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07080055 CITE'OF CUPERTINO BUILDING DIVISION PERMIT i.lJ T�A�� )R, �. PERMIT NO. BUILDING ADDRESS: 20230 JOHN DR TBD - TO BE DETERMINED 07080055 PERMIT ISSUE DATE OWNER'S NAME: 07 WITT DAVID R ET AL SANITARY N CONTROL NO. INE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH z LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9(commencing U with Section 7000)of Division 3 of the Business and Professions Code,and my license is SERVICE UPGRAD AMPS L eneClpsndcfCect (� —C-Al r-7 Al ELECTRIC PAID FOR BL 08/07/07 z License C]pss r k b Lia#ctor " p Date_ '�.>^tZj Contractor ARCHITECTS DECLARATION 1 l understand my plans shall be used as public records Licensed Professional j OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the ofollowing reason.(Section 7031.5,Business and Professions Code:Any city or county W rm ai. which requires a peit to construct,alter,improve,demolish,or repair any structure y prior m its issuance.also requires the applicant for such permit to file a signed statement ;q Ft.Floor Area that he is licensed pursuant to the provisions of the Contractor's License LaValuation 0 w(Chapter 9 $2100 •o (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 0 that he 4 Sxempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7431.5 by arty applicant for a permit subjects the applicant to a civil penalty of A�D,7}��Number not more than five hundred dollars($500). L36935004 . V V ❑1,as o((ncr of the property,or my employees with wages as their sole compensation, will do th&ork.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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Conuactoes Li- cerise Law does 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. ❑1 am exempt under SeB&P C for this reason Sec. Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: have and will maintain a Certificate of Consent to self-insure for Worker's Compen- .an,as provided for by Section 3700 of the Labor Code,for the performance of the work Cor which this permit is issued. ❑1 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 Wo is Compensation Insurance carrier and Policy number am: of No�'tL u r pk 7 14jo Cartiecy r i RTiFiCATE OF X PTION FROM WORKERS' COMPENSATION INSURANCE Crhis 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 0 forthwith 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 Lender's Address C) i certify that 1 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 U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. y (We)agree to save,indemnify and keep harmless the City of Cupertino against y Cn liabilities,judgments,costs and expenses which may in any way accrue against said City A Z in consequence of the granting of this permit. Date ►+ AFE1,ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�,: S E REGULA N Re-roofs Signature of Applicant/Contractor Data Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP 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 roofE shall be inspected prior to any roofing material being installed. El Yes 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 whicn all new materials for inspection. it havardous air contaminants as defined by the Bay Arca Air QualityManagement .rStI'Itl? Cl Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Caldi or- ng Health&Safety Code,Sections 25505,25533 and 25534.i understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the Date re n�ntcl�hichmust P nor to issuance Ora Certificate of Occupancy. Slgnatur'of Applicant �- All roof coverings to be Class"B" or better Owner or authorized agent Dat CITY OF CUPERTINO 4 ITEMS OF 4 PERMIP RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36335004 . 00 DATE ISSUED. . . . . . . : 08/07/2007 RECEIPT #. . . . . . . . . : BS000002283 REFERENCE ID # . . . : 07080055 SITE ADDRESS . . . . . : 20230 JOHN DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WITT DAVID R ET AL ADDRESS 20230 JOHN DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4417 RECEIVED FROM . . . . : A-1 ELECTRIC 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 ------ ------------- ---------- ---------- ---------- ---------- ---------- BELEC200 METERS 1. 00 29 .43 0. 00 29 .43 0. 00 BSEISMICRE VALUATION 2, 100. 00 0.50 0. 00 0.50 0. 00 BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 . 00 0. 00 EPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 175 .30 0. 00 175 .30 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 175. 30 10361 --------------- TOTAL RECEIPT 175 .30 VOICE. ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL CITY OF C UPERT INO CITY OF PERMIT APPLICATION FORM CUPE�TINO APN# Date: � (2113I_�b(0 9. -�- Building Address: Mailing Address (if different from building address). ,)-C>y O 7S 6tX,.J of Owner's Name: Phone #- `rp � Con. actor. License # Contact: Phone: Cupertino Business License#: AL tip$ LcG 3 2 5 b Building Permit Info: Bldg ❑ Elect"< Plumb ❑ Mech ❑ Job Description: Residential Elee_�► G Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Droject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boile-> 100K to 500K Btu MECHANICAL BBOILER3 Boil.r> 500K to IM Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX (construction Tax BUILDING BCONSTAX Incl/Off/Comm/Quasi BUILDING BCONSTAXBQ Co 1. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 El,-,c 600V <= 1000A ELECTRICAL BELEC1001 E(ec 600V > 1000 ELECTRICAL BELEC200 Elec Svcs 600V<=(2_00Aj ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA investigation fee BUILDING 1 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIN OF Fax(408)777-3333 CUPEI�TINO Building Department JOB ADDRESS: PERMIT # 201a-3Q 0t-? OWNER'S NAME: >-.� w, PHONE # Lt-S3 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature 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