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07060178 CITY OF CTIPERTINO BUILDINDIVISION PERMIT +C1TRAt-aTfl G I ? ATIC}N� BUILDING ADDRESS: PERMIT NO. 10157 CAMBERLEY LA CHEROKEE CONTRACTING CO. 07060178 OWNER'S NAME: PERMIT ISSUE DATE DAVE CLARK 356 MATHEW ST 06/21/2007 SNE: SANITARY NO. CONTROL NO. (408) 727 -9850 ABUILDING PERMIT INFO RCHITECCJBNGINEER: BLDG ELECT PLUMB MECH i p o LICENSED CONTRACTOR'S DECLARATION Job Description %UF 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z UW with Section 7000)of Division 3 of the Business and Professions Code,and my license is INSTALL 3AC KWATER VALE SEWER. H in full force and effec C V z License Class Lam•# t-p Date rJ 1 L Lan Contractor ARCHITECT'S DECLAR TION 7 C< 1 understand my plans shall be used as public records )ulU U.H Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the p 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 Z�y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 S�.Ft.Floor Area ut- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $2750 y 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 ofNumber Occupancy Type not more than five hundred dollars(5500). 34242 023 q� ❑1,as owner of the property,or my employees with wages as thew sole compensation, will do the work.and the structure is not intended oroffered for sale(Sec.7044,Business ns Required Inspections and Professions Code:The Contractor's License Law does not.apply to an owner of 9 P 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.). p I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractoes U. cense Law does not apply to an owner of property who builds or improves thereon,and RY who contracts for such projects with a conuactor(s)licensed pursuant to the Contractor's License Law. AN TA ❑I am exempt under See. B do P C for this reason Owner Dare 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. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 37W of the Labor Code,for the performance of the work for which this permit is issued. My WorkeessC.!;oAm nsadon Insurance carrier and Policy number are: Cartier: ✓tClAan Policy No.:—/Jr43 t"Q CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for anc 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. z, CONSTRUCTION LENDING AGENCY (--h c4f) 1 hereby affirm that there is a construction lending agency for the performance of _ Q!> the work for which this permit is issued(Sec.3097.Civ.C.) Rw.A Lender's Name a z Lenders Address U C) I certify that I have read this application and state that the above information is V.h correct.I agree to comply with all city and county ordinances and state laws relating to 0 J building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against HrA liabilities,judgments,costs and expenses which may in any way accrue against said City V z in consequence of the granting of this permit. Date * APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUR RE UL TIONS. In JAL Z( I Re-roofs Signiture of Applic=t/ContractoL Date Type Of RO Jf 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)? All roofs shall be inspected prior to any roofing material being installed. No Yes t 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new ma.erials for inspection. District? J J ❑Yes [ S 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 rhe building docs not currently have a tenant,that it is my responsibility to notify the occupant of the req ' nts which tut be met prior to issuance of a Ccrtifica mf occupancy. Signature c f Applicant Date L 1 G All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF C:UPERTINO ITEM 1 OF 1 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk; Lot: APN 342,12023 . 00 DATE ISSUED. . . . . . . : 06/21/2007 RECEIPT #. . . . . . . . . : BSO )0001732 REFERENCE ID # . . . : 07050178 SITE ADDRESS . . . . . : 10157 CAMBERLEY LA SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER DAVE CLARK ADDRESS CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2632 RECEIVED FROM . . . . : ROBERT RUIZ CONTRACTOR . . . . . . . : YATES, JAMES H LIC # 702 COMPANY . . . . . . . . . . : CHEROKEE CONTRACTING CO. ADDRESS . . . . . . . . . . : 356 MATHEW ST CITY/STATE/ZIP . . . : SAETA CLARA, CA 95050 TELEPHONE . . . . . . . . : (408) 727-9850 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ------ ---------- ---------- ---------- ------- ---------- PPERMITFEE FLAT RATE 1. 00 -_---38_37 ------0_00 ----- - ------ -- -- TOTAL PERMIT 38.37 0. 00 38.37 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------ CREDIT CARD 38.37 MC --------------- TOTAL RECEIPT 38.37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO 010(0 01 .......zll �' SERVCE I C I ITWY F' REPIPE/SE`,-,V, /MAIN!Wk�, CUPEkTINO PERMIT APPLICATION FORM CPN - Zq oZ©�3 Building Address- 1,5:z . Owner's Name: Phone#: �-.o ractoj-. 11hoiie: er 1z Contact: Phone: Cupertino Business License 7\ Building Permit Info: Bldg El Elect El Plumb Job Desc4#tionl • Residential Commercial F-1 Cost of Pro' F :-,77 Qty. if Applicable Fee ID Fee Descripti Fee Group BPERMFEE Bk g. Permit Fees BUILDING BPGAS G&; Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Seivers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING