07020122 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � k: '� ' QN
BUILT
OG,,,APERMIT NO.
MORETTI DR WATER SEATERS ONLY 07020122
OWNER'S jNiAUME: PERMIT ISSUE DATE
PATRICK HAMILL 970 E. MAIN ST, SUITE 200 02/26/2007
)NE: SANITARY NO. CONTROL NG
(800) 835-5946
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 � 0
o c LICENSED CONTRACTOR'S DECLARATION Job Description
U(= 1 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,�nd my license is RE PLAC? WATER HEATER
I=y in full force and effect 7
License Class Lie.g
F tipDale Contractor
'a� A CHITEcrS DECLARATION
7 a< I understand my plans shall he used as public records
)WU
'
U.y Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city 0 county
`e m which requires a permit to construct,alter,improve,demolish,or repair any structure
Zy prior to its issuance,also requires the applicant for such permit to file a signed statement
o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Ll[—$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $11000
L 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 Number Occupancy Type
not more than five hundred dollars(5500). 3 7 5 15 0 L 1 .
0 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 dos not apply m an owner of fl 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 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7144,Business and Professions Code:)The Contractor's Li-
cense Law docs 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.
0 I am exempt under Sec. B&P C for this mason
OwnerDate
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 Conscnt 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 Worker's Compensation Insurance,as required by Section
3700 of the Labor Codc,for the performance of the work for which this permit is issued.
My Worker s compensation surance arricr and Policy number are:
Carrier.OA '� Policy No.:7 W-3 V�S
CEN!"IFICATE 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,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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
(-r tP+ 1 hereby affirm that there is a construction lending agency for the performance of
GY,> the work for which this permit is issued(Sec.3097,Civ.C.)
Q Lendcr's Name
Z Lender's Address
U C) I certify that I have read this application and state that the above information is
4L . correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
W
above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
fn 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
�. APP 1CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued ty:
S REGULATIONS.
a 4- Re-roof;
Signature of Applicant/Contractor V A Date T of Roof
HAZARDOUS MA S 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 roofs shall be inspected prior to any roofing material being installed.
0 Yes IAINo
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 contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes o
I have read the hazardousmaterials requirements under Chapter 6.95 of the Califor-
nia Health a Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs currently have a tenant that it is my responsibility to notify the occupant of the
req re nts which st be prior to issuance of a Certificate of Occupancy. Signature of Applicant Date
"a-b"L) All roof coverings to be Class"B"or better
Owner or a.t'..z. agent Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 37515011. 00
DATE ISSUED. . . . . . . : 02/26/2007
RECEIPT #. . . . . . . . . BS000000531
REFERENCE ID # . . . : 07020122
SITE ADDRESS . . . . . : 10300 MORETTI DR
SUBDIVISION . . . . . .
CITY CU PERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PPTRICK HAMILL
ADDRESS . . . . . . . . . . : 1C300 MORETTI DR
CITY/STATE/ZIP . . . :
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : MCGEE, PAT LIC # 18986
COMPANY . . . . . . . . . . : WF.TER HEATERS ONLY
ADDRESS . . . . . . . . . . : 970 E. MAIN ST, SUITE 200
CITY/STATE/ZIP GFASS VALLEY, CA 95945
TELEPHONE . . . . . . . . : (E00) 835-5946
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
BENERGY PERMIT FEE 1.00 34. 86 0 .00 34 .86 0. 00
BPWHEATER PER HEATER 1.00 10 .79 0 .00 10 .79 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0 .00 38 .37 0 .00
- --------- ---------- ---------- ----------
TOTAL PERMIT 84.02 0 .00 84 .02 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 84 .02 M/C
---------------
TOTAL RECEIPT 84. 02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- ------ ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
CITY OF CUPERTINO
WATER HEATER
CUPCITY S TING PERMIT APPLICATION FORM
APN# Date: J
a3-
Building Address:
/0 -f-'
3 u� A)o 9
Owner's Name: /� !� Phone#:
/ -Lfi Ila
Contractor: Phon�: License#:
Peq 4trs 57-3,2 '2 7y- 3 �z�z 3JyS7 3
Contact: Edward Grene: 9z _�15 7 7r Z,,— Cupertino Business License#:
North Bay Permit Servicc /s
Building Permit Info:
Bld ❑ Elect ❑' Plurnb '9 Mech (�
Job Description: .� Q l9Ce (,)4 ,I �l -le
Residential (� Commercial ❑
Cost of Project: !l UU
Strapped ❑ On Platform Bonded
New Location ❑ Replacement
Qty. if
A lic f Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING