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07080157oa :m V i� iW yU U. N ,oa 3oa 1—rn '?a CITE' 0-F CUPEKI ENU BUILDING DIVISION PERMIT BUILTsi � FERNGROVE DR OWNER'S lNAME: BOB & MARY KIRBY JE: ARCHITEC (ENGINEER: I hereby affirm that I am licensed under provisions of with Section 7000) of Division 3 of the Business and Profession in full force and eff, ct O v g License Class Lic• ri Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records BETTER NATER HEATERS 351 FALCATO (408)250-6672 PERMIT NO. 07080157 PERMIT ISSUE DATE SANITARY NO. 9 (commencing Job Description indmylicenscis REPLACE 30 GAL W/H WITH NEW W/H Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a 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 that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 not more than five hundred dollars ($500). ❑ 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 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.). ❑ 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 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. ❑ I am exempt under Sec B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION �z 0 z� W? wQ �Dz UO u, El. �U H C/7 U I hereby affirm under penalty of perjury one of the following declarations: j I have and will maintain a Certificate of Conscnt to self -insure for Workces Compen- ation, as provided for by Section 3700 of the Labor Code, for the performance of the vork for which this permit is issued. ] I have and will maintain Workces Compensation Insurance, as required by Section 1700 of the Labor Code, for the performance of the work for which this permit is issued Ay Worker's Compensation Insurance carrier and Policy number I �� :artier. hA0_ Policy No.: Y" (� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) ar 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 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.) Lender's Name Lenders Address 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 building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments• costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTAINS AND WILL COMPLY WITH ALL NON -POINT of a Date V , * HAZARDOUS MATERIALS DISCLOSURE 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)? ❑ Yes 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 District'.) , / 17-1Yeso 1 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 does not currently have a tenanL.AQ it is my responsibility to notify the occupant of the re uir enta which must be el prior to issuance of a Certificate ofkll 7U� Owner or authorized agent / Date Floor 37539055AE�Num 01 Issued b, Re -roofs Type of1Zoof $700 Required Inspections CONTROL NO. BUILDING PERMIT INFO ELECT PLUMB Valuation Occupancy All roofi shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new Inaterials for inspection. Signatur ,- of Applicant Date All roof coverings to be Class "B' or better CIT1f OF `MkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Buildi.nDepartment JOB ADDRESS: 1/6 - 6��/C 1>t1V1:r :7:jPHONE# PERMIT # OWNER'S NAME: XoR BUSINESS NAME GENERAL CONTRACTOR: 5fylyn PV ffry . A FAX # y02 y -5211 I am not using any subcontractors: Signature P]PSICP At-rk nnnlicable subcontractors and comolete the following information: Date y _w 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 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37539055.00 DATE ISSUED.......: 08/16/2007 RECEIPT #.........: BS000002402 REFERENCE ID # ...: 07080157 SITE ADDRESS 915 FERNGROVE DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER BOB & MARY KIRBY ADDRESS .......... CITY/STATE/ZIP ...: OPERATOR: patg COPY # : 1 RECEIVED FROM ....: FRANS CARTWRIGHT CONTRACTOR .......: FRANS CARTWRIGHT LIC # 26514 COMPANY BETTER WATER HEATERS ADDRESS 351 FALCATO DR CITY/STATE/ZIP ...: MILIPITAS, CA 95035 TELEPHONE (408)250-6672 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 ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 84.02 --------------- 84.02 VOICE ID DESCRIPTION -------- ---------------------------- 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 506 GAS TEST M-,-7-, CUPEkTINO 0)00157 CITY OF CUPERTINO PERMIT APPLICATION FORM APN # U Date: /Me / 7- ,!2 7 Building Address: v/ i Owner's Name: K� K13 V Contractor: S Contact: Phone #: VOg Z!�5 _ b 40 License Cupertino Business License #: ilo Building Permit Info: Bldg11 Elect Plumb Mech Job Description: 12 fpj � �o G+1- ov1p wIfY tirW .1(/ f Residential Commercial ❑ Cost of Project: Strapped On Platform Bonded New Location ❑ Replacement 0 Qty. if Fee ID BPWHEATER PPERMITFEE BIN ERGY BUSLIC Fee Descnpuon Water Heater / Vent Plumbing Permit Issuance Energy Business License FeeGroup BUILDING PLUMBING BUILDING BUILDING