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07030291CITY OF CUFERI17 BUILDING DIvISION PERMIT, BUILD4bQRPUMPKIN DR OWNER'S NAME: STEWART WAYNE D AND ORVA L ONE: ARCHITECT/ENGINEER: 00 LICENSED CONTRACTOR'S DECLARATION W P I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z with Section 7000) of Division 3 of the Business and Professions Code, and my license is r H in full force and cfCec b --79L' � � o I aM z License Clap ��. Lld• # p Date �� %—+ I �. --I Contractor ? ITECT S DECLARATION i < 1 Mndcrst any06 plans �bC used u public records u.H License ro cssio I : C a OWNER -BUILDER DECLARATION a1 hereby affirm that 1 am exempt from the Contractors License Law for the :no 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 " y no 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 2(-- (commencing with Section 7000) of Division 3 of the Business and Professions Code) or i that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 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 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.). 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- ccnse 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. 0 I am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: -1 I have and will maintain a Certificate of Consent to self -insure for Worker's Compcn- ation, as provided for by Section 3700 of the Labor Code, for the performance of the vork for which this permit is issued. ] I have and will maintain Worker's Compensation Insurance, as required by Section 5700 of the Labor Code, for the performance of the work for which this permit is issued. Ny Workers Compensation Insurance carrier and Policy number are: 2arrier. rtl]s. %_LrM no Policy N..:.L t.9- C TE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he compacted if the permit is for one hundred dollars ($100) ur 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 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 (Sec. 3097, Civ. C.) Lender's Name Lcndees Address I certify that I have read this application and state 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 ahove-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 SOURCE I%GUL1A'nONS. �, i 2, � D--' Signature of Applicant/Contractor Date 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)7 D Yes Will the applicant or �'No re building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management 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 !wilding does not currently have a tenant, that it is my responsibility to notify the occupant of the rcquircMnts which must be met prior to4ssuancgrof a Ctrtifrcate of Occupanry. _ Owner orauorizcd agcrd Date ALL VALLEY PLUMBING 3345 SELDON WATERHEATER REPLACEMENT Issued by Re -roofs Type of Roof >q. Ft. Floor Area umber PERMIT NO. 07030291 PERMIT ISSUE DATE SANITARY NO. CONTROL NO. Job Description "Required Inspections BUILDING PERMIT INFO ELECT PLUMB Type All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new rlaterials for inspection. Signaturc of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: christya COPY # : 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN 36:;02039.00 DATE ISSUED.......: 03,'27/2007 RECEIPT #.........: BS()00000804 REFERENCE ID # ...: 07030291 SITE ADDRESS .....: 7967 PUMPKIN DR SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ST] -WART WAYNE D AND ORVA L ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4931 RECEIVED FROM RECEIPT INTERFACE CONTRACTOR MAZY SANDBRINK LIC # 23015 COMPANY AL.J VALLEY PLUMBING ADDRESS 3315 SELDON CT CITY/STATE/ZIP ...: FREMONT, CA 94539 TELEPHONE ........: (510)376-4816 FEE ID UNIT QUANTITY )MOUNT PD -TO -DT THIS REC ---------- ---------- NEW BAL --------------------------------- BENERGY PERMIT FEE 1.00 ---------- 34.86 ---------- 0.00 34.86 0.00 BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 ---------- 38.37 ---------- ---------- 0.00 TOTAL PERMIT ---------- 84.02 0.00 84.02 0.00 VOICE ID DESCRIPTION VOICE -------- ID ------------- DESCRIPTION -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING INVOICE INVOICE INVOICE. INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: christya Sec: Twp: Rng: Sub: Blk: Lot: APN ........ 36::02039.00 INVOICE DATE......: 03,'27/2007 REFERENCE ID # ...: 07030291 SITE ADDRESS ..... 7967 PUMPKIN DR SUBDIVISION ....... CITY ............. =:)ERTINO IMPACT AREA ...... OWNER ............ ST --'WART WAYNE D AM ORVA L ADDRESS .......... CITY/STATE/ZIP ... CU3ERTINO CA, 95014-4931 CONTRACTOR ....... MXff SANDBRINK LIC # 23015 COMPANY .......... ALS VALLEY PLUMBING ADDRESS .......... 3315 SELDON CT CITY/STATE/ZIP ... FREMONT, CA 94539 TELEPHONE ........ (5L0)376-4816 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID ---------- ---------- BALANCE --------------------------- ------------- ENERGY APPLICATIDN ---- --------- 34.86 0.00 34.86 WATER HEATER/VENT PRINTING PERMIT 10.79 0.00 10.79 PLUMBNG PERMIT ISSUE PRINTING PERMIT 38.37 0.00 ---------- ---------- ---------- 38.37 84.02 0.00 84.02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING Lk { CUPEf�OCTINO CITY OF CUPERTINO WATER NEATER PERMIT APPLICATION FORM 0 -7 03 0 c2 I1 APN # ree w TER Date: I I �-7 Building Address: 'i Owner's Name: a� Phone #: _ZfiF -- Contractor:JJ / P ne License #: Contact% / one Z Cupertino Busines License #: ( ri rl Building Permit o: Bld Eli Elect Plumb V�-' Mech L� Job Description: G� i Residential Commercial ❑ Cost of Project: Strapped On atform Bonded New Location Replacement Qty. if FPP IlPcrrinfion Fee Group A licable Bp pp BENEWY BUSLI ree w TER Water Heater 1 Vent Plumbing Permit Issuance -Energy Business License BUILDING PLUMBING BUILDING BUILDING 8q,-02 I CITY Of JPE�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Buildin De artment JOB ADDRESS: PERMIT # `I��' OWNERS NAME. �/�/A,�( -r' PHONE GENERAL CONTRA OR- FAX # I am not using any subc retractor . Sigliature Date Please check applicable s4Dcontra rs area cuui 1CLC LLLC 1V1Lvwu� �auviu.µ+++ SUBCONT CTOR BUSINI-SS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carp ting Linoleum / W od 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