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07030041 --777 7777 CITY OF CUPERTINO � ETQ IIIZMATIEIN. BUILDINeDIVISION PERMIT PERMIT NO. BUILDING ADDRESS: JOHN GLACE UNDERGROUND 07030041 18771 HOMESTEAD RD PERMIT ISSUE DATE OWNER'S NAME: 07/2007 TOM MYERS 1116 DELL AVE SANITARY NO. CONTROL NO. tNE: (408) 379-3010 BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH reo a LICENSED CONTRACTOR'S DECLARATION Job Description 1 u !hereby affirm that I am licensed under provisions of Chapter 9(commencing INSTALL `3ANI TARP SEWER CLEAN OUT JOHN Z� with Section 7011n)of D�ARCHrMCTSDECLARATION iBusiness and Professions Code,and my license is .=)w H in full force and effect. Lie, 57 GLAGE UNDERGROUND CONST RENEWED BL #18417 3/7/7 t n? License Class 3 t-w Date Contractor � (f h fro j C-J 1 understand my plans shall be used as public records >yU a H Licensed Professional o a OWNER-BUILDER DECLARATION }J I hereby affirm that 1 am exempt from the Contractor's License Law for the p O Collawing reason.(Section 7031.5,Business and Professions Code:Any city at county which requires a permit to construct, improve,demolish,or repair any structure Valuation a"N prior w its issuance,also requires the applicant for such permit to file a signed statement S, .Ft.Floor Area -Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 l $1000 tZ-a (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of N Number Occupancy Type Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of 313 41 O not more than five hundred dollars(5500). ❑1,as owner of the property.or my employees with wages as their sole compensation, Required Inspections 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 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 We.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 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. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. &,g P C for this reason f_11 am exempt under See Owner -- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the fulbYringdsclaret+otts:: J I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provi for by Section 3700 of the Labor Code,for the performance of the work for this permit is issued. ave and will maintain Workers Compensation Insurance,as required by Section SANITARY 700 of the Labor Code.for the performance of the work for which this permit is issued. My Warkees Compensation Insurance carrier and Policy number Oar Carrier. L�� A� E � Policy No.: 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,I shall not employ any person in any manncr a�to b em •ct to the Workers'Compensation Laws of California Date -� Applicant NOTICE TO APPLICANT:If, ter making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of pv > the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name a z Lender's Address U C) I certify that 1 have read this application and state that the above information is U. correct.I agree to comply with all city and county ordinances and state laws relating to rJ U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We,)agree to save,indemnify and keep harmless the City of Cupertino against Fr liabilities,judgments,costs and expenses which may in any way accrue against said City Date ! O U Zin consequence of the granting of this permit. �. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE na. 11 Re-roofs Signature of pplicant/Contractor ato T of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle,hazardous material as defined by the Cupertino Municipal ptcr 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. [3 Yes If a roof s installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant quipmenl or devices which emit hazardous air contaminants as defined b ay Arca Air Quality Management all new materials for inspection. District? 13 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 does not currently have a tenant,that it is my responsibility to notify the occupant of the Date requirements wh' ust'Cl�ffRT la lssuancc of a Ccrtificatc of occ�up5,utry) ignaturc of Applicant r I All roof coverings to be Class"B"or better --r Date, Owner or authorized agent P'0 79 CITY OF CUPERTINO /MAIN SERVICE 1TWY REPIPES CUPEkTINO PERMIT APPLICATION FORM APN # � j� � rJ� Date: 3 / 16 Building Address: Owner's Name. Phone#: Iry rn iM `s O Contra tor: Phone: yog -37`t -3 v lv License #: a�1k ��a c_ v�.Cu ro �� 5-{- so Lf k Contact: Phone: Cupertino Business License#: C, aVa ti env V, 1 `(0 6 -?591 Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: -3--� C (--a v,- o../ fi- ,f7r- P Residential Commercia Cost of Project: *f 1 � oa � Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE E-ldg. Permit Fees BUILDING BPGAS Cas Piping System Fee PLUMBING PPERMITFEE Flumbing Permit Issuance PLUMBING BPREPIPE F.epipe of Fixtures PLUMBING BPFIXTURE F blg. Fixture PLUMBING BPWSVCS main Water Service PLUMBING BPSEWER r ewers PLUMBING BPSEWAGE sewage Disposal PLUMBING BUSLIC Business License BUILDING I CITY OF C'UPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk Lot: APN . . . . . . . . : 313 41 070 DATE ISSUED. . . . . . . : 03/07/2007 RECEIPT #. . . . . . • • • : BSOo0000621 REFERENCE ID # . . . : 070:30041 SITE ADDRESS . . . . . : 18711 HOMESTEAD RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TOM MYERS ADDRESS : 18771 HOMESTEAD RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : GLAGE, JOHN LIC # 18417 COMPANY . . . . . . . . . . : JOHN GLAGE UNDERGROUND CONST ADDRESS : 1116 DELL AVE CITY/STATE/ZIP CAMPBELL, CA 95008 TELEPHONE (4C8) 379-3010 FEE ID UNIT QUANTITY .MOUNT PD-TO-DT THIS REC --NEW-BAL- ___ ---------- -- ------------- ---------- -- -------- BPSEWER SEWER SYSTEM 1.00 21.58 0 .00 21.58 0.00 BUSLIC FLAT RATE 1.00 107. 00 0 .00 107 .00 0. 00 PPERMITFEE FLAT RATE 1.00 38 .37 0 .00 38 .37 ------ - TOTAL PERMIT 166 . 95 0 .00 166 . 95 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- --------------- - ----- CHECK 166 .95 11187 --------------- TOTAL RECEIPT 166.95 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