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07030133CITY OF CUFEKI11NkJ BUILDING DIVISION PERMIT au1LgI��RPROSPECT RD OWNER'S NAME: JASKOWAR MARY C ,,ONE: ARCHITECT/ENGINEER: C C LICENSED CONTRACTOR'S DECLARATION Jt !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 t d„ in full force and eff t Lj ? License as. µ r • p Dato — — Contractor �+ :E u AR HITECTSDECLARATI N j aa a I understand my plans shall he used as public records >yU U. y Licensed Professional a OWNER -BUILDER DECLARATION ja I hereby affirm that I am exempt from the Contractor's License Law for the C o following reason. (Section 703 1.5, 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 ti F (commencing with Section 7000) of Division 3 of the Business and Professions Code) or i 3 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 (S500). 0 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. 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 Contratxoes 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. 0 1 am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 0 O Z 0 CI. Q �z UO U i' tea, H t% Uz r CUPERTIISO PLUMBING I hereby affirm under penalty of perjury one of the following declarations: ] I 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 +ork for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 700 of the Labor Code, for the performance of the work for which this permit is issued. 4y Worker's Compensation jIn Insurance carrier and Policy number are: 'arrier.� I v Policy No[_l.' o ' (' 2 25 CERTIFICATE OF EXEMPTION FR M WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($ 100) )r less.) f certify that in the performance of the work for which this permit is issued. I shall not =mploy 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 Lenders 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 ahovc-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 COMP Y WITH ALL NON -POINT SOURCE GULATIONr Signature ofAppl5�Z Date ALS DISCLOSUREWil pplicant occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12, and die Health and Safety Code, Section 25532(a)? 0 Yes ON 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? 0Yes �1O 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 rc uircments Irty est be met prior to is ante of !,5crtificatc of Occupancy. Owner Date - 1300 DELL AVE, STE C (408)25=-0618 PERMIT NO. 07030133 PERMIT ISSUE DATE 03/19/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description RE -PIPE GALVANIZED TO COPPER ONLY. NO FIXTURES. Ft. Floor Area 3662403:? :�� Num Issued by Re -roofs Type of Roof Valuation $5000 Occupancy "Required Inspections 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. Signature; of Applicant All roof coverings to be Class "B" or better Date 2 ITEMS OF 4 CITY OF �UPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36624032.00 DATE ISSUED.......: 03/19/2007 RECEIPT #......... BS000000718 REFERENCE ID # .•.: 07030133 SITE ADDRESS .....: 7549 PROSPECT RD SUBDIVISION ....... CITY CUFERTINO IMPACT AREA ....... OWNER JASKOWAR MARY C ADDRESS ........... CITY/STATE/ZIP ...: CUFERTINO CA, OPERATOR: kiersaw COPY # : 1 95014-5242 RECEIVED FROM ....: RECEIPT INTERFACE CONTRACTOR .......: CARDIA, FRANK L LIC # 612 COMPANY ..........: CUFERTINO PLUMBING ADDRESS ..........: 13CO DELL AVE, STE C CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: (4C8)253-0618 FEE ID UNIT QUANTITY ,MOUNT PD -TO -DT -------- THIS REC NEW BAL ----------------------- BPREPIPE NO OF FIXTURE -------------------- 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 ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 94.74 --------------- 94.74 VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION -------- ---------------------------- 502 FINAL PLUMBING ENERGY o", CITY OF _,UPEkTIN0 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: C, n PERMIT # 07X --16 e OWNER'S NAME: PHONE # Lfog GENERAL CONTRACTOR: t --OL., r- (-5,- k o6 FAX # I am not using any subcontractors: - Signature Date Please check a licable subcontractors and complete the following information: Owner/Contractor Signature Date SUBCONTRACTOR 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 ITY dF CUPEkTINO CITY OF (-".UPERTINO REPIPE/ E.I-" /MAIN SERVICE PERMIT APPLICATION FORM 010 30133 APN # �. as _ O3� BUILDING Date: --, Building Address: Or 2, A Plumbing Permit Issuance PLUMBING L)5 R epipe of Fixtures PLUMBING Ow er's Name: �` PLUMBING Phone #: Main Water Service PLUMBING BPSEWER 25-3--(,(/Y9 Contractor �I �ltt, V� Phone: / (tc)�)`ZS3`UV�1 License #: ��7/O ,rtJ BUSLIC Contac BUILDING Phone: Cupertino Business License #: o Building Permit Info: Bldg ❑ Elect ❑ Plumb ET — Job Description: �� 1'p-� vn •.- � v �: � i �- rc Residential ComFnercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description � . Fee Group BPERMFEE E ldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE R epipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Eusiness License BUILDING