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07060153 -7777777777777777 7: CITY OF CTIPERTINO C ? I' ktAIC)R BUILDING DIVISION PERMIT PERMIT NO. BUILf41bIG„PD[}R%ILKINSON AV SIGURA C DNSTRUCTION 07060153 l U 7 G PERMIT ISSUE DATE OWNER'S NAME: 06/19/2007 LIOR LANDESMAN 819 DUFF CT SANITARY NO. CONTROL NO. 3NE: (408) 736-7952 BUILDING PERMIT INFO rRCECT/ENGINEER: BLDG ELECT PLUMB MECH p zOLICENSED CONTRACTOR'S DECLARATION Job Description v Fhereby affirm that 1 am licensed under provisions of Chapter 9(commencing REPLACING VANITY FIXTURES PLUMBING WORK. y ion 7000)oCDivicion 3 of the Business and Professions Code,and my license is y in full force and effect. v�Z Licen Lic• p Datc Comracwr t ARCHITECTS DECLARAT i a a understand my plans shall be used as public records >yU LL H Licensed Professional :or OWNER-BUILDER DECLARATION ja f 1 he affrm that I am exempt from the Contractors License Law for the O O following reason.(Section 7031.5,Business and Professions Code:Any city or county W which requires a permit to construct.alter,improve,demolish,or repair any structure Valuation prior h)its issuance.also requires the applicant for such permit to file a signed statement Ft.Floor Area ?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $450 q e H (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 OCCll Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3561305- Number Occupancy YP not more than five hundred dollars(1500). 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 Conuactoes 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.). 0 1,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 docs not apply to an owner of property who builds or improves thereon,and RY. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's SANITA License Law. B&P C for this reason 0 I am exempt under Sec Owner Date WORKER'S COMPENSATION DECLARATION I 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. 0 1 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 Wor *m -al1';tlWnsLuaoceXEMcr and Policy number are:Cartier. Policy No.:IC TE F EPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(S 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 `A I hereby affirm that there is a construction lending agency for the performance of �i> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Namc Lenders Address z U 0 1 certify that I have ad this application and state that the abo reve information is correct.I agree to comply with all city and county ordinances and stale laws relating to Vbuilding 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 fF,C/1 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: SOURCE G TIO ° bb C Re-roofs SignaturcofA tcant/Contractor are T of Roof HAZARDOUS MATERI DISCLOSURE Type 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 No 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 defined by the Bay Area Air Quality Management all new r laterials for inspection. District? 0 Yes No 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 t°notify the occu ant of the Dale requiremc h u t et 'or cc of a Certificate of pan Signatur;of Applicant Y% U All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF ]UPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35613054.00 DATE ISSUED. . . . . . . : 06/19/2007 RECEIPT #. . . . . . . . . : BS000001689 REFERENCE ID # . . . : 07060153 SITE ADDRESS 10972 WILKINSON AV SUBDIVISION . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . . OWNER LICR LANDESMAN ADDRESS . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4700 RECEIVED FROM . . . . : SIC�URA CONSTRUCTION CONTRACTOR . . . . . . . : ILIN SIGURA LIC # 28892 COMPANY . . . . . . . . . . : SIGURA CONSTRUCTION ADDRESS . . . . . . . . . . : 81c-, DUFF CT CITY/STATE/ZIP . . . : SUTTNYVALE, CA 94086 TELEPHONE . . . . . . . . : (408) 736-7952 FEE ID UNIT QUANTITY i,-MOUNT PD-TO-DT THIS REC NEW BAL ------------- ---------- ----------- ---------- BPFIXTURE UNITS 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 CITY OF C UPERTINO dF PERMIT APPLICATION FORM CUPERTINO APN# Date: Building Address: Mailing Address (if different from building address): �o Owner's Nam : . Phone #: or o G�q_1 Contractor: License #: Contac � Phon `� Cupertino B�n���ens,. AO Fax: Building Permit Inf V�n� � IU1r�5 Bldg Elect ElJ I lumb Mech ElEl Job Description: Residential 1-1Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy-Grow t Ll50 -0 Type of Construction: C-71 Please check this box if the project is a 16AJ_ second-story addition: El Project Size: Standard ❑ Large ❑ Ma or ❑ Quantity Fee ID Fee Descri tion Fee Group BAPPLOTHER ,Jther Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 10 KK to 500K Btu MECHANICAL BBOILER3 Boil er> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Cc nstax—Resi/Mobile BUILDING BELEC 1000 E lec 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Ele,.- Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF C UPERTINO alF PERMIT APPLICATION FORM CUPEkTINO Quanti Fee ID I'ee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N,:w Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atrlospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Blde Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK flan Check Fee BUILDING BPLANCKADD Plai Check Add Multi BUILDING BPLANCKREP Plait Check Repeat Fee BUILDING BPREPIPE Rei e Of Fixtures PLUMBING BPSEWAGE '�ewa a Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSpRINK Lawn SprinklerBackflo PLUMBING BPSTORM torm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT :Zeinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rel c) Furnace> IOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Ir stallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Reri Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc ,tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Re:nodel Res Appliance ELECTRICAL of 3 CITY OF C UPERTINO OCF PERMIT APPLICATION FORM CUPEI,TINO Quanti Fee ID I'ee Descri tion Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vert Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE `.Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP T,,,m orary Power ELECTRICAL BTEMPPERM emporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Eke Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Meeh Permit Issuance MECHANICAL j PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 of 3 Community Development 10300 Torre Avenue axe,. Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ;UPEkTINO Buildin De artment JOB ADDRESS: m PERMIT # PHONE # OWNER'S NAME: GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin information: SUBCONTRAC'T'OR 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