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07080019 CITY OF CUPERTINO ' g� BUILDING DIVISION PERMIT PERMIT NO. BUILDIiIjtDI�R�:SSN TANTAU AVE M & H P:,UMBIidG INC 07080019 U 6PERMIT ISSUE DATE OWNER'S NAME: VERITAS PROPERTY MGMT 739 N 10TH STE FT SANITARY N CONTROL NO. PHONE: (408) 281)-7606 BUILDING PERMIT INFO ITECT/ENGINEER: BLDG ELECT PLUMB MECH O LICENSED CONTRACTOR'S DECLARATION Job Description F I hereby affirm that I am licensed under provisions of Chapter 9(commencing UW with Section 7000)of Division 3 of the Business and Professions Code,and ,�Wicensc is GAS – NEW METER PER PG&E in full force and cf ect. S ? License Class Lic.1 M&H PAIL) FOR BL 08/02/07 p Date COnlraclor ARC ITECCS DE ATION I understand my plans shall he used lic records U E Licensed Professional a OWNER-BUILDER DECLARATION � 1 hereby affirm that I am exempt from the Contractor's License Law for the oa following reason.(Section 7031.5•Business and Professions Code:Any city or county Ir. which requires a permit to construct•after•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 Sq.< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $ (commencing with Section 70DO)of Division 3 of the Business and Professions Code)or $1400 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). 3161803'A ❑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(!ontractor's Lieense law does not 9pOy t0;In Owfttr 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.). ❑I,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 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 Contractors License Law. ❑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 have and will maintain a Certificate of Consent to self-insure for Workers Compen- 'ion,as provided for by Section 3700 of the Labor Code.for the performance of the t for which this permit is issued. J f have and will maintain Workers Compensation Insurance,as required by Scction 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: Carrier:!!,f,,�/i+r�1Q/,Policy No:D/904 /Z^/ <3 —.,74(.I CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(5100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not wnploy 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 O forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY +�. I hereby affirm that there is a concoction lending agency for the performance of the work fur which this permit is issued(Sec.3097,Civ.C.) a Q Lendci'Name z Lenders Address C) I certify that 1have 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 concoction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. y (WF)agree to save,indemnify and keep harmless the City of Cupertino against ti r/y liabilities,judgments•costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit. "^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU REGULATIONS. • c� 2—CLI Re-roofs attire of Appli vcomracto V Dam Type of Rc of HAZARDOUS MATERIALS DISCLOSURE Will applicant or future building occupant store or handle hazardous material as defined by,lhe Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs s tall be inspected prior to any roofing material being installed. ❑Yes t-�° 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 materials for inspection. 'tistrict? n� ❑Yes Y I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Heal th&Safety Code,Sections 25505,25533 and 25534_I understand that if the building does not currently have a tenant,that it is my 'bility to notify the occupant of the rcquirc nes which must be met prior w i a Certificate of cupancy. Signature c f Applicant Date O�'� .C,z p All roof coverings to be Class"B" or better 0 cr or autbe'cd agent Date' 3�►!` � �� fir` � ,-1 ,1 kA CG 51 Zk fi rl Pt 03 0) cn ��, j' ., Cn //NN� -n 0 " > Ll aw OD 00 i 0) cFQo ft 7- 0 N) M -4 ((D0 05 S INVOICE INVOICE INVOICE INVOICE IIVOICE INVOICE INVOICE INVOICE INVOICE CITY 01' CUPERTINO PERMIT INVOICE OPERATOR: CathyS Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 31618035 . 00 INVOICE DATE. . . . . . : OE/02/2007 REFERENCE ID # . . . : 07080019 SITE ADDRESS . . . . . : 10596 N TANTAU AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER VERITAS PROPERTY MGMT ADDRESS 10596 N TANTAU CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 CONTRACTOR . . . . . . . : HOLM, GEORGE & SUSAN LIC # 22038 COMPANY . . . . . . . . . . : M &, H PLUMBING INC ADDRESS 739 N 10TH STREET CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408)280-7606 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ---------------- ---------- ---------- ---------- GAS PIPING SYSTEM FEE PRINTING PERMIT 5 .40 5.40 0.00 PLUMBNG PERMIT ISSUE PRINTING PERMIT 38.37 38.37 0. 00 ---------- ---------- ---------- 43 .77 43 .77 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 202 � UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING Community Development - ' 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPERTINO Buil&ng Department JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE #�,2 GENERAL CONTRACTOR: FAX # 7(G o I am not using any subcontractors: S!gnature Date Please check applicable subcontractors and corrlete 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 DD Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile �S- Zc 7 Owner/Contractor Signature Date CITY OF CUPERTINO -50� REPIPE/S E W -S/FAIN SERVICE OF CUPERTINO PERMIT APPLJICATION FORM APN# _ Date: Building Address: l � T Owner's Name: Phone#: S � 41. ' 77 �,FZ 2./Zc2 Contractcl License #: �. Contact: Phone: Cupertino Business License#: ce�- Sv Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: Residential ❑ Commercial Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING �( BPGAS (Jas Pipin System Fee PLUMBING j PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE l'blg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER ;Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING