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07090173CITY OF CUPI"RHNv BUILDING DIVISION PERMIT BUILaff5aty�DRR_TERFORD DR OWNEWS NAME: SAMUEL LIU YNE: ARCHITECT/ENGINEER: CHARVEZ CONSTRUCTION 360 W 8TH ST (408)89-,-7693 I hereby affirm that I am licensed under provisions of Chapter 9 (core mencing ELECTRIC TEMP POWER with Section Mm) of Division 3 of the Business and Professions Codc, and m license is in full force and effe ,,// License Class Lic. # — 0 Date_ Contractor C M11►✓ Z CT7bfr ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 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 to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7010) 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 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 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 and Professions Code: The Contractor's License Law dots 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 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 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 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: 12 n, as provihi- and will maintain a Certificate of Consent to self -insure for Workers Compen- ded 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 Worker's Compensation Insurancecarrierand Policy number are: �f Carrier: �Iri—rte r'�^ Policy No.:i)LZXCI 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, 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 Cenificatc 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 , CONSTRUCTION LENDING AGENCY F.c CA 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 A L.endcr's Name Z Lcnder's Address certify that I have read this application and state that the above information is CUt. O correct. I agree to comply with all city and county ordinances and state laws relating to rJ U building construction, and hereby authome representatives of this city to enter upon the W above-mentioned property for inspection purposes. Q. (We) agree to save, indemnify and keep harmless the City of Cupertino against Ht) liabilities, judgments, costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. ►'� APPLICANT UNDE STANDS AND WILL COMPLY WITH ALL NON -POINT SOUR GULA NS. Signal reof ApplicanHConuutor to 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 0-K0_ 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 District? 0 Yes Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth& Safcty Cudc, Sections 25505.25533 and 25534.1 understand that if the building docs not currently ve a tenant/ n u my responsibility to notify the occupant of the requirements w ' � t ( r issuance of a Ccrtificatc of Occypanry• Owner or authorized agent _ Date ;q. Ft. Floor 3661702'7: Issued b) Re -roofs PERMIT NO. 07090173 PERMIT ISSUE DATE 09/25/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description Valuation $350 Occupancy Required Inspections Type of hoof All roofs 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 riaterials for inspection. Signaturt. of Applicant All roof coverings to be Class "B" or better Date " a(4 CITY OF CUPERTINO CITY OF CUPERTINO TP 30%R. PERMIT APPLICATION FORM M() 9 o 173 CPN # � � Date: Building Address: EPERMITFEE Eloct. Permit Issuance ELECTRICAL Owner's Name: v Phone #: Contractor:�� I2 Phone: �5 t- �� - �4 3 7G `t 3 License #: 3 1> L3ci G Contact: Phone: Cupertino Business License #: %CALPA CAxave i- 1-lor4 -q3 -7G 3 5 Building Permit Info: Elect 2'__ `-rIty Paw £ W2' Job Description: Residential [i/— Commercial ❑ Cost of Project: ❑ �� ma Qty. if 4r�r�lirahla Fee m Fee Description Fee Group vµv BTEMP Temporary Power ELECTRICAL EPERMITFEE Eloct. Permit Issuance ELECTRICAL BUSLIC Bi siness License BUILDING 2 ITEMS OF 2 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: B1}=: Lot: APN 36(117027.00 DATE ISSUED.......: 0925/2007 RECEIPT #.........: BS000002761 REFERENCE ID # ...: 07090173 SITE ADDRESS 75_`)9 WATERFORD DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER SA1IUEL LIU ADDRESS 7559 WATERFORD DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014-5233 RECEIVED FROM ....: RA],PH R CHARVEZ CONTRACTOR RA7,PH CHARVEZ LIC # 23615 COMPANY CHrkRVEZ CONSTRUCTION ADDRESS 3 6 1) W 8TH ST CITY/STATE/ZIP ...: GI:JROY, CA 95020 TELEPHONE (4)8)893-7693 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ------- NEW BAL ----------------------- BTEMP FLAT RATE -------------------- 1.00 62.10 ---------- 0.00 62.10 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 ---------- 0.00 ---------- TOTAL PERMIT ---------- 102.89 ---------- 0.00 102.89 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 102.89 --------------- 102.89 REFERENCE NUMBER -------------------- #895 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------- 103 UFER 304 ROUGH ELECTRICAL 1 F, CITY OF -42, CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: ,_. 7-7 5'9 �v� 7�AFO �� PERMIT # fez c)'-7 42 OWNER'S NAME: ::,5 M 'r C_ 4 rJ PHONE # ,{p S'- S l 3•'7.13 GENERAL CONTRACTOR: *A-Av4z C 0 z,S FAX # I am not using any subcontractors: ' C 4 Z� a `7 Si gnature VDate Please check annlicable subcontractors and complete the following information: Owner/ Contractor Si e Date SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical may , / 4 Cmc - 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 Tule Owner/ Contractor Si e Date