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070201170 Z_ H W C.t .`7 U 0 H ►-t U CITE' OF CUPERTINO ' 1i�RM�TI�� BUILDING DIVISION PERMIT��i�� BUILDING ADDRESS: PERMIT NO. 802 CANDLEWOOD DR BARBARA RUDD 07020117 OWNER'S NAME: PERMIT ISSUE DATE BARBARA RUDD 02/23/2007 JNE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, my license is COPPER RE—PIPE Qand in full force and effect.3bLicense Class Lie. x Dale 10 7 CContractorARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to rile a signed statement Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $3500 that he is exempt therefrom and the basis for the alleged exemption. Any violation of Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of�pN not more than rive hundred dollars (3500). 3 6 919 0 3 3 . UU 0 1, as owner of the property, or my employees with wages as their sole compensation, Required Inspections nsot will do the work, and the structure is not intended or offered forsale (Sec. 7044, Business and Professions Code: The Contractor's License Law does napply to an owner of q P 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.). 0 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 cont actors) licensed pursuant to the Contractor's License Law. 0 1 am exempt under Sea . B & P C for this reason __. _ . ... . ..... ..... Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 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 ;7Z work for which this permit is issued. 0 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 Worker's Compensation Insurance carrier and Policy number are: Carrier. Polley No.: 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 ias d. I shall not employ any person in an cr se to become subject to Workers' ompcnsadon Laws of C ' Applicant NOTICE TO APPLI ANT: If, affer making this Cern tc oT Ez prion, fou should become subject to the Worker's Compensation provisions of the Libor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. I CONSTRUCTION LENDING AGENCY 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.) Lender's Name Lender's Address j I 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 building construction, and hereby authorize representatives of this city to enter upon the ' ahovc-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against j liabilities, judgments, costs and expc - which may in anyway accrue against said City in consequence of ing of ' rmil. i APP NDER D D ILL COMPLYVWIALL N POINT Issued by Date S GU 0 Signature A licant/Conuactor Datc Re -roofs of HAZARDOUS MATERIALS DISCL RE Type of Roof uilding occupant store or handle hazardous material Will the applicant or fYNo as defined by the Cupertino pal Code. Chapter 9. 12, and the Health and Safety Cede, Section 25532(a)? All roofs ihall be inspected prior to any roofing material being installed. C] Yes If a roof i ; installed without first obtaining an inspection, I agree to remove Will the applicant or building occupant use equipment or devices which emit hazardous air contamina defined by the Bay Arca Air Quality Management all new materials for inspection. District? 0 Yes I have read the hazard materials uircmcnts under Chapter 6.95 of the Califor- nia Health & , c o 255(1 533 and 25534.1 understand that if t/bu,ingdoes not rremly h a Lena u m ' ' ylonotil'y the uthe reyuircm nts m t eofaCertificate of Oce ane Signature of ApplicantDate 7 All roof coverings to be Class "B" or better Owner authori d agent a� CITY OF 7UPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB�RESS: pZ (f44 v�l/� 0 / �. PERMIT # �O� �/� OWNER'S NAME: yi-\-;A PHONE # 2-.57 , 9,1F 2 - GENERAL CONTRACTOR: d' ( F # I am not using any subcontractors: 4a 7 Signature ate Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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 3 ITEMS OF 3 PERMIT' RECEIPT Sec: Twp: Rng: Sub: Bl}:: Lot: APN ......... 361,19033.00 DATE ISSUED.......: 02/23/2007 RECEIPT #.........: BS000000524 REFERENCE ID # ...: 07020117 SITE ADDRESS .....: 802 CANDLEWOOD DR SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............. BARBARA RUDD ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO CA, OPERATOR: amyw COPY # : 1 95014-4653 RECEIVED FROM ....: RECEIPT INTERFACE CONTRACTOR .......: LIC # *OWNER* COMPANY ..........: BARBARA RUDD ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4653 TELEPHONE ........ FEE ID UNIT QUANTITY ILMOUNT PD -TO -DT THIS REC NEW BAL ----------------------- BPREPIPE NO OF FIXTURE ---------- 12.00 --•-------- 108.00 ---------- 0.00 ---------- 108.00 ---------- 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 TOTAL PERMIT ---------- 253.37 ---------- 0.00 ---------- 253.37 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 253.37 --------------- 253.37 VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING REFERENCE NUMBER -------------------- 6003 VOICE ID DESCRIPTION -------- ---------------------------- 502 FINAL PLUMBING ENERGY F CUPEI�TINO CITY OF CUPERTINO REPIPE/S. ESV .Tt.S/MAIN SERVICE PERMIT APPLICATION FORM 0102011-1 APN # �U3 Date: a3 O Building Address: `� oa C�4 7-5-01 Owner Name: ( l Ar b t ra3 Zv cc Phone #: f/og S7 - $ Contractor: Phone: Wrrl ell y c7g License #: 1970/ s Conta^�'T Phone: zt� zf� o,� yob --q� - �s a Cupertino Business License #: Building Permit Info: PLUMBING Bldg ❑ Elect ❑ Plumb Fblg. Fixture Job Description: (,vo ri /Z -LJ ?o Corex r , BPWSVCS Residential Commercial ❑ PLUMBING Cost of Project: SDO, 0 0 $3S-00, c ewers Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE F lumbing Permit Issuance PLUMBING BPREPIPE F_epipe of Fixtures PLUMBING BPFIXTURE Fblg. Fixture PLUMBING BPWSVCS main Water Service PLUMBING BPSEWER c ewers PLUMBING BPSEWAGE c ewage Disposal PLUMBING BUSLIC Business License BUILDING