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07080007 CITY OF CUPERTINO BUILDING►DIVISION PERMIT � TRR�� PERMIT NO. [iU1LDI,NQ�l(�Qp "; NGLISH OAK WY TBD — TO BE DETERMINED 07080007 l lJ PERMIT ISSUE DATE OWNER'S NAME: FAJARDO LUIS F AND LORELA 08/01/2007 SANITARY NO. CONTROL NO. VE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 Z LICENSED CONTRACTOR'S DECLARATION 00 Job Description W p I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z w with Section 70(IU)of Division 3 of the Business and Professions Code,and my license is BATHROC M REMODEL NON STRUCTURAL (NO LIGHTING, OR a. in full force and effecL I _71 . 7 v�Z License Class Lic.# C" �` ELECTRICAL) Date A �1�_Contractor ARCHITECTS DECLAR ON I a< I understand my plans shall be used as public records ;WU u.t Licensed Professional i y< OWNER-BUILDER DECLARATION } 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 1 p o 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 z r prior to its issuance.also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation =G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq- t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)ur $5000 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($500). 34232145q. 0 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.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors U cense Law does not apply to an owner of property who builds or improves thereaa.and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. 0 I 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: i I I have and will maintain a Certificate of Consent to self-insure for WorkeesCompen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the 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 Com tion Insurance carrier and Policy nu r (n/j 7/. Carrier. emsaTe 1� olicy No.: v v C(� ICERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(3100) 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 Workers Compensation provisions of the Labor Code•you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction(ending agency for the performance of f>' > the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name 0z Lcnder's Address U C) I certify that I have read this application and state that the above information is h- correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. CL (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue againstsaid City U ,Z in consequence of the granting of this permit Date /�� ►" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b3: SOURCE RE A ON — /, V Re-roofs Signature ofApplicant/Contractor Dale HAZARDOUS MA RIALS DISCLOSURE Type of Roof 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. ❑Ycs Nu If a roof is 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 r laterials for inspection. District? C]Yes VKNo 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 docs not currently have a tenant,that it is my responsibility to notify the occupant of the rcquircmcnta�USLbe rtu' .otaCcrtificatcofOccupaneyvSignature:of Applicant Date � 7 All roof coverings to be Class.,B„ or better Owner of aut ori-red agent Dare CITY OF CUPERTINO 5 ITEMS OF 5 PERMI`[' RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN 34.232145. 00 DATE ISSUED. . . . . . . : 08/01/2007 RECEIPT #. . . . . . . . . : BS)00002227 REFERENCE ID # . . . : 07)80007 SITE ADDRESS . . . . . : 10116 ENGLISH OAK WY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FAJARDO LUIS F AND LORELA ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : PALO ALTO CA, 94306-3841 RECEIVED FROM . . . . : STEVE RUTLEDGE CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 5, 000. 00 115 .56 0. 00 115 .56 0. 00 BPFIXTURE UNITS 3 . 00 27 .00 0. 00 27 . 00 0. 00 BSEISMICRE VALUATION 5, 000. 00 0.50 0. 00 0.50 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 288:43 0. 00 288.43 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 288.43 MC --------------- TOTAL RECEIPT 288 .43 CITY OF CUPERTINO «Y OF: PERMIT APPLICATION FORM CUPEkT[NO o-76 S 6 e�c� u Date: A,� Building Address- �4ailing Address (if different from building address): Owner's Name:) =Phone C�C tltrpctor' Uceiise -fie. vv 10 enc Contact: pj) E 6 -F y Cupertino Business License#: Building Permit Info: Bldg R( Elect [ Plumb 3-� Mech ❑ Job Description Residential Y Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: C, Occupancy Group: Type of Construction: i _ Please check this box if the project is a �.� 0l TO"1til 0 second-story addition: ❑ roject Size: Standard Ifl/ Large ❑ Maj:)r ❑ Quantity Fee ID l+ee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boilei > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX InclOff/Comm/Quasi BUILDING BCONSTAXBQ Cote. Tax for BQ Zone BUILDING BCONSTAXH :3otel 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 Investigation fee BUILDING 1 of 3 NTRA�-TO Q ' 5TEV E'PVTLL-DGF 161110 efy'ru-W OA k vt e w �f- crvt VU i s6wey, VOI/t W/ prov,4, hfw s6wev, p-o inerbrosie- �Vryv to -�� s i awN Z COWRA,-ro$ � CJTEV C4�;a 1611 t Et,*u-W 04 k - Cu t,r+ C-A- q -d vlecAj yr< U SCC-P? f �2p(�c- S�r,tvr va(v�� p�o��de hew s how em r h m RECE ED Ptl'o+/ Ode, vt a 'f I f e- t It S ko t, 94— f v�r to c�., ��, - d��.... �. � � ?��► f V I � _ I J ii t k,t'�', i iE Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 jF Fax(408)777-3333 .�� LKTINO Building Department JOB ADDRESS: �� ,, - PERMIT # '�`, foo �7 OWNER'S NAME: 0 PHONE # �' U GENERAL CONTRACTOR ait I f i �e FAX # I am not using any subcontractors: ;0`7 Si€;nat e 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