07060004 CITY OFCUPERTINO
DIVISIO
� TN*
BUILDPN PERMIT
PERMIT No.
BUtLD)JJQ�pDI "E HAR LAP DR CUPERTINO PLUMBING 07060004
l�J U b PERMIT nUE DATE
OWNER'S NAME:
CHARLES MA 1300 =j]li AVE 06/01/2007
SANITARY NO. CONTROL NO.
'NE: (408) 25:3-0618
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
ce ZO LICENSED CONTRACTOR'S DECLARATION Job Description
:UIP I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is WATER M I N
=y in full tome and effect - C Z 9
Z Licenx Clots C Lic.a< �y
[;- V 7 Contraclor
Date -moi RCHn'ECPS DECLAPATIbN
i a I understand my plans shall be used as public records
>yV
'a�M Licensed Professional
C a OWNER-BUILDER DECLARATION
3 I hereby affirm that I am exempt from the Contractor's License Law for the
,no 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
r" prior to its issuance,also requires the applicant for such permit to file a signed statement „ Valuation
Z, 9 , .Ft.Floor Area $1500
< that he is licensed pursuant to the provisions o[the Contractor's License Law(Chapter q
2 tT (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of pOccupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 32618026 ."C1 t!�Number
not more than five hundred dollars($500).
0 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 Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
awn 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:)Tie Contractor's U-
cense Law does not apply to an owner of property who builds or improves thereon,and. 11AR
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law. SAt
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:
0 f have and willmaintain 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.
0 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. 6rR',-r f� Policy No.: -2 54Z5 4755
, f
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
('this section need not be completed if the permit is Cor one hundred dollars($100)
or less.)
1 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
0 forthwith comply with such provisions or this permit shall be deemed revoked.
z 0� CONSTRUCTION LENDING AGENCY
[�En I hereby affirm that there is a construction lending agency for the performance of
(Yr> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lendci s Name
=z Lcnder's Address
U 0 1 certify that I have read this application and state that the above information is
w H correct.I agree to comply with all city and county ordinances and state laws relating to
construction,
building consction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
,Hy liabilities,judgments,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:
SOU '
Re-roofs
Signature Dare
re H DUMTERIALS
DISCLOSURE Type of I:oof
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.
0Yes p1le- If a roof s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes R111(r-
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 the building
docs not currently have a tenonFitonsihility to notify the occupant of the
uircme ch emeof teofOccupancy. Signature:of Applicant Date
G 7-6v All roof coverings to be Class"B"or better
Owner or nred agent Date
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 32618026 . 00
DATE ISSUED. . . . . . . : 06/01/2007
RECEIPT #. . . . . . . . . BS000001524
REFERENCE ID # . . . : 07060004
SITE ADDRESS 1OC61 PHAR LAP DR
SUBDIVISION . . . . . .
CITY CUFERTINO
IMPACT AREA . . . . . .
OWNER CHIRLES MA
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1111
RECEIVED FROM CUPERTINO PLMB
CONTRACTOR CAFDIA, FRANK L LIC # 612
COMPANY CUPERTINO PLUMBING
ADDRESS 1300 DELL AVE
CITY/STATE/ZIP CMIPBELL, CA 95008
TELEPHONE (408) 253-0618
FEE ID UNIT QUANTITY RMOUNT PD-TO-DT THIS REC NEW BAL
------------- ---------- -- --------
BPWSVCS WATER SERVICE 1. 00 9. 00 0 .00 9. 00 0. 00
PPERMITFEE FLAT RATE 1. 00 38.37 0 . 00 38 .37 0 .00
----------- ---------- ---------- ----------
TOTAL PERMIT 47. 37 0 . 00 47 . 37 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ------------
CREDIT CARD 47.37 VISA
---------------
TOTAL RECEIPT 47.37
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
REPIPE/SE `E S/M.AIN SERVICE
CUPS TINO PERMIT APPLICATION FORM
APN # ' Date:
B� f'
Building Address:
.
Owner's Name: Phone#:
C�Gf '�S Mme- S��3 --z� �,3
Contractor: Phone: License#: � Z 4 C;()5
Z S 3 —vC� I �-',
ContAct: Phone: Cupertinous. ss License#:
('Gn�
O 7 - 3`l 'l
Building Permit Info:
Bldg ❑ Elect ❑ Plumb B�-
Job Description:
Residential D---" Commercial ❑
Cost of Project:
Qty. if
Applicable— Fee ID Fee Description Fee Group
ER
MFEE ]31dg. Permit Fees BUILDING
GA
BP
BPER Gas Piping System Fee PLUMBING
PPERIVIITFEE :'lambing Permit Issuance PLUMBING
BPREPIPE :Zepi e of Fixtures PLUMBING
BPFIXTURE :?blg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING