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07090160 1777--7777777777777 CITE'OF CUPERTINO BUILDING DIVISION PERMIT NFQRM�TI°'�� PERMIT NO. BUILpIll�G�JWE16ARVER DR AMERICAN RESIDENTIAL 07090160 OWNER'S N NAMEE: PERMM ISSUE DATE JACK YETTAN 860 RIDGE LAKE BLVD 09/24/2007 SANITARY NO. CONTROL NO. SNE: (408) 28;-2165 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB METH 0 p a LICENSED CONTRACTOR'S DECLARATION Job Description U affirm p I hereby am that I am licensed under provisions of Chapter 9(commencing Z U, with Section 70(10)of Division of the Business and Professions C Amy license is REPLACE 15 ' O F MAIN SEWER LINE ° in full force and a , j ? License Class Lie.# wDate Contractor w AR HITECI S DECLARATI t/ i a a l undo rand ans hall be used as public recn s '1 >4U a i- Licensed Professional OWNER-BUILDER DECLARATION j< 1 hereby affirm that I am exempt from the Contractor's License Law for the .C O following reason.(Section 7031.5,Business and Profusions Code:Any city or county e m which require a pernit to concoct,alter,improve,demolish,or repair any structure —y prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �q $4500 21=- (commencing with Section 7(100)of Division 3 of the Business and Professions Cade)or i 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 3753202-- . Number Occupancy Type not more than rive hundred dollars($500). ❑I,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.). Q 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's In- 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 Contractor's License Law. Q I am exempt undo Sec. ,B&P C for this reason Owner Date71 WORKER'S COMPENSATION DECLARATION ( t4 s� t111 I hereby affirm under penalty of perjury one of the following declarations: Q 1 have and will maintain a Certificate of Consent to self-insure for Workces 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 Wor r's, ompe afion Insutan carrier and Policy num r Carrier: Policy No.: 3CV`� -V—T'Z-E"FIPA16EOF'EXEXIPTIONFROMA OFAR 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,1 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z— CONSTRUCTION LENDING AGENCY [~-h C'n 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.) fila A Lender's Name aZ Lender's Address U 0 1 certify that I have read this application and state that the above information is Lt. correct.I agree to comply with all city and county ordinances and state laws relating to Q U building construction,and hereby authorize representatives of this city to enter upon the U ahovc-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against 2 liabilities,jut osts and expense which may in any way accrue against said City in cone c of the ting of this permit Date 0' FSC ANT UND STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: REGU Re-roofs Sigaamfc ,'Applicant/Con D Type of F.00f HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material fined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Q Ye Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.1 agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? Q Yes �t w 1 have read the hazardous materials requirements undcrChapter 6.95 of thc Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building docs not curer 11EWIyt.that it is my responsibility to notify the occupant of the require which m prior to issuance of a Certificate of Occup Signature of Applicant Date All roof coverings to be Class"B"or better cont or- orizcd agent ate CITY OF t�UPERTINO REPIPE/SE � . 4-S/MAIN SERVICE CUFEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: 1061. 0- Owner's NamV. Phone#: r veicevi 9 S� Contractor: � Phon _ � � License.#, Contact, Phon Cupertino Business License#: Building Permit tnfNI. Bldg ❑ Elect ❑ Plumb Job Description: Yf A(4 J (�71&Axy V o ResidentialA Commercial ❑ Cost of Project: (—�� ---- V Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE B:dg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Ri;pi e of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sc wage Disposal PLUMBING BUSLIC Business License BUILDING CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blh: Lot: APN 37532021. 00 DATE ISSUED. . . . . . . : 09,'24/2007 RECEIPT #. . . . . . . . . : BS000002740 REFERENCE ID # . . . : 07090160 SITE ADDRESS . . . . . : 10616 CARVER DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER JACK YETTAN ADDRESS 10616 CARVER DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RESCUE ROOTER CONTRACTOR D014ALD KARNES LIC # 21504 COMPANY AMERICAN RESIDENTIAL SERVICES ADDRESS 860 RIDGE LAKE BLVD CITY/STATE/ZIP . . . : ME]4PHIS, TN 38120-9417 TELEPHONE (408)287-2165 FEE ID UNIT QUANTITY AMOUNT 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 ----------------- --------------= -------------------- CHECK 62 .37 #004370 --------------- TOTAL RECEIPT 62 .37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING Community Development 10300 Torre Avenue a Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 `;UPEI�TIN0 Building Department JOB ADDRESS: PERMIT # /�/a • ► D �V ( �C V "' OWNER'S N PHONE # — Z GENERAL CONTRACTOR FAX # (-//o I am not using any subcontracto �� Z Si mature Dat Please check applicable subcontr d comi:)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 er/Contractor Si ture Da e