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07080164 7OWNER'SNAME: PERTINO � IipRMAfiIUI�' IVISION PERMIT PERMIT NO. S: CUPERTII`O PLUMBING 07080164 MERRITT DR PERMIT ISSUE DATE ON K ET AL 1300 DELL AVE SANITARY NO. CONTROL NO. NE: (408) 25: -0618 BUILDING PERMIT INFO rARCHITECT/:ENGINEER: BLDG ELECT PLUMB MECH Z LICENSED Co DECLARATION Job Description WP: ereby affirm that I am licensed under provisions of Chapter 9(commencing UZ on 7000)of Division 3 of the Business and Professions Code,and my license is RE P I P E C iALV TO COPPER NO F I TURE S AND REPLACE =w in full force and effectr �C(S'0 ( z License Clan F✓ Lic.N WATER " —( 7 Contractor M p Date ARCHITEC'CS DECLARATIO '1'E HEATER :5-1i a I understand my plans shall be used as public records yU U.ti Licensed Professional •O a OWNER-BUILDER DECLARATION 1 a 1 hereby affirm that I am exempt from the Contractor's License Law for the :n ofollowing reason.(Section 7031.5,Business and Professions Code:Any city or county (i which requires a permit to construct,alter,improve.demolish•or repair any structure Valuation r y prior to its issuance,also requires the applicant for such permit to rile a signed statementF31629071 j Ft.Floor Area Z< that he is licensed pursuant to the provisions of the ConUactef s License Law(Chapter 99 $5000 H (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 ofN Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of0 Number not more than five hundred dollars(5500). ❑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 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 contract°rs to construct the project(Sec.7044,Business and Professions Code:)The Contractor's 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 Conuwwes License Law. B&P C for this reason ❑1 am exempt under Sec. OwnerWDate ORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L_l I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sati°n,as provided for by Section 3700 of the Labor Code,for the performance of the work for 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 Worker's Compensation Igsunnce carrier and Policy number are: UG'S L Z Carrier: G� — -_ Policy No.:L7 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for rine 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 ',Z forthwith comply with such provisions or this permit shall be deemed revoked. Z� CONSTRUCTION LENDING AGENCY (�Cn. I hereby affirm that there is a construction lending agency for the performance of IY+> the work for which this permit is issued(Sec.3097,Civ.Q W Q Lender's Name G+ Lender's Address I certify that I 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 ahovc-mentioned property for inspection purposes. >'' a (We)agree to save,indemnify and keep harmless the City of Cupertino against Hr/] liabilities,judgments,costs and expenses which may in any way accrue against said City t;)Z m consequence of the granting of this permit. Date / APPLICANT UNDE TANDS AND WILL COMPLY WITH ALL NON-POINT Issued Ey: �_— SOURCERE N 07 Re-roof Signatu ppli ontractor Dare T of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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. r-1 Yes N° If a too is installed with first obtaining an inspection,I agree to remove ( Will the applicant or future building occupant use equipment ordevices which all new materials for inspection. emit hazardous air contaminants as defined by the Bay Area Air QualityManagement District? �,,,,/� ❑Yes ISry0 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sox' 25505.25533 and 25534.I understand that if the building d current) ant,tha y respansibility to notify the occupant of the Date quire hch stbe iss of aeertificateofOccupancy. Signature of Applicant C D Al]roof coverings to be Class"B" or better Owner or authorized ag t Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN 31629074 .00 DATE ISSUED. . . . . . . : 08, 17/2007 RECEIPT #. . . . . . . . . . BS000002412 REFERENCE ID # 07080164 SITE ADDRESS . . . . . : 19660 MERRITT DR SUBDIVISION . . . . . . . CITY CU-?ERTINO IMPACT AREA OWNER . . . . . . . . . . . . : 001 BOON K ET AL ADDRESS : 19560 MERRITT DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2439 RECEIVED FROM FRkNK CARDIA CONTRACTOR CARDIA, FRANK L LIC # 612 COMPANY CUPERTINO PLUMBING ADDRESS . 1300 DELL AVE CITY/STATE/ZIP CAMPBELL, CA 95008 TELEPHONE (408) 253-0618 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 BPWATER UNIT 1. 00 9 . 00 0. 00 9 . 00 0. 00 BPWHEATER PER HEATER 1. 00 10.79 0. 00 10.79 0.00 BSEISMICRE VALUATION 5, 000. 00 0.50 0.00 0.50 0. 00 PPERMITFEE FLAT RATE 1.00 38.37 0. 00 -----38_37 ------0_00 ---------- ---------- TOTAL PERMIT 93 .52 0. 00 93 .52 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -- CREDIT CARD 93 . 52 VS --------------- TOTAL RECEIPT 93 .52 VOICE ID DESCRIPTION VOICE ID DESCRIPTION __ __ - ----------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING Community Development :h 10300 Torre Avenue J ,� Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF 'UPEkTINO Buildin De ar"I' JOB ADDRESS: PERMIT.# / 4 c � WNER S NAME: PHONE # ' '7 3 S`f O n GENERAL CONTRACTOR: FAX # -- I am not using any subcontractors: - Date Si;;,tiatur Please check applicable subcontractors and complete the followin information: SUBCONTRACTOR BUSIrTESS 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 CITY OF C,'UPERTINO 0 of PERMIT APPLICATION FORM CUPEIiTINO 0-70, (D © � PN# I� Z 1�� � - Date: - 0 — 07 Building Address: Piailing Address (if different from building address): 6C Ike 0, Owner's Name: Phone#: CC � , 5 )U 9-73 - (4- 0 Contractor: P� License #: — r Contact: Phone: 2S -3 C`G 1 Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect ❑ Plumb �— Mech ElJob Description: v �'t Y+v rc5 ' r Residential C e 1 c s� d c� / Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: OccupV__ —7 Type of Construction: �— Please check this box if the project is a � _ v 0 C) second-story addition: El �oject Size: Standard ❑ Large ❑ Major ❑ Fee ID Fee Description Fee Group Quantityether Appliances MECHANICAL BAPPLOTHER BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS L oiler> 1.75M Btu MECHANICAL BCONSTAX -onstruction Tax BUILDING BCONSTAX In 3/Off/Comm/Quasi BUILDING BCONSTAXBQ Ccn. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 E=ec 600V <= l OOOA ELECTRICAL BELEC1001 E lec 600V> I OOOA ELECTRICAL BELEC200 Elec. Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING L of 3