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07060215 CITY OF CUPERTINO BUILDING DIVISION PERMITIaI�` BUIL DRESS: PERMIT NO. �69 RAINBOW DR CHEROKEE CONTRACTING CO. 07060215 OWNER'S NAME: PERMIT ISSUE DATE CHAN, HENRY 356 MATHEW ST 06/25/2007 )NE: (408) 727-9850 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH i c p LICENSED CONTRACTOR'S DECLARATION Job Description U (= 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z M with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPLACE 4" SEWER LINE. y in lull force and eif, t. j n Z License Class_ '� Lic.# 3 E top Date r Contractor RCHITECTS DECLARATION 1 understand my plans shall be used as public records )yU I,.H Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the O O following reason.(Section 7031.5,Business and Professions Code:Any city or county <m V which requires a permit to construct,alter,improve,demolish,or repair any structure Zprior to its issuance,also requires the applicant for such permit to file a signed statement >a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation EEO FZ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5350 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 of �,p Number Occupancy Type not more than five hundred dollars(S500). 36611028 :C?l 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 ns Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of �l 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.). 0 I,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 thereon,and, who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. 0 1 am exempt under See. B&P C for this reason iANITARY Owner Dau WORKER'S COMPENSATION DECLARATION I hereby alum under penalty of perjury one of the following declarations: �I 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 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 am: '' gLG rb�, 3Sc 7 Carrier: C(� w T . a4 Policy No.:hh 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,1 shall not employ any person in any manner so as to become subject to the Workeri 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 Qforthwith comply with such provisions or this permit shall be deemed revoked. z" CONSTRUCTION LENDING AGENCY E-r CA I hereby affirm that there is a construction lending agency for the performance of a> the work for which this permit is issued(Sec.3097,Civ.C.) a Q Lender's Name Lender's Address V C I certify that I have read this application and state that the above information is — correct.1 agree to comply with all city and county ordinances and state laws relating to 0J building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against rF-+rn 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 SOURCEGULATIONS. t t $c-y, 6� < <2 a7 Re-roofs Signature ol'ApplicantlComractor Dat HAZARDOUS MATERIALS DISCLOSURE Type of F.00f 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. o Yes � If a roof is 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 define by the Bay Arca Air Quality Management all new n.aterials for inspection. District? DYes u 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understated that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the require which must tX IBM prior to issuance of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class"B"or better Owner or authorized agent CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B1{: Lot: APN 36511028.00 DATE ISSUED. . . . . . . : 06/25/2007 RECEIPT #. . . . . . . . . : BS)00001777 REFERENCE ID # . . . : 07)60215 SITE ADDRESS . . . . . : 7638 RAINBOW DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER CHW, HENRY ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : SARATOGA CA, 95070-4236 RECEIVED FROM . . . . : ROBERT RUIZ CONTRACTOR . . . . . . . : YAPES, JAMES H LIC # 702 COMPANY . . . . . . . . . . : CHEROKEE CONTRACTING CO. ADDRESS 356 MATHEW ST CITY/STATE/ZIP . . . : SA',TTA CLARA, CA 95050 TELEPHONE . . . . . . . . : (408)727-9850 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPSEWER SEWER SYSTEM 1. 00 21.58 0. 00 21 .58 0. 00 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38 .37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 59 .95 0. 00 59 .95 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER CREDIT CARD 59.95 MC --------------- TOTAL RECEIPT 59 .95 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 '�',7 n�° 0 2-( 5 REPIPE/SEI ',! .RS/MAIN SERVICE CUPEI�TINO PERMIT APPLICATION FORM APN # 2 O. � � Dat Build' g ddxess: te LJ f� -1 A - --7 1& 1 tO L Owne 's Name: Phone#: C:c��tractor: i' - ' Cron . ! Phone: Cupertino Business License #: Building Permit Info: Bldg ❑ Elect ❑ Plumb Job scription, < Res'dential ❑ Commercial ❑ Cost of Projec Qty. if Applicable Fee ID Fee Description. Fee Group BPERMFEE B dg. Permit Fees BUILDING BPGAS Gis Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE R,-pipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC B-zsiness License BUILDING Community Development % 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEkTINO Building Department JOB ADDRESS: PERMIT # r"A 0 Cc; 0`7 b G U 2--(s OWNER'S NAME: t4VEP✓t�j PHONE #4ZCs r� d GENERAL CONTRACTOR: OR FE-A o FAX # I am not using any subcontractors: 2- Si;natu.re 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 Ck vzo�; Cel �7- Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Si Date