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07080017 CITY OF CUPERTINO y�7� y A� BUILDING DiVISION PERMIT �� ����i ���Y�����• PERMIT NO. BUILDII{G,p�gR�SS:N TANTAU AV M & H FLUMBING INC 07080017 PERMIT ISSUE DATE OWNER'S NAME: VERITAS PROPERTY MGMT 739 N 10TH STREET 07 SANITARY N CONTROL NO. iE: (408) 21:0-7606 BUILDING PERMIT INFO ARCHITECT'/ENGINEER: BLDG ELECT PLUMB MECH Z LICENSED CONTRACTOR'S DECLARATION Job Description C P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing UL with Section 7000)of Division 3 of the Business and Professions Code,and my license is NEW 2ND I WATER SERVICE W/ RPBF AND INTERIOR PIPING in full force andcffect Lie a ^!� AND NEW GAS METER WITH MINOR PIPING M&H PAID FOR z License s p Date A HITECI-S D ErA ION BL 08/C2/07 u I undcrstanJ my plans shall be used as rc rccorJs :J Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the Oy following rcason.(lScction 7031.5,Business and Professions Code:Any city or county i which requires at permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation .4 9 that he is licensed purguanl to the previsions of the Contractor's License Law(Chapter 9 a $6500 e (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or :'4 that he is exempt therefrom and the basis for the alleged exemption.Any violation of 1�Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 316180 . 5 . V not more than five hundred dollars(5500). ❑1,as owner of the propery,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered forsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). [11,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractors License Law. B&P C for this reason ❑I am exempt under Sec Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Cari,&4V 41!& -�,¢ Policy NoQLDA_XAA/dcar9 CERTIFICATE OF$XEMPTION FROM WORKERS' COMPENSATION INSURANCE ('Ibis 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 va 1Z 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 Codc.you must Qforthwith comply with such provisions or this permit shall be deemed revoked. 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.) a Q Lender's Name Z Lenders Address 0 1 certify that I have read this application and state that the above information is �-' cortccl.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorise representatives of this city to enter upon the y above-mentioned property for inspection purposes. (We)agree to save,indemnity and keep harmless the City of Cupertino against y v) liabilities,judgments,costs and expenses which may in any way accrue against said City ,Z in consequence of the granting of this permit. Date 2 �/ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued brr: SOUR�q REGULATIONS. Z •v Re-roofs ore o Rppl' ontractor Date T of:Zoof HAZARDOUS MATERIALS DISCLOSURE Type Will dtc.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 roof: shall be inspected prior to any roofing material being installed. ❑Yes . "a 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 i naterials for inspection. District? ❑Yes I have rcad•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 Date X.require ich must be mel prior to issuan f er ificate of Occupancy. S ignatur'of Applicant �-`� r All roof coverings to be Class"B" or better JJVC�ncrauthorized nt Datc' 0 CN cr -S, to r\ C� \d) C 0) Ill CD 0 0) N C) (D B 6 6 6 C) 2 co co 0 4� C: LO Z W 0) 0c) co k L5< 0 0 CD c) It It " x (D cz 0c) 0 o LL ca U) U) g LO LO co ft CITY OF C UPERTINO %IF REPIPE/SE ' 1 , /MAIN SERVICE CUPk , INO PERMIT APPLICATION FORM C ��� C,(j APN # *3 ) � �IS Date:C , T � z 7 Building Addre s: 'SOS" � tiT Phone#: Owner's Name: � g� 'y �LT� '�-tLr-�J � 7 z z.� Z Contractor: Phone: License#: 1 11 PL� �$t� i►� 4rr�.2�d 7�©� 4c4v.S� Phone: Cupertino Business License#: Contact: X101ir Building Permit Info: Bldg ❑ Elect ❑ Plumb 2r Job Description: �14 IT 1ro� A/S-� ,Z, ' ,ems-"C_ /�t'�✓ Residential ❑ Commercial " Cost of Project: I tPr Qty. if Fee Group Fee Description P Applicable Fee ID BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE I:e i e of Fixtures PLUMBING BPFIXTURE I'blg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE :sewage Disposal PLUMBING BUSLIC Business License BUILDING CITY OF CUPERTINO 4 ITEMS OF 8 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31618035.00 DATE ISSUED. . . . . . . : 08/C2/2007 RECEIPT #. . . . . . . . . : BS000002244 REFERENCE ID # . . . : 070E�0017 SITE ADDRESS . . . . . : 105(10 N TANTAU AV SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : VER:CTAS PROPERTY MGMT ADDRESS : 105: 0 N TANTAU CITY/STATE/ZIP . . . : CUP:ERTINO, CA 95014 RECEIVED FROM . . . . PLUMBING: HOL:vl, GEORGE & SUSAN LIC # 22038 CONTRACTOR . . . . . . . COMPANY . . . . . . . . . . : M & H PLUMBING INC ADDRESS : 739 N 10TH STREET CITY/STATE/ZIP • • . SAN OS0,7606 CA 95112 TELEPHONE FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- --NEW-BAL- ---------- ------------- ---------- --------- --------- --- BPGAS OULETS 1. 00 5 .40 0. 00 5.40 0. 0 BPWSVCS WATER SERVICE 1. 00 9 . 00 0. 00 9 . 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 ------ -- -- TOTAL PERMIT 159 .77 0. 00 159 .77 0. 00 VOICE ID DESCRIPTION VOICE ID ------DESCRIPTION -- _ -------- -- ----------- .202, UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 'S-02- FINAL PLUMBING ENERGY 507 FINAL PLUMBING Community Development mow' 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF 'UPEkTINO Buildi�l De"PERMIT - JOB ADDRESS: ? OWNER'S NAME: PHONE #2� GENERAL CONTRACTOR: FAX # I am not using any subcontractor Signature Date Please check applicable subco ctors and co m Tete the followin information: jZ:ISUBCONTRACTOR 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 �er/C�ontractor Signature Date