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07080248 77'-777777777777777777—. 77 CITY®F CUPERTINO BUILDING DIVISION PERMIT � � �R jNpATI01 , PERMIT NO. BUILDING ADDRESS: 910 FT BAKER DR TBD - TO BE DETERMINED 07080248 PERMIT ISSUE DATE OWNER'S NAME: MIAOKI AND EVELYN 08129/2007 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH Z LICENSED CONTRACTOR'S DECLARATION Job Descriptiono m CI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is 200 AMPS UPGRADE ain full force and effect 1613Q& z License Cla _ kQ —Lic• F Date Contractor AN ARCHITECTS DECLARATION i a< 1 understand my plans shall be used as public records :yu U.y Licensed Professional a OWNER-BUILDER DECLARATION 1 hereby lfirm that 1 am exempt from the Contractor's License Law for the :00 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure prior u)its issuance,also requires the applicant for such permit to rile a signed statement Valuation '? Ft. Floor Area < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq _ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $3300 that he is exempt therefrom and the basis for the alleged exemption.Any violation of N Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 6110 3 0 . 0 Number Occupancy Type not more than five hundred dollars($500). ❑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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors 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 Convactofs 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- LJ eclarationsLJ I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I 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 Workers Compensation insurance carrier and Policy number are: Carrier: S �� 0 Policy No.: 131 35-51C) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Chis 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 Workers Compensation provisions of the labor Code,you must O forthwith comply with such provisions or this permit shall be deemed revoked. Z , CONSTRUCTION LENDING AGENCY (~i C4 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.) W Q Lender's Name az Lenders Address U Q I certify that 1 have read this application and state that the above information is [l.►-� cored.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the L3-) above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date " APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�: SOURCE REGULOQNS. /�—.. $_2 g.a7 Re-roof: Signature of Applicant/Contractor Date Type of Roof 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. ❑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 which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new:naterials for inspection. District? ,� ❑Yes /tl no I have read the hazardous materials requirements under Chaptcr6.95 of Utc Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirement%which in metprior toissuance ofaCcrtificatcofOccupancy. Signature Of Applicant Date 7 All roof coverings to be Class"B"or better Owner or authorized agent Data - — CITY OF CUPERTINO �noF' PERMIT APPLICATION FORM CUPE��IN0 (3-7o8c)z11 TIN# Date: "L�'—J1 356 <<U3a , csS Building Address: Mailing Address (if different from building address): G 1 o f0tc 13 ft-OZ Owner's Name: Phone #: �loFF - z.s-1- 9 313— Contractor: License #: wwrA L��(.- `l 6y '3 LS P ----- Contact: Phone: L105'-S9,t-t%j Cupertino Business License#: "1-14 c oSTeN-A_Q Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential F9 btv, Q Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group:3 Type of Construction: Please check this box if the project is a El second-story addition: •oject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID 'F'ee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boili;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 In(UOff/Comm/Quasi BUILDING BCONSTAXBQ Co. . Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 Eli;c 600V <= 1000A ELECTRICAL BELEC1001 E lec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA [nvestigation fee BUILDING 1 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ;