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07090188
CITY OF CUPERTINO 777777-777777777, BUILDING DIVISION PERMIT BUILI G ESS: PERMIT NO. �Ci �� SANTA TERESA DR BAY AREA HAULING & BOBCAT 07090188 OWNER'S NAME: PERMIT ISSUE DATE JOANNE & HSIAO—LAN LIU P 0 BOX 36143 09/26/2007 INE: (408) 592-9755 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB0 MECH (� O p LICENSED CONTRACTOR'S DECLARATION Job Description :113 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing p :Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is SWIMMING POOL DEMO y in full force and effect. t�? License Class Lic.# E ❑ Date Contractor ARCHITECTS DECLARATION VI understand my plans shall be used as public records .a +o y Licensed Professional n OWNER-BUILDER DECLARATION 3< I hereby affirm that I am exempt from the Contractor's License Law for the -00 following reason.(Section 703 1.5,Business and Professions Code:Any city or county <m 04 which requires a permit to construct,alter,improve,demolish,or repair any structure z In prior to is issuance,also requires the applicant for such permit to file a signed statement =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 95q.Ft.Floor Area Valuation Z!:: (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5 0 0 0 3 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 araC p�Number QCCIl not more than five hundred dollars($500). 3 5 6 13 0 14 1 ,`lJ'l1' Occupancy Type ❑1,as owner of the property,or my employers with wages as thew 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 Required Inspections 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 sak.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.). I,as owner of the property,am exclusively contracting with licensed contractors to nstruct the project(Sec.7044,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for^h projects with a contractors)licensed pursuant to the Contracta's License Law. ❑[am exemp un r Sec. B&PP 9 It, this reason Owner < Date / d ftRICER'S M A D CLARATION I 4e b a1frm under penalty of perjury one of the following declarations C]1 have an ill 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. ❑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 are: 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 c rfornance of the work for which this permit is issued,1 shall not employ any pc n n any manner so as to bee c jed to o ri Compensation Laws of Calif i Date n Applicant NOTICE NT:If,after maki g tilts Certificate of Ex mption,you should becomes Ic to the Workces Compensation provisions of the Labor Code,you must 0 forthwith o ly with such provisions or this permit shall be deemed mvoked- CONSTRUCTION LENDING AGENCY (-+ I hereby affirm that there is a construction lending agency for the performance of GG the work for which this permit is issued(Sec.3097,Civ.C.) ALenders Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is ly correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. i Hfar (We)agree to save,indemnify and keep harmless the City of Cupertino against 61 f) liabilities,judgments,costs and expenses which may in any way accrue against said City U z in cone ce of the granting of this permit. / " APPLI A UNDERSTANDS AND L COMPLY WITH ALL NON-POINT Issued by: A4Date al SOUR E EGULATIONS. /' O Re-roofs gden�cd A t/Comracto Date HAZARDOUS MATERIALS DISCLOSURE Type of Rc of t the applicant or future building occupant store or handle hazardous material y the Cupertino Municipal Code.Chapter 9.12,and Ute Health and Safety n 25532(a)? ❑Ycs ®No All roofs sliall be inspected prior to any roofing material being installed. 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 ma.erials for inspection. District? �/ ❑Yes [*j Nu 1 have r9Q the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth& e Code,Section 25505.25533 and 25534.1 understand that if the building does not cu nt have a tenant,that it is esponibiltty to notify the occupant of the rcquircmcn w ich most be met prior once of a Certificate of panty Signature of Applicant Date 0 Owner r thorizcd agent ale All roof coverings to be Class "B"or better u - CITY OFCUPERTINO o-7 oq c 8 a DEMO OR OF CUPERTINO PERMIT APPLICATION FORM APN# Date: Jam" i)C ) -- -o Building Address: Owner's Name�joa Phone#: 0�r,z L �`u ��S � � - Lam L c4 o� C ntractor: License#: t,4 4"LtA)Cr v- Contact: �q l Phone#: -0/2 �S L- '75 Applicant/Contractor: Joa L B 'lding Permit Info: 1lectPlu ech Job Description: Residential: �� ►W Ev D ' 1✓ i!�!%D Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuation: Type of Construction: Occupancy Group: � 2 - 3 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN . . . . . . . . . 35013014 . 00 DATE ISSUED. . . . . . . : 09,'26/2007 RECEIPT #. . . . . . . . . . BS0100002784 REFERENCE ID # . . . : 07090188 SITE ADDRESS . . . . . : 10£ 10 SANTA TERESA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JOtd\NE & HSIAO-LAN LIU ADDRESS . . . . . . . . . . : 10310 SANTA TERESA DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4725 RECEIVED FROM . . . . : JOANNE LIU CONTRACTOR . . . . . . . : R013ERT ARRIGHI LIC # 24175 COMPANY . . . . . . . . . . : BA: AREA HAULING & BOBCAT SERV ADDRESS P () BOX 36143 CITY/STATE/ZIP . . . : SAN JOSE, CA 95158 TELEPHONE . . . . . . . . : (408) 592-9755 FEE ID UNIT QUANTITY �MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 5, 000. 00 115 .56 0. 00 115 .56 0. 00 BSEISMICRE VALUATION 5, 000. 00 0.50 0. 00 0.50 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 116. 06 0. 00 116 .06 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 116 . 06 VISA --------------- TOTAL RECEIPT 116 . 06 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform: A _ All the work authorized by this permit B. A portion of the work C. _ None of the work If B or C is checked,cc mplete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the wo:-k (complete section below) Ztractor Address/City Phone # State License # Type of work to be erformed U jD v%ce 3. I will utilize unlicensed person(s) mat ma be aer than my n employer (ediate see reverse side)y to perform�A r portions of the authorized work. I understandy Certificate of Insurance covering workers' torr pensation must be on file at the City of Cupertino Building Department office. Address/City Phone Number Type of work to be Person/Firmerf ormed ......................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse side). r / Date: 0 Property Owner's Signature: .- © � Permit# Job Address: Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 `'UPEkTINO Building Department JOB ADDRESS: PERMIT #�9 76 Q n( S-cY— OWNER'S NAME: S � , - cc ONE # L GENERAL CONTRACTOR: f3 4 FAX # I am not using any subcontractors: - - Sig nature Date Please check applicable subcontrac and com lete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation -� ,-464 w(� 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 Owner/Contractor Signature Date ��J