07080198 CITY.OF CUPERTINO
BUILDING 12WISION PERMITTTfl ZEQIA'TI(�N�;
PERMIT NO.
BUILDJJIQ 7 9 BROOKWELL DR STERLING GENERAL 07080198
l(J /y PERMIT ISSUE DATE
OWNER'S NAME:
MERCER SHERRYL E 1566 SA13INA WAY 08/21/2007
SANITARY NO. CONTROL NO.
JE: (408) 26,-)-2036
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
cd Z LICENSED CONTRACTOR'S DECLARATION Job Description
W F I hereby affirm that I am licensed under provisions of Chapter 9(commencing
zwith Section 7000)of Division 3 of the Business and Professions Code,and my license is FIVE DA'NAGE REPAIR NEED TEM POWER POLE
y in full force and cff t l
z License Class �•
o
it
Date Contractor !9V1M tun /,d._linL-5`t
W ARCHITECTS DECLARATION
i a< (understand my plans shall be used as public records
iyU
w y Licensed Professional
o a OWNER-BUILDER DECLARATION
aI hereby affirm that 1 am exempt from the Contractor's License Law for the
:C0 following reason.(Section 7031.5,Business and Professions Code:Any city or county
%m, which requires a permit to construct,alter,improve,demolish,or repair any structure
i' prior to its issuance.also requires the applicant for such permit to rile a signed statement S Ft.Floor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 fl $606
t=G (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 Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 9 210 3 3 q. 64 Number P Y YP
not more than five hundred dollars(3500).
0 1,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 J.
0 1,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 conuactor(s)licensed pursuant to the Contractors
License Law.
B&P C for this re
0 1 am exempt under Sec con
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
L]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.
0 1 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:
Carrier.li 66 _ � Policy No.:ptk�140
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not he 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 Workces 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
(�►�. I hereby affirm that there is a construction lending agency for the performance of
,x > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
p+ Lender's Address
U CI certify that 1 have read this application and state that the above information is
corcct.I agree to comply with all city and county ordinances and state laws relating to
F" Zbuilding construction.and hereby authorize representatives of this city to enter upon the
W 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
()Z in consequence of the granting of this permit. Date
►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b y:
&,fEG�LATIOIJ,S.
� t Re-roof:Sig "Ii.UCntrutor Date T e 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 roof;shall be inspected prior to any roofing material being installed.
0 Yes No
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new Tiaterials for inspection.
District?
0 Yes o
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
INE��
s my responsibility to notify the occupant of theDate
issuance of a Certificate of Occupancy. Signatul e of Applicant
All roof coverings to be Class"B"or better
Own auth ircd agent Date
CITY OF C'UPERTINO
TEMP POWER
CITY OF.
CuPEkTINO PERMIT APPL_[CATION FORINT L-7 C
I-11PN# Date:
Building Address: C1
Owner's Name: Phone#:
Contractor: -- -- --- Phone: License 41
Contact: - Phone: Cupertino Business License #:
Building Permit Info:
Elect 0
Job Description:
Residential Commercial ❑
Cost of Project: 06
Cw?v
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Ti,mporary Power ELECTRICAL
EPERMITFEE E:ect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
CITY OF CUPERTINO
2 ITEMS OF 12 PERMIT RECEIPT OPERATOR: CathyS
COPY # 1
Sec: Twp: Rng: Sub: Blk-: Lot:
APN . . . . . . . . . 36-21033 .00
DATE ISSUED. . . . . . . : 0821/2007
RECEIPT #. . . . . . . . . : BS000002444
REFERENCE ID # . . . : 07080198
SITE ADDRESS . . . . . : 10'198 BROOKWELL DR
SUBDIVISION
CITY CU?ERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MERCER SHERRYL E
ADDRESS . 10798 BROOKWELL DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4609
RECEIVED FROM STERLING
CK WGENERAL
LIC # 22979
CONTRACTOR . . . . . . .
COMPANY . . . . . . . . . . : STERLING GENERAL CONSTRUCTION
ADDRESS : 1566 SABINA WAY
CITY/STATE/ZIP . . . : SPN JOSE, CA 95118
TELEPHONE . . . . . . . . : (408) 266-2036
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS-REC- --NEW-BAL-
------ ---------- - -
---- ---
BTEMP FLAT RATE 1.00 62 .10 0. 00 62 .10 0.0
38.37 0.00 0
EPERMITFEE FLAT RATE 1. 00 ---------- -
----- ----- _00
------
TOTAL PERMIT : 100.47 0. 00 100 .47 0. 00
VOICE ID
DESCRIPTION VOICE ID -------DESCRIPTION
---------
-- --------------------------- -
- -----------
--------
103 UFER 304 ROUGH ELECTRICAL