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07060246 CITY OF CUPERTINO BUILbING DMSION PERMIT BUILDING ADDRESS: PERMIT NO. 10910 NORTHSKY SQ CUPERTI.gO PLUMBING 07060246 OWNER'S NAME: PERMIT ISSUE DATE HAMMES MICHAEL 1300 DE,L AVE 06/27/2007 NE: SANITARY NO. CONTROL NO. (408) 253-0618 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 p o LICENSED CONTRACTOR'S DECLARATION V - l hereby affirm that I am licensed under provisions of Chapter 9(commencing lob Description Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE WATER HEATER. H in full force and effect. >h? License Class Lic.# F OW Date Contractor J ARCHITECTS DECLARATION UI understand my plans shall be used as public records a Licensed Professional O 0� OWNER-BUILDER DECLARATION j a 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 703 1.5,Business and Professions Calc: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 rule a signed statement _ that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 iq.Ft. Floor Area Valuation t (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1150 9 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($500). 31640055 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 l red Ins ect10I1S and Professions Code:The Contractor's License e Law docs not apply to an owner of q 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. I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Conuactoes In- cense Law docs not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. ❑lam ex em B&P/ f C'for ththisreason Of Owner Date 2—A) WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: J 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 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 the performance of the work for which this permit is issued.I shall not employ any person in any manners beepm�ubject ro the Workers'Compensation Laws of California.Date �(V Applicant M� 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 Fr►�-� 1 hereby affirm that there is a construction lending agency for the performance of L>~ the work for which this permit is issued(Sec.3097,Civ.C.) aQ Lender's 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 0U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Fti V) 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 UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2 SOURCE LA �,f , Q1Z1/l�2 Re-roofs Signature of Applicanr/Contractor r Date HAZARDOUS MATERIALS DISCLOSURE Type of R(of Will the applicant or future building occupamstore 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 s call be inspected prior to any roofing material being installed. ❑Yes U44. Will thea applicant or future building occupant use If a roof is installed without first obtaining an inspection,I agree to remove pp g p equipment a devices which emit hazardous air contaminants as derrned by the Bay Area Air Quality Management all new materials for inspection. District? / 0 Ycslr--t�w_! 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 docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements wh' be �Jp'or to issuance of a Certireate of Occupancy. Signature c f A Applicant Date �l_&51� �12�U? PP All roof coverings to be Class"Bn or better Owner or authorized agent Dire CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 31640055.00 DATE ISSUED. . . . . . . : 06/27/2007 RECEIPT #. . . . . . . . . . BS000001819 REFERENCE ID # . . . : 07060246 SITE ADDRESS . . . . . : 10910 NORTHSKY SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HA\lMES MICHAEL ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0537 RECEIVED FROM . . . . : MI�HAEL J HAMMES CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612 COMPANY . . . . . . . . . . : CUPERTINO PLUMBING ADDRESS . . . . . . . . . . . 13)0 DELL AVE CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (4)8)253-0618 FEE ID UNIT QUANTITY. AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BENERGY PERMIT FEE 38.37 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 ----------------- --------------- -------------------- CHECK 84. 02 #3326 --------------- TOTAL RECEIPT 84 . 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 4 Community Development ^ 10300 Torre Avenue ` Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: CL Mes PHONE # �{� G - ,�-7752— GENERAL 75ZGENERAL CONTRACTOR: u rV blit FAX # I am not using any subcontractors: Si,-,,,nature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS 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/Contractor Signature Date