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07030168 CITY OF CUPERTINO �-+ �sr 77-77777777777 7 BUILDING DIVISION PERMIT 1 � Vr4� y}, 6 M. T Q c sulL�r�� LEs BLANEY AV DRAIN DOCTOR PERMIT 07030168 C•uNER'S NAME: PERMIT ISSUE DATE 3ESMEHN, KERRY 1775 WINCHESTER BLVD 03/22/2007 SNE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO SEWER CLEAN OUT BLDG ELECT PLUMB kfH e p LICENSED CONTRACTOR'S DECLARATION j J F 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description awith Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. / ,/ p�� License Cl Li..It /1 7 T 't p Date 3 v— Contractor In &C I2 W ARCHITECCS DECLARATION ra U I understand my plans shall be used as public records -a O in Licensed Professional H< OWNER-BUILDER DECLARATION a I hereby affirm that I am exempt from the Contractor's License Law for the a O following reason.(Scction 7031.5,Business and Professions Code:Any city or county e which requires a permit to construct,alter,improve,demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation 2 (commencing with Scction 7000)of Division 3 of the Business and Professions Codc)or u 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 A]'N Number Occupancy Type not more than five hundred dollars(5500). ❑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 and Professions Code:The Contractor's License Law docs not apply to an owner of "Required Inspections 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to 1 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 ay who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. yj :r-� ❑1 am exempt under Sea B&P C for this reason t ai K ^^mer Date WORKER'S COMPENSATION DECLARATION jPI hereby affirm under penalty of perjury one of the following declarations: z ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn- sation,as provided for by Section 3700 of the Labor Code,for the performance of the t o� work for which this permit is issued. n ❑I have and will maintain Worker's Compensation Insurance,as required by Section t 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1'; My Worker's Compensation Insurance carrier and Policy number are: Carier.7nLKtr_117S1,rA"Cfr Policy No.: R! ?/So3 83 CERTIFICATE OF EXEMPTION FROM WORKERS' 1yT COMPENSATION INSURANCE (This section need not be completed if the permit is foronc 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 yr' NOTICE TO APPLICANT:If.after making this CcrtiGcatc of Exemption,you should f. ` 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 I hereby affirm that there is a constructinn lending agency for the performance of Cl> the work for which this permit is issued(Sec.3097,Civ.C.) 0 Lender's Name a z Landers Address U O I certify that 1 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 building construction,and hereby authorise representatives of this city to enter upon the Q.a ahove-menioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against \\\_ t� liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this pc it. F UNDERSTANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date GULATI 7'7-2 V7. Re-roofs ignatureof App rcanUComractor Date HAZARDOUS MATERIALS DISCLOSURE Type Of Roof 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 "dc.Section 25532(a)? All roofs shall to inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building occupant use equipment or devices which If a roof is 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 materials for inspection. District? ❑Yes 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 o y have a tenant,drat it' my responsibility to notify Ore occupant of the 'c' _nis Ohich mu I prior j cc of a Certiftc of Occu�Z •. .2o7_ Signature of Applicant Date Owner or authorized agent Date- All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 JPERTINO Building Department JOB ADDRESS: PERMIT# /O V3 I Al, OWNER'S NAME: A /Z5 RZs�yj � r,' PHONE # GENERAL CONTRACTOR: /y7 / ,e FAX # G ' p � 3 I am not using any subcontractors:�y 3 ,27 -o-7 Signature Date Please check applicable subcontractors and com lE-te the followin information: SUBCONTRACTOR BUSINF SS 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 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 3163;,112 . 00 DATE ISSUED. . . . . . . : 03/2:/2007 RECEIPT #. . . . . . . . . : BS000000751 REFERENCE ID # . . . : 07030168 SITE ADDRESS . . . . . : 1043S N BLANEY AV SUBDIVISION . . . . . CITY CUPEF.TINO IMPACT AREA . . . . . . OWNER BESMEHN, KERRY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPEFTINO CA, 95014-2333 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : JOHN H. LIM LIC # 24784 COMPANY DRAIN DOCTOR ADDRESS 1775 WINCHESTER BLVD CITY/STATE/ZIP . . . : CAMPEELL, CA 95008 TELEPHONE (408) 370-3082 FEE ID UNIT QUANTITY AMCUNT 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 ----------------- --------------- -------------------- CHECK 59. 95 13284 --------------- TOTAL RECEIPT 59. 95 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/ ENV . /MAIN SERVICE OF UPEkTINO PERMIT APPLICvATION FORM APN # Akagwom%e �� 33,�1� Dat -;-7 -2 -0 :7 Building Address: L13 vi!57 Ow}/er's Name: Phone#: !� /?e_ 16 Sh'I C A 12 Contractor: P h o License#: Contact: Phone: Cupertino ys,7 ess�,icense#: Building Permit Info: t� Bldg ❑ Elect ❑ Pluinb Job Description: �A) Cljk C1-CG,l Ot4y Residential 9 Commckcial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description. Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING / PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Busir ess License BUILDING Told 14101 DISTRICT MnNAGER•ENGINEER 4,��0 5A#iTi��), � BOARD OF DIRECTORS �iy � A.r STEPHEN C.ANDREWS MARK THOMAS&COMPANY,INC. aha fi WILLIAM A.BOSWORTH DAVID E.ROSS JOHN M.GATTO Y>rA;2S Q� DISTRICT COUNSEL SEkLVI"5 CUSS B•HARRISON l� �II�N>t0��,e WENDI;LL H.KERR.JR. ATKINSON•FARASYN,LLP. HAROLD S.TOPPEL 20833 STEVENS GREEK 13OUL°VARD,SUITE 104 CUPERTINO,CAWFORNIJ►950142154 (408)2537071 PHONE • (4M 253.5173 FAX WW w.Cupertinosaniter/distriCt.COM File: CuSD—MOP Building Dept.—Cupertino City of Cupertino Attn.: Building Departrnent 10300 Torre Ave. Cupertino, CA 95014-3202 Subject: Residential Addition/Remodel Name: Besmebn&Kerry Residence Address: 104" N Blaney Avenue aL7 .3� APN: 316-33-112 71 Oe�� Perniit No.07030168 lt2 Rr� ■ Videotape and Property Line Cleanout inspected. No additional conditions/requirements by the District. Inspector: George Santos/Tony Soares/-foe Sullivan Date:...03�-28-2007•........•••••••••• Sanitary Sewer Location; cc: Property owner SUPPLYING SANITARY SEWERAGE SERVICES FOR:Grry OF I UNINC OOF THE D AREASRTIONS ITIES OF SARATOGA.SUNNYVALE,LOS ALTOS AND SURROUNDING TO/Told dno SUWOHl >I?JUW Tb:80 L00z-8z-dUW