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07030344 CITY OF CUPERTINO BUILDING DIVISION PERMIT Co GTCj IF+E�RMATI(J1Y` BUILDING ADDRESS: �— PERMIT NO. ]-�d r OWN A E: RA 3345 SE DON CT s"TARY940•2 0 0 7 CONTROL NO. ARCHITECT/ENGINEER: 19 13:7 481:6 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Z LICENSED CONTRACTOR'S DECLARATION Job Description J p I hereby affirm that I am licensed under provisions of Chapter 9(commencing •w with Section 7000)of Division 3 of the Business and Professions Code,and my license is �d in full force and cffecjO REPLACE WATER HEATER ? License Class `-�� Lic.# -p Date Contractor f W ?j RCHITECr'S DECLARATIONIF I understand my plans shall he used as public records U ti Licensed Professional nOWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the j O following reason.(Section 7031.5,Business and Professions Code:Any city or county o which requires a permit to construct,alter,improve,demolish,or repair any swcturc y prior to its issuance,also requires the applicant for such permit to file a signed statement =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 :.q.Ft.Floor Area Valuation -$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 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 APN Number Occupancy Type not more than five hundred dollars(5500). 0 I,as owner of the property,or my employees with wages as their sole compensation, 21 will do the work and the structure is not intended or offered for sale(Sec.7044,Business ns Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P 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 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 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 I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of peijury one of the following declarations: have and will maintain a Certificate of Consent to self-insure for Worker's Compen- ..on,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 f 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: Cartier.::1-Nl: ZEM I M Policy No.:(_ rLO'>40 CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE ('This section recd 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 Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Zr forthwith comply with such provisions or this permit shall be deemed revoked. O CONSTRUCTION LENDING AGENCY 4 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 z Lender's Address 1 certify that I have read this application and state that the above information is correcL I agree to comply with all city and county ordinances and state laws relating to Vbuilding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless to 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. Z LTf Z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUWEREGULATIONS� �•. �1 �u/0_1 Re-roofs Si�ure of Applicant/Contractor ate HAZARDOUS MATERIALS DISCLOSURE Type of Rc of 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 Cotte,Section 25532(a)? All roofs s Iall be inspected prior to any roofing material being installed. 0 Yes 1lo 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 I hazardous air contaminants defined by the Bay Arca Air Quality Management all new mi terials for inspection. .strict? 0 Yes o I 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 currently have a tenant,that it is my responsibility to notify the occupant of the require cots w �hich must be mel prior to issuance of a Certificate Occupancy. Signature(f Applicant Date —.��^ - 1 16 All roof coverings to be Class"B"or better Owner or authorized agent rswe CITY OF CUPERTINO WATER HEATER *, of0 CUPEkTlNO PERMIT APPLICATION FORM i APN# Date: Building Address: Owner's Name: r� Phone#: Contractor: �f12 ��) License Contact: ow Cupertino Busmen License#: Building Permit o: Bldg ❑ Elect C - Plumb Yom' Mech Job Description:. kkc J Residential Commercial ❑ i Cost of Project: S-0 StrappedPlatform Er Bonded New Location ❑ Replacement i i Qty. if Applicable Fee ID Fee Description Fee Group BP TER Water Heater/Vent BUILDING pp Plumbing Permit Issuance PLUMBING BENE GY Ener BUILDING BUSUC Business License BUILDING i i i I �i i �I Community Development ., 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT# X025 vax,n rxJvV r. OWNER'S NAME: LaErjjAOL PHONE # y OSS -5 V0 S - 1�1 GENERAL CONTRACTOR FAX# I am not using any subcontractor Sign lature Date Please check applicable subcontra rs and complete the following information: SUBCONTRACTOR BUSIM_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 A CITY OF C UPERTINO CITY F PERMIT APPLICATION FORM CUPEkTINO 11 PN# Date: .3_ t 4_U 34, )-// co _ Buildin Address: railing Address (if different from building address): �a5' RAenigoo) De- (UPLgT100 CA gSZJtI Owner's Name: Phone#: LA tx9-e NU3 Contractor: , License #: Contact: Phone: Cupertino Business License#: C�wrvz,� Fax: Building Permit Info: lyluA`TI 0.41t5111 -pK,�, ds-✓ , A,eT tLA�e -/►tuJ ►W,w�w✓J t�� tj61 i cJ re Bldg ❑ Elect ❑ PI umb ❑ Mech ❑ Job Description: Residential R Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: i Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ --oject Size: Standard -Large ❑ Majcr- Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boil-r<= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX C)nstruction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con Tax for BQ Zone BUILDING BCONSTAXH F.otel and Motel BUILDING BCONSTAXR Con::tax—Resi/Mobile BUILDING BELEC1000 Elec, 600V<= 1000A ELECTRICAL BELEC1001 Elcc 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Er.ergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of3 CITY OF C'UPERTINO . zY OF C�PE�- ��,� CATION FORINT C► PERMIT APPLI Quantity Fee ID lee Description Fee Group BREMSIGNAD Rmc 1 Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR The uncal Lighting Fix ELECTRICAL BREMVENFAN Ven t Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE eismic Fee Res BUILDING i BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS "emp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec. Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mecl Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plwnbing Fee sq foot PLUMBING PLLONGRNGC Planningl.R Comme/Multi-Fam PLANNING PLLONG-RN K- � Planning bong Range Residential PLANNING _ ZADDCHG Address Change __ BUILDING 3of3 CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: BlY: Lot: APN . . . . . . . . : 36211047. 00 DATE ISSUED. . . . . . . : 03/14/2007 RECEIPT #. . . . . . . . . : BSCO0000687 REFERENCE ID # . . . : 07C30105 SITE ADDRESS . . . . . : 8025 RAINBOW DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LARRY HARA ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0.00 34 .86 0.00 BPERMFEE VALUATION 2, 500 .00 83 .16 0.00 83 .16 0. 00 BSEISMICRE VALUATION 2, 500.00 0.50 0.00 0.50 0. 00 EPERMITFEE FLAT RATE 1 .00 38 .37 0 .00 38.37 0.00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 156 .89 0 .00 156 .89 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 156 .89 3383 --------------- TOTAL RECEIPT 156.89