Loading...
07060049 77 7 CITY OF CUPERTINO BUILDING DIVISION PERMIT I��IRMATI�N* _ . PERMIT NO. BUILg1r5G�a�D!��tESDRYDEN AVE S I GURA CONSTRUCTION 07060049 l(J y l PERMIT ISSUE DATE OWNER'S NAME: SMITH STEPHEN G AND BARBARA A 819 DUFF CT 06/07/2007 SANITARY NO. CONTROL NO. NE: (408) 7--,6-7952 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MLC] p LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9(commencing v ?Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE WATER HEATER W/TANKLE S S a m in fullforce and effect.'" 'S Z License Lic• t D Contra— SIM" n ARCHrTECTSiA DECLAR ON j 1 understand my plans shall be used as public records D U-- )w U.y Licensed Professional O a OWNER-BUILDER DECLARATION aI hereby affirm that 1 am exempt from the Contractor's License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county W 9 which requires a permit to construct,alter,improve,demolish,or repair any structure -N prior to its issuance,also requires the applicant for such permit to file a signed statement r;q FtFloor Area Valuation -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 . $4 0 0 0 4 t=-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)of i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of 35615010 �Number not more than five hundred dollars(3500). 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.704t,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of properly 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.). C]1,as owner of the property.am exclusively contracting with licensed conlrscmrs to construct the project(Sec.7041.Business and Professions Code:)The Contractor's Li. cense Law docs 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. I am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of Perjury one of the following declarations: L]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 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 Wor s.Co hp�jensatiR— Policy rance carrier and Policy be Carrier. �/ No•: CERT 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,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 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.) LA Q Lender's Name 0 Z Lender's Address U 0 1 certify that I have read this application and state that the above information is k. ►+ 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 Uahove-mentioned property for inspection purposes. Q. (We)agree to save,indemnify and keep harmless the City of Cupertino against tifn liabilities,judgments,toss and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date ►� APPL UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: �&V��6 6"-� SOU ATIO S. {I Y Re-roofs Signature of Applicant/Contractor IDate HAZARDOUS MA ALS DISCLOSURE Type of Loof 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. fi Yes ❑No Will the applicant or future building occupant use equipment or devices which If a roof s installed without first obtaining an inspection, agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? Q Yes ❑Nu 1 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 the building does not currently have a tenant,that it is my responsibility to notify the occupant of the Date requirements which must be met prior to issuance of a Certificate of Occupancy. Signaturc Of Applicant All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 35E15016 . 00 DATE ISSUED. . . . . . . : 06/07/2007 RECEIPT # . . . . . . . . . BSC00001571 REFERENCE ID # . . . : 07C60049 SITE ADDRESS 10514 DRYDEN AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SM-= STEPHEN G AND BARBARA A ADDRESS . . . . . . . . . . CITY/STATE/ZIP CUPERTINO CA, 95014-4746 RECEIVED FROM . . . . : SIGURA CONSTRUCTION CONTRACTOR . . . . . . . : ILAN SIGURA LIC # 28892 COMPANY . . . . . . . . . . : SIGURA CONSTRUCTION ADDRESS . . . . . . . . . . : 819 DUFF CT CITY/STATE/ZIP . . . : SUMYVALE, CA 94086 TELEPHONE . . . . . . . . : (408) 736-7952 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- - --------- ---- BENERGY PERMIT FEE 1 .00 34 . 86 0 . 00 34 . 86 0 . 00 BPWHEATER PER HEATER 1 .00 10 .79 0 . 00 10 .79 0 . 00 PPERMITFEE FLAT RATE 1 .00 38.37 0 .00 - -38 . 37 - 0_00 - --------- ---------- TOTAL PERMIT 84 . 02 0 . 00 84 . 02 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------ CREDIT CARD 84 . 02 VISA --------------- TOTAL RECEIPT 84 . 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION - -------- ---------------------------- ------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO % -74Z CUPERTINO PERMIT APPLICATION FORM �� APN# y, Date: � Sin /.5 0/� Building Address: o14- m6A� Owner's Name: � Phone#: Contractor:- License#: Contact: Cupe no Business License #: uv� �� 2, Building Permit Info: �1 �/,1 VUA t e l V U��� W T �I,1C't (/��1�/► u`cl/4 Ivt l�U1l � �� 11� Bldg ❑ ElectPlumb rr-- Mech Job Description: Residential Commercial ❑ Cost of Project: # Strapped 17 On Platform El Bonded New Location ❑ Replacement ET--, Qty. if Applicable Fee ID _._...........__EDescri tion Fee Group BPWHEATER CvVater Heater/Vent BUILDING PPERMITFEE Plumbm Permit Issuance PLUMBING BEN ERGY Energy BUILDING BUSLIC 3usiness License BUILDING Community Development 10300 Torre Avenue a Cupertino CA 95014 Telephone(408)777-3228 CIV OF Fax(408)777-3333 CUPERTINO Buildin De artment JOB �-} �� �e" 1 I 1(\lJ�,� PERMIT # a�� � ?DRESS: OWNER'S NAME: �� PHONE # ( GENERAL CONTRACTOR11 Va aKi it FAX # li I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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 Tile Owner/Contracto S gnature Date CITE'OF CUPERTINO BUILDING DIVISION PERMIT �T� IQRM�4Tf�N'; PERMIT NO. BUIL¢'effTh FOE DR TBD - TC BE DETERMINED 07060167 "R''SS NAME:ll — / PERMIT ISSUE DATE �OLB BRADLEY A AND ADRIAN G 06/20/2007 SANITARY NO. CONTROL NO. PHONE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH IU p Q LICENSED CONTRACTOR'S DECLARATION Job Description %m I hereby affirm that I am licensed under provisions of Chapter 9(commencing �UZ with Section 70(X0)of Division 3ofthe Business and Professions Code.and mylicense is BATHR00?[ REMODEL-NON STRUCTURAL-REPLACES EXPIRED in full force and effect. j n Z License Class Lic.N PERMIT ( 6060152 . -t-oDam Contractor m ARCHITECTS DECLARATION 7 a e 1 understand my plans shall be used as public records �yU Q.F'• Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the j _c0 following reason.(Section 7031.5,Business and Professions Code:Any city or county '19 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 <' Ft.Floor Area Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 hq r F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $15000 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 Q Number Occupancy Type not more than five hundred dollars(5500). 35925021. V V ❑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 Contractors 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.). as owner of the property,am exclusively contracting with licensed contractors to donswct 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. ❑lam exempt nder Sec B&P C for this reason Le,,yl,° ,b Date 4-11 12 0 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 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 Worker's Compensation Insurance carrier and Policy number are: Carrier. 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 the performance of the work for which this permit is issued,I shall not employ any person in any manner so as 5becom�bi4 ft to the Workers'Compensation Laws of California.Da�qq_& G ' I Applicant G+c( t `c✓t L3'C W 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 Fr I hereby affirm that there is construction lending agency for the performance of (y. > the work for which this permit is issued(Sec.3097,Civ.C.) QLender's Name Lender's Address U O I certify that I have read this application and state that the above information is LL ►" correct.I agree to comply with all city and county ordinances and state laws relating to CJ 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 v) liabilities,judgmenis,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date �— APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGUTIONS. —AP Re-roofs Signature of Applicant/Contractor Date Type Of R JOf HAZARDOUS MATERIALS DISCLOSURE yp Will the applicant or future building occupant store or handle hazardous material -defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes qto Will the applicant or future building occupant use equipment or devices which If a roof i:.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 m iterials for inspection. District? ❑Yes IN. 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requiremcn which must be met pto issuance of a Certificate of Occupancy. Signature of Applicant Date 91'w c mu, � 9� �``��- �' (Z c'f �'7 All roof coverings to be Class"B"or better Owner or authorized agent Date