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07080250 CITY OF CUPERTINO PERMIT BUILDING DIVISION iERMI1 PERMIT NO. BUILDN WRESS: BROSCOE ELECTRIC 07080250 ��3y YORKSHIRE DR PERMIT ISSUE DATE OWNER'S NAME: VINCENT JAMES H AND CAROLE L 1658 ESANICAPITOL EXPWY PMB 08TARN 02NO. CONTROL NO, Meer NE: (408) 22;,-8111 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB Mn 0�Z LICENSED CONTRACTOR'S DECLARATION Job Description O UI o I hereby affirm that I am licensed under provisions of Chapter 9(commencing SERVICE CHANGE TO 200 AMP S Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full force and effect v2 Z License Class C "i Lie.H ❑ Datc Contractor ;mow C CTS DEC i a I understand my plans shall be used as public records i0.V u.y Licensed Professional O a OWNER-BUILDER DECLARATION 3 a I hereby affirm that 1 am exempt from the Contractor's License Law for the Business and Professions Code:Any city or county ❑o following reason.(Section 7031.5, 1w ru which requires a permit to construct, improve.demolish,or repair any structure Valuation i-•� prior m its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area $1800 ?a that he is licensed pursuant to the provisions of Ole Contractor's License Law(Chapter 9 q Ire❑ (commencing with Scction 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 36207018 `V(l Number not more than five hundred dollars(5500). 0 1,as owner of the property,or my employees with wages as thew sole compensation, Required Inspections will do the work.and the structure is not intended or offered for sale(Sec.7044,Business and Professions Crede:The Contractor's License Law docs 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 be did not build or improve for purpose of sale.). 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business ess and Professions buil Codeds or improves tractors Li- cense Law does not apply property who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's and License Law. B&P C for this reason 0 I am exempt under Sec . Owner Date 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 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 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 arc: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This 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 man so as to become iro the Wor Compensation Laws of Califo tc Applicant NOTICE TO A CANT:I,after making this Certificate of Exemption,you should become subject the Workcr'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 [�.C4-r I hereby affirm that there is a construction lending agency for the performance of ai> the work for which this permit is issued(Sec.3097,Civ.C.) Lfa QLender's Name aZ Lender's Address U Q I certify that 1 have ad this application and state that the above information is re LL 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 above-mentioned properly for inspection purposes. a (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 U Z in consequence of the granting of this permit. Date / ►+ APPLI A"ULAn ANDS AND WILL COMPLY WITH ALL NON-POINT Issued t�y: SOUR E SRe-roofsSigna, nv for °are Type of Roof HAZARDOUS MATERIALS DISCLOSURE YP Will the applicant or future building occupantstore or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roo's shall be inspected prior to any roofing material being installed. 0Yes "° 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 materials for inspection. District? .� 0 Yes 1"`'. I 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 docs not currently have a tenant,that it is my responsibility to notify the occupant of the Date requirements whi h m t be m prio o issuance of a 'Certificate of Occupancy. Signatt.re of Applicant All roof coverings to be Class 'B11 or better Date Owner or autho agent d Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 C1T1(OF Fax(408)777-3333 "UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # v , 0it '? d OWNER'S NAME: S PHONE # — C GENERAL CONTRACTOR: 6 1Z r6Mi FAX # I am not using any subcontractors: ldlaz—V2,L ! " Si gnature Date Please check applicable subcontractors and comn:)lete 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 9,A. I V, c2cl- QI qwner/Contractor Signature Date CI'T'Y OFC UPERTINO 07� d W PERMIT APPLICATION FOM CUPEkTINO PN# OR Date: 1,2-q=0 39 I' S 1 c G Building Address: Mailing Address (if different from boli g address): S Owner's Name: Phone#: q 11 CPT — 2 — Il Contractor: ¢n _ �� ense#: Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Sc •� �,e T 7`O a .4 Bldg ❑ Elect P''.umb ❑ Mech ❑ Job Description: Residential Commercial El Sq.Ft. Floor Area: Sq.Ft.: i Cost of Project: cW Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ •oject Size: Standard Ir Large ❑ Major ❑ Quinti Fee ID Tee Description Fee Group BAPPLOTHER C►ther Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Inc/Off/Comm/Quasi BUILDING BCONSTAXBQ Cori. Tax for BQ Zone BUILDING BCONSTAXH "I3otel and Motel BUILDING BCONSTAXR Cortstax—Resi/Mobile BUILDING BELEC 1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD ]Energy Add Multi BUILDING BINVESTIGA -nvestigation fee BUILDING 1 of 3 CITY OF CUPERTINO 2 ITEMS OF 3 PERMIT RECEIPT OPERATOR: nancyc COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN 36: 07018 .00 DATE ISSUED. . . . . . . : 08/ 29/2007 RECEIPT #. . . . . . . . . . BS(100002508 REFERENCE ID # . . . : 07080250 SITE ADDRESS 11:59 YORKSHIRE DR SUBDIVISION . . . . . . CITY CU'ERTINO IMPACT AREA . . . . . . . OWNER VI14CENT JAMES H AND CAROLE L ADDRESS . . . . . . . . . . CITY/STATE/ZIP CU?ERTINO CA, 95014-4916 RECEIVED FROM . . . . : BRDSCOE ELECTRIC CONTRACTOR BRDSCOE, STEVE LIC # 21429 COMPANY . . . . . . . . . . . BRDSCOE ELECTRIC ADDRESS 1658 E CAPITOL EXPWY PMB #554 CITY/STATE/ZIP SAN JOSE, CA 95121 TELEPHONE (408) 223-8111 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---- BELEC200 METERS 1 .00 29.43 0 .00 29.43 0.00 EPERMITFEE FLAT RATE 1 .00 40.79 0 . 00 -----40_79 ------0_00 ---------- ---------- TOTAL PERMIT 70.22 0. 00 70 .22 0 .00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- __ _ -------- -------------------- -- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL