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07090012 -7777777777777. 77777 7:!77 :j: CITY OF CUPERTINO �}T� BUILDING DIVISION PERMIT PERMIT NO. ""DT DpRESS: 1H S STELLING RD PLUMBERS ON CALL 07090012 PERMIT ISSUE DATE OWNER'S NAME: BEAM ROY D AND CATHERINE A 520 E MCGLINCY LN 09/05/2007 SANITARY NO. CONTROL NO. NE: (408) 8'79-0483 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p 0O LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing z cU with Section 7000)of Division 3 of the Business and Professions Code,and my license is RE—PIPE TO COPPER AND WATER HEATER. a- in full force and effect. v�z License�l� Lic.N t— Date %l Contractor ARCHITECTS DECLARATION i a I understand my plans shall be used as public records iaU U.y Licensed Professional O OWNER-BUILDER DECLARATION 3 a I hereby affirm that I am exempt from the Contractors License Law for the MC following reason.(Section 7031.5,Business and Professions Code:Any city or county rZr, which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to rile a signed statement ;q.Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $8564 e (commencing with Section 7000)of Division 3 of the Business and Professions Code)or r3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of ,�Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 2 2 6 0 0 . not more than five hundred dollars(5500). 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 improvem �di oner of completion,the owner- builder will have the burden of provind or improve for purpose of sale.). ❑1.as owner of the property,am exwith licensed contractors to concoct 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 contractors)licensed pursuant to the Contractees License Law. 1 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: 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. Ihave 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 Insurance carrier and Policy number are: Carrier. 5�� T Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not le 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,t 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 Q CONSTRUCTION LENDING AGENCY E r►.-c I hereby affirm that there is a construction lending agency for the performance of (Y.> the work for which this permit is issued(Sec.3097.Civ.C.) W Q Lender's Name ZLender's Address I certify that I have read this application and state that the above information is LUI,O correct.1 agree to comply with all city and county ordinances and state laws relating to rJ U building construction,and hereby authorise representatives of this city to enter upon the about-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against cn liabilities,judgments,toss and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date > G APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Date T Of F:oof 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 Hcalth and Safety Code,Section 25532(a)? �e All roofs shall be inspected prior to any roofing material being installed. Yes Will the applicant or future building occupant use equipment or devices which If a roof .s installed without first obtaining an inspection, agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? / Yes o 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 does nut currently have a tenant,that it is my responsibility to notify the occupant of the requirements wn;�be,rt prior to i;sutancc of a Certificate of Occupancy-,� Signature,of Applicant Date All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 36226005.00 DATE ISSUED. . . . . . . : 09/05/2007 RECEIPT #. . . . . . . . . : BSC00002553 REFERENCE ID # . . . : 07C90012 SITE ADDRESS . . . . . : 1124 S STELLING RD SUBDIVISION CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BE7,M ROY D AND CATHERINE A ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5021 RECEIVED FROM . . . . : PLUMBERS ON CALL CONTRACTOR . . . . . . . : ROBIE DOBKINS LIC # 27158 COMPANY PLUMBERS ON CALL ADDRESS 520 E MCGLINCY LN CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE (408) 879-0483 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- -------- BPFIXTURE UNITS 2 . 00 18 .00 0. 00 18.00 0. 00 BPWHEATER PER HEATER 1. 00 10.79 0. 00 10.79 0. 00 BSEISMICRE VALUATION 8, 564. 00 0 .90 0. 00 0.90 0. 00 BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 . 00 0. 00 PPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 177 .48 0. 00 177 .48 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 177 .48 #15168 --------------- TOTAL RECEIPT 177 .48 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING ,.3 CITY OF C�UPERTINO 0-7 �q ��tZ CITY F PERMIT APPLICATION FORM CUPERTINO -PN# Date: Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: Contra tor: License #: _ '7/,? 6r G Contact: Phone: C�G� 7� v" upertino Business License#: Fax: 7 Building P it Info: Bldg ❑ Elect ❑ Plumb [ Mech ❑ Job Description: J11, Residential 14 G Gc� Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: i3 Type of Con ruction: Please check this box if the project is a second-story addition: El ;•oject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID fee Description Fee Group BAPPLOTHER Other 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 Bciler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind.'Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Con3tax —Resi/Mobile BUILDING BELEC1000 Ele-, 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec 35vcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD E:iergy Add Multi BUILDING BINVESTIGA llvestigation fee BUILDING 1 of 3