MIN 100 AMP y in full force and effect. j ? License Class Lic.k t-p Date Contractor UJ ARCHITECTS DECLARATION ccv 1 understand my plans shall be used as public records 4 WO rn Licensed Professional H OWNER-BUILDER DECLARATION 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 K which requires a permit to construct.alter,improve,demolish.or repair any structure prior w its issuance,also requires the applicant for such permit to file a signed statementValuation -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $100 xF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 35906043 .`l9'lt' Number rm not more than five hundred dollars($500). ❑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 sale(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.). 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 contractor(s)licensed pursuant to the Contractor's License Law. C]I am exempt der S ,B&P C for 's reason //teryr Owner Date V-) WORKER'S�COMPLJTSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: Q 1 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. ❑1 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. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section aced 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 manZ so as to become SVIct to the Work rs'Compensation Laws of California.Date��r L Applicant wy - NOTICE TO APPLICAWrIlf,after making this dcrtifidific 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 [~-t I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) OW.A Lender's Name Lender's Address I certify that I have read this application and stare that the above information is CUt.O correct.1 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 U above-mentioned property for inspection purposes. 0. (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 P V Z in consequence of the granting of this permit. Date / Z —("G �+ APPLICA UNDERSTAND, ND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE GUL 4 __z__1__1z__-1 C 2y Re-roofs Sign ureofApplicanVContr 'Date T of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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)? �_(/ All roo s shall be inspected prior to any roofing material being installed. ❑Yes L7 ryO Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminarN. cfined by the Bay Area Air Quality Management all new materials for inspection. District?C3Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safe Codcnt ,Sections 25505.25533 and 25534.1 understand that if the building does not curie have a tena ,that it ism responsibility to notify the occupant of the rcquiremcn ichmust of Certificate fOc pancy. Signature of Applicant Date a-t C7 All roof coverings to be Class"B"or better Date Ownef or authorized agent CITY OF CUPERTINO ►nf' PERMIT APPLICATION FORM CUPEkTINO QYjOI o15 .CPN # Date: � ��S`f _ ( 2 Building Address: :Mailing Address (if different from building address): `7 7� z I.) �% ��Cz � � � Owner's Name: Phone#: c -r` 1 �: i 'Z- Contractor: License #: ) '1 CC AS1 Q ._ -2 LI I Contact: Phone: 3 '7 - .72v�° Cupertino Business License#: Fax: Building Permit Info: _� ;v Zs� a r u c��L- vV\1n Bldg ❑ Elect Q Plumb ❑ Mech ❑ Job Description: Residential 2"' Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: L ( civ Occupanc Group: Type of Construction: Please check this box if the project is a y� second-storyaddition: eroject Size: Standard R Large ❑ Major ❑ Quantity Fee ID Fee Descri tion Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bciler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boi_er> 500K to 1M Btu MECHANICAL BBOILER4 Boilor> IM to 1.75 M Btu MECHANICAL BBOILER5 Moiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ir d/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 E tec 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 (:UPERTINO CITY OF CITY OF PERMIT APPLICATION FORM CUPEkTINO 2uanti Fee ID Fee Desc tion Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Th.-atrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Sf ismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tempora 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 Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG P:umbing Fee sq foot PLUMBING PLLONGRNGC Planning;LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning;Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3