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07020021 CITY OF CUPERTINO BUILDING biViSiON PERMITI�FUIM�TI()N+' PERMIT NO. BUILDING ADDRESS: 20065 DE PALMA LA LAW' S CCNSTRUCTION 07020021 PERMIT ISSUE DATE OWNER'S NAME: FRANKIE & SUE LAW 10559 FELTON WAY 02/06/2007 SANITARY NO. CONTROL NO. NE: (408) 99E-2353 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 00 LICENSED CONTRACTOR'S DECLARATION Job Description W 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ;ZtUir with Section 70(X))of Division 3 ofthc Business and Professions Code ndmylicenscis INSTALLI.TION OF TEMP POWER POLE H in full force and effect. 8 )n z License Class Lic.S t w Date 9 —`� Contractor �l P ARCHITECTS DECLARATION ,2-i< i understand my plans shall he used as public records )yU u.in Licensed Professional a a OWNER-BUILDER DECLARATION } I hereby affirm that 1 am exempt from the Contractor's License Law for the a0 following reason.(Section 7031.5,Business and Professions Code:Any city or county <m which requires a permit to construct,alter,improve,demolish,or repair any structure Z} prior m its issuance,also requires the applicant for such permit to file a signed statement �, a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q.Ft.Floor Area Valuation G (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $200 i 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 36932031_, .W 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 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.). p 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 contractor(s)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 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 Workers Compensation insurance,as required by Section 3W of the Labor Code,for the performance of the work for which this permit is issued. Worker's Com ensation insgrance carrier and Policy b. b r— Carrier. S1rPolicy No A6- CERTIFICATE OF EXEMPTION FROM S' 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 V) CONSTRUCTION LENDING AGENCY F I hereby affirm that there is a construction lending agency for the performance of p(> the work for which this permit is issued(Sec.3097,Civ.C.) WGI.A Lender's Name Z) 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 Vbuilding construction,and hereby authorise representatives of this city to enter upon the U 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 2 in consequence of th ranting of this pernik- Dat ►-� APPLICANT STANDS WILL MPLY WITH ALL NON-POINT Issued by'. SOURCE ONS. D Re-roofs signalf plicae on Dam T Of Roof Id ALS DISCLOSURE ype C011thc 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 roofs ihall be inspected prior to any roofing material being installed. ❑Yes No f- If a roof i;installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes bi No 1 have read the hazardous rials requirements under Chapter 6.95 of the Califor- nia Health ct Code,Sections 25 5533 and 25534.1 understand that if the building docs n urently,have a'I t,that it is y sponsihility to notify the occupant of the rcyu' me h mel ' rto' cc of aCetrificatco Occupancy. Signature of Applicant Date -�� All roof coverings to be Class"B"or better wncro agcn Dam CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: B1l:: Lot: APN . . . . . . . . . 36S32039 . 00 DATE ISSUED. . . . . . . : 02/ 06/2007 RECEIPT #. . . . . . . . . : BSC,00000398 REFERENCE ID # . . . : 07020021 SITE ADDRESS . . . . . : 20065 DE PALMA LA SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : FRZNKIE & SUE LAW ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : REC'EIPT INTERFACE CONTRACTOR . . . . . . . : FR7.NKIE LAW LIC # 25316 COMPANY . . . . . . . . . . : LAVI'S CONSTRUCTION ADDRESS . . . . . . . . . . : 10_ 59 FELTON WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (4(18) 996-2353 FEE ID UNIT I QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BTEMP FLAT RATE 1. 00 62 .10 0. 00 62 .10 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 100.47 0. 00 100.47 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 100.47 MASTERCARD --------------- TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL Community Development 10300 Torre Avenue . ; Cupertino CA 95014 Telephone(408)777-3228 C1TY OF Fax(408)777-3333 #-UPE�TINO Building Department JOB ADDRESS:2ccxe De Fb J�� L• PERMIT # r'w (n o OWNER'S NAME: 15Lt e PHONE # - -2�5 GENERAL CONTRACTOR: ►3llp FAX # )j'am not using any subcontractors• i;;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 011MD0ZI at�- TEMP POWER CITY OF CUPEkTINO PERMIT APPLICATION FORM APN # ��;�?V��, I Dater Building Address: Owner's Name: Phone#: -- (Ae-e- AAW I Contractor: Phone: License #- Contact: ZA Phone: Cupertino Business License #: Building Permit Info: Elect Job Descnption: Li��° Residential C mmercial ❑ Cost of Project: OrJ Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE F lect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING