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07030106:UU :2 ray .a Baa >yU =y,F .oa 2� u LE .BUILDINr DIVISION PERMIT BUILDING ADDRESS: 873 COTTONWOOD DR OWNER'S NAME: LAHERRAN RICHARD J AND VIC )NE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and of ct 7 �� U License CI s Lic. S Date Contractor I.i, tJt4LLk _+ai v_+^�RI ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the 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 prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 1, 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. 7041, Business and Professions Code: The Contractor's 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.). ❑ 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- ccnse 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. ❑ 1 am exempt under Sec. B & P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ... PERMIT NO. ALL VALLEY PLUMBING 07030106 PERMIT ISSUE DATE NO. CONTROL NO. BUILDING PERMIT INFO water neater replacement Job Description tia t,� 3q. Ft. Floor Area Valuation APN Number Occupancy Type 1 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- ation, as provided for by Section 3700 of the Labor Code, for the performance of the Nork for which this permit is issued. ] 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 Worker's Compensation Insurance carrier and Policy number are: Carrier: TI41' Z ('� I Policy No.: CERTIFICATE OF EXEMPTION FROM ORKERS' 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 manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT. If, after making this Ccnificatc of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ. C.) Lender's Name Lender's Address 1 certify that I have read this application and sate that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building 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 liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOUNE REGULATI NS. s" 412& 40-t�. Signature of Applicand ontractor bate HAZARDOUS MATERIALS DISCLOSURE 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)? ❑ Yes VNo 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 District? ❑Yes Po 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 to notify the occupant of the menu which must btrmet prior o issuance of a Certificate of Occupancy. req _ 1 �.., r !.Ill !4 l�u�— Owner or authorises agcm - _ t Dao Issued by Re -roofs Type of Loof Required Inspections I�f*Q] All roofs shall be inspected prior to any roofing material being installed. If a roof s installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better Building Ater Owner's v`7034j)0(� CITY OF CUPERTINO WATKR HEATER PERMIT APPLICATION FORM ____J�_. Ph46#: License #: Contxaset Cupertino Busines License #: Contact:r��' /J�if't yid i'}tOf -��lcf Building Pemitv: Bld ❑ Elect Joh Descripfim Residential Cost of Strapped on Platform New Lmafim Replac U^? Qty. if,pplicaMe Fee ID ____ ��VVHEATER l P'pFRMrrFEE BENERGY ICU SLIC plumb Mech Commercial ❑ Bonder Fee Description Water Heater / Vent Plumbing Peru Issuance Energy R111r.1-neryss License Fee Group BUILDING PLUMBING BUILDING eq 02- Community Development r 10300 Tone Avenue ' ";- ' Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 JPEkTINO Building Department JOB ADDRESS:�� 3 C 1 ` U� j� PERMIT � �� /# OWNER'S NAME: MC L -a H ( V-1 PHONE GENERAL CONTRACTOR FAX # I am not using any subcontractor Signature Date d te te h 4:,,11 ow information Please check appucable subcontra SUBCONTRACTOR rs an com :.e ul 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 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: bethe Sec: Twp: Rng: Sub: Blk: Lot: APN 365,17037.00 INVOICE DATE...i`14/0�'7-`� REFERENCE ID # 07030106 SITE ADDRESS .....: 873 COTTONWOOD DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: LA]IERRAN RICHARD J AND VIOLET ADDRESS CITY/STATE/ZIP ...: CU?ERTINO CA, 95014-4621 CONTRACTOR .......: MAZY SANDBRINK LIC # 23015 COMPANY ..........: ALS VALLEY PLUMBING ADDRESS ..........: 3345 SELDON CT CITY/STATE/ZIP ...: FREMONT, CA 94539 TELEPHONE ........: (510)376-4816 FEE DESCRIPTION DUE FOR --------------------------- -------------- ENERGY APPLICATION WATER HEATER/VENT PRINTING PERMI PLUMBNG PERMIT ISSUE PRINTING PERMI VOICE ID DESCRIPTION -------- ---------------------------- 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING AMOUNT DUE PAID BALANCE -- ---------- ---------- ---------- 34.86 34.86 0.00 T 10.79 10.79 0.00 T 38.37 38.37 0.00 ---------- ---------- ---------- 84.02 84.02 0.00 VOICE ID DESCRIPTION -------- ---------------------------- 506 GAS TEST