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07080241 CITY OF CUPERTINO 4 ITEMS OF 9 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36347014 .00 DATE ISSUED. . . . . . . : 08/28/2007 RECEIPT #. . . . . . . . . : BS300002491 REFERENCE ID # . . . : 07080241 SITE ADDRESS . . . . . : 20306 PINNTAGE PY SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : YO\TEZAWA HIROSHI ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5645 RECEIVED FROM . . . . : MI NIELSEN CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 137. 16 65 .84 0. 00 65 .84 0. 00 BPERMFEE VALUATION 6,200. 00 137 .16 0. 00 137 .16 0. 00 BPLANCHK PERMIT FEE 137 .16 183 . 04 0. 00 183 . 04 0. 00 BSEISMICRE VALUATION 6, 200. 00 0.70 0. 00 0.70 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 386 .74 0. 00 386 .74 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 849 . 98 VS --------------- TOTAL RECEIPT 849 .98 CITY OF CUPERTINO BUILDING DIVISION PERMIT c�1RRE�cTo IE(}RMATIOI�°' PERMIT NO. BUILDING ADDRESS: 20306 PINNTAGE PY TBD - TJ BE DETERMINED 07080241 PERMIT ISSUE DATE OWNER'S NAME: YONEZAWA HIROSHI SANITARY NO. CONTROL NO. INE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION 0 o Job Description tc I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z5W with Scctt7000)ofDivision 3of the Business and Professions Code,and mylicense is SKYLIGHT WINDOW REPLACEMENT- ROOF LEAK REPAIR �, in ful���A , icu nom 2 M. L. NEILSEN'CONSTRUCTION AK Licen G pareontractor S DECLARATION �a< 1 understand my plans shall be used as public records �aV U.N Licensed Professional O a OWNER-BUILDER DECLARATION 3< 1 hereby affirm that 1 am exempt from the Contractor's License Law for the in o 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 t "y prior in its issuance,also requires the applicant for such permit to rile a signed statementValuation G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapuz 9 Sq.Ft.Floor Area $6200 t— (commencing with Section 7000)of Division 3 of the Business and Professions Cade)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 Number Occupancy Type not more than five hundred dollars(6500). 36947014 . V V 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 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.). 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 thereat,and. who contracts for such projects with a contractors)licensed pursuant to the Conttactoes 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: 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. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Work Compensauon Insurance carrier and Policy number are: Cartier. IrYWa+G� Policy No.-.0 I A2,4U1 61 CERTI CATS OF EXEMPTION FROM WORKERS' (iYk(i7�(rOMPENSATION 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.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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY E~+a 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 Q Lender's Name az Lender's Address U 0 I certify that I have read this application and state that the above information is LL, r—' correct.1 agree to comply with all city and county ordinances and state laws relating to O U building construction•and hereby authorize representatives of this city to enter upon the Lfa above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,costs and expenses which may in any way accrue against said City ^ '' U Z in consequence of the granum is permit. Date G ►+ APPLI M U RST DS ND W L COMPLY WITH ALL NON-POINT Issued b­: SC E L ONS ' Re-roofs tgnature of Applicant/Contractor Idate HAZARDOUS MATERIALS DISCLOSURE Type of,Zoof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and tbe Health and Safety Code,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed. 0 Yes 9d vo Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants as rued by the Bay Arca Air Quality Management all new I naterials for inspection. District? ❑Yes o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Codc,Sectioru 255 33 and 25534.1 understand that if the building does not currently haw a tenant,tit it u y re nsibility to notify the occupant of the rcy • me s whi m t be met ssuan of a Certificate o a ancy Signator°of Applicant Date All roof coverings to be Class"B"or better wncr or authorized agent to CITY OF C'UPERTINO 07 ID V-0. CITY OF PERMIT APPL I[CATION FORM CUPEkTINO PN # Date: Building Addres • Mailing Address (if diff ent from building address): Owner's Name: Phone#: � ss `1 - b Contractor: License #: Co tact: 4VVN*lone:t--10- '1 Cupertino Business License#: Fax:,510- Building Permit Info: Bldg JA Elect ❑ F'lumb ❑ Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: �G Occupancy Groin Z Type of-Construction: Please check this box if the project is a E"AQ . h-L second-story addition: El roject 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 Boile.r> 500K to 1M Btu MECHANICAL BBOILER4 Boile-> 1M to 1.75 M Btu MECHANICAL BBOILER5 B)iler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX In(VOff/Comm/Quasi BUILDING BCONSTAXBQ Coil. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC 1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 El ec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 y 1 CUPEkTINO M , THIS PLAN S11"U11L �� � i-i I ON Assessor's Parcel Number: f r- ,--p • UVLJ /ALL O i U Name of owner. OV-) t Project address. Contact person. e Phone. 31 Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y� Is privacy protection planting required for the p-oject? Y N On what floor(s) is work being done? =I� — Brief description of work. Code editions: 2001 CBC (Y -N)2001 CF(' (Y -N)2001 CMC (Y-N) 2001 CPC (Y-N)2001 NEC (Y -N) Effective 11/1/020�sv tits cj�;GBD N,{ S1rCaEU • dt`� nn p ,S and�t is ,D, set ue kept onanbes °r 00 Iron. .,.._.,... nn same u;,\d'sn q : 0t�d sP a ha �tamP�n�of th,s p'an e � bathe s N0j be t�e,d , of ,1t V of the violat►on °PC°sal dno r ©� r';tu (ltd�ri Plan Review Process Work Book Page-8-Revis A 8/22/05 Ya» v i s f i r .. { .i r JJy V� c` t� � - ---- .. .. -----. - _ - _ ----------- — y . .... ,. �� _ `� �- v� �' �,; �� � � � G � �� � � - � � � � �, ti .� �. � � [� � �� r � � l� ��� r� ���\ � �� i\ `�\ l � r I ,� �- � - �„� c- `� ; �'� �'�� � � r� �_- �.� ,, ti � ^ �� .,._.....1.��14'� '^"^-=..�� V lis' � � � `� � l �, �1 `� `` 1 /'^„ � � _� I `' ,y LJ `til f�x` v.�.````` r� i � 'w� i i ` �`, °'� 1 i i� � � . 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