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07080261CY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: 10743 BROOKWELL DR OWNER'S NAME: HEMEL ALBERT AND HERTHA ')NrAb T T c+mv ARCHITECT/ENGINEER: W ZLICENSED CONTRACTOR'S DECLARATION O UC I hereby affirm that I am licensed under provisions of Chapter 9 (commencing z �� with Section 7000) of Division 3 of the Business and Professions Code, and my license is ra„ in full force and erre v� Z License CI s Lic. k F p Datc b Contractor � �C ARCHITECTS DECLARATION a-t 1 understand my plans shall be used as public records aV w0 rF„ Licensed Professional OWNER -BUILDER DECLARATION e1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason. (Scction 7031.5, Business and Professions Code: Any city or county .9 which requires a permit to construct. alter, improve, demolish, or repair any structure H prior to its issuance, also requires the applicant for such permit to file a signed statement Z a that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 t= $(commencing with Section 7000) of Division 3 of the Business and Professions Codc) 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). 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 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:). 0 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 docs 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 Contractor's License Law. 0 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: .. . PERMIT NO. CHEROKEE CONTRACTING CO. 07080261 PERMIT ISSUE DATE 356 MAT: i SANITARY NO. CONTROL NO. (408)727-9850 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 o a I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- ation, 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 5700 of the Labor Code, for the performance of the work for which this permit is issued. N Workers C m ��syauuon Iroprance carrier and Policy number UD R Carrier. � �7 G /�y1d Policy No.: ((3 (JO I � CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone 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 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 (See. 3097, Civ. C.) Lender's Name Lender's 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 UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. L/? Signature of of Applicant/Contractor Date 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)? 0 Yes ub Will the applicant or future building occupant use equipment or devices which ,mit hazardous air contaminants as d/crened by the Bay Area Air Quality Management District? ❑ Yes o 1 have mad este hazardous materials requirements under Chapter 6.95 of the Califon nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understated that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requiremenlsayhich roust be met prior to issuance of a Certificate Of Occupancy. Owner or o D? Date ' Job Description REPLACE OLD SEWER LINE 36921006. Issued b Re -roof: Ft. Floor Area $6650 Required Inspections Type,of Roof All roof:; 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. Signature of Applicant Date All roof coverings to be Class "B" or better CM of CUPEkTINO CITY OF CUPERTINO REPIPE/SE E L _S/MAIN SERVICE PERMIT APPLICATION FORM O-7 2� AVN # '3(9 ..Go U BUILDING Date /-3 Cf07 Building Address: 1 0 -7 e66k0-)E z CGr P: umbing Permit Issuance Owner's Name: /9 1 � e -Z,� 0�—soq e-1, Repipe of Fixtures Phone #: Contract Phone: � ,,4 P01g. Fixture License #: .� Contact: Phone: PLUMBING Cupertino Business License #: �' Z c - - b "Z_ 2 Buil ring'Permit Info: Bldg ❑ Elect ❑ dumb ®l---*'- Job Desc ' 'on: tf r-- 4) Inr /0J '-S rC-,� L-! V., , Residential Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING ' PPERMITFEE P: umbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE P01g. Fixture PLUMBING BPWSVCS N:ain Water Service PLUMBING BPSEWER S,;wers PLUMBING BPSEWAGE Si. -wage Disposal PLUMBING BUSLIC B isiness License BUILDING CITY Of -UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: g © �L+J�L L Df' Co PERMIT # OWNER NAME: z� v� r ' PHONE # T GENERAL CONTRACTOR: V 2 P E- FAX # q C (5- j 6 7— () z 8" 4:0 �0 I am not using any subcontractors: - Si gnature Date Plvaca rl�Prlt an»l;d-able a,lhrontrartnrG and comn:)lete the following information Owner/ Contractor Si e Date v �y 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 G c' " 4 ; - �.�-- Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Si e Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: CathyS COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36921006.00 DATE ISSUED.......: 08/30/2007 RECEIPT #.........: BSC00002519 REFERENCE ID # ...: 07C80261 SITE ADDRESS .....: 10-/43 BROOKWELL DR SUBDIVISION ....... CITY CUPERTINO IMPACT AREA OWNER ............: HEIKEL ALBERT AND HERTHA TRUSTE ADDRESS ..........: 10-/43 BROOKWELL DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014-4608 RECEIVED FROM ....: ROBERT RUTZ CONTRACTOR .......: YATES, JAMES H LIC # 702 COMPANY ..........: CHEROKEE CONTRACTING CO. ADDRESS ..........: 356 MATHEW ST CITY/STATE/ZIP ...: SANTA CLARA, CA 95050 TELEPHONE ........: (408)727-9850 FEE ID UNIT QUANTITY !MOUNT PD -TO -DT THIS REC NEW ------- BAL ----------------------- BPSEWER SEWER ---------- SYSTEM 1.00 --------------------- 21.58 0.00 21.58 0.00 PPERMITFEE FLAT RATE 1.00 40.79 ---------- 0.00 40.79 ---------- ---------- 0.00 TOTAL PERMIT ----------- 62.37 0.00 62.37 0.00 METHOD OF PAYMENT AMOUNT REFERENCE -------------------- NUMBER ----------------- CREDIT CARD --------------- 62.37 MC TOTAL RECEIPT --------------- 62.37 VOICE ID DESCRIPTION VOICE ID -------- --------- DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL