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07050297 CITY OF CUPERTINO BUILDING DIVISION PERMIT � QR� � '�TI�N' PERMIT NO. BUILD,{Nd6TI"SCARMONA CT TOM' S PLU1QBING 07050297 l U 3 PERMIT ISSUE DATE OWNER'S NAME: CARTER,NANCY P 0 BOX 362 05/31/2007 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITFCTIENGINEER: WATER HEA'L'ER REPLACEMENT BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description V F I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z Vu with Section 7000)of Division 3 of the Business and Professions Code,and my license is ! y in full force and effect r v�z License Class Lic.l_ — i t-o pate Coulmaor LU .a ARCHrMC7rS DECLA TIO i a< I undcrstanJ my plans shall be used as public records oA.0 U.F- Licensed Professional a OWNER-BUILDER DECLARATION j< 1 hereby affirm that I am exempt from the Contractor's License Law for the :M0 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 Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area e hs (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 AF N Number Occupancy Type not more than five hundred dollars($500). ❑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 Required Inspections 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- cerise 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. ❑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: ❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Cook,for the performance of the work for which this permit is issued. ❑I 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 Workefs Com nsag�tan�Insurance carrier and Policy /number am: CaCarrier. "Ttl A f 19 1 5 Z^/1 ! 7 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Jbis section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workeri Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shalt be deemed revoked. Z ' CONSTRUCTION LENDING AGENCY Er rA I hereby affirm that there is a construction ending agency for the performance of _ pG> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name z Lenders Address U 0 1 certify that I have read this application and state that the above information is fJ.►� correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against �r uj liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. �. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Se Date (�t?"7 SOURCE REGULATIONS. Re-roofs MSignaturebf Applicant/Contractor Dare Type of Roof ` HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cc&,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes t$ to __\\ If a roof is installed without first obtaining an inspection,I agree to remove 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 all new materi ils for inspection. District? ❑Yes u 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 does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which m si be met prior to i fell Certificate of '7 Date �°1�'i—U Signature of Applicant All roof coverings to be Class"B"or better Own r autho red agent Dare CITY OF CUPER"INO 3 ITEMS OF 6 PERMIT REC&-PT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 35716114 . 00 DATE ISSUED. . . . . . . : 05/31/20 )7 RECEIPT #. . . . . . . . . BS000001516 REFERENCE ID # . . . : 07050297 SITE ADDRESS 10031 CAZMONA CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CARTER,NANCY ADDRESS 10031 CAt2MONA CT CITY/STATE/ZIP CUPERTINJ, CA 95014-2850 RECEIVED FROM JOSEPH CLARKE CONTRACTOR CLARKE, JOSEPH M. LIC # 10044 COMPANY TOM'S PLUMBING ADDRESS P O BOX 362 CITY/STATE/ZIP . . . : SARATOGA, CA 95071 TELEPHONE (408) 867-6010 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 BPWHEATER PER HEATER 1 .00 10 .79 0 .00 10 .79 0. 00 PPERMITFEE FLAT RATE 1 . 00 38 .370 .00 38 .37 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 84 . 02 0 .00 84 . 02 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 168 . 04 VISP --------------- TOTAL RECEIPT 168 . 04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- - ------- ------------ 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO WATER HEATER CUPEt�TINO PERMIT APPLICATION FORM _1 r_ r 9 APN r� _� ' Dater Building Address: p U 3 ( CA r— ate-•4 C Owner's Name: Phone#: Contractor: f / t Phone: License#: I-Tevvx Contact: Phone: Cupertino Business License#: �0 �� Dov Building Permit Info: Bldg ❑ Elect Plumb [ Mech Job Description: Residential [A- Commercial ❑ Cost of Project: _a,-- 0.0- 3 -7 IST6 Strapped g- On Platform ❑ Bonded New Location ❑ Replacement `® i Qty.. f Fee Group A 1f Fee ID Fee Description BPWHEATER Water Heater/Vent BUILDING ppERMITFEE PlumbingPermit Issuance PLUMBING BENERGY Eneigy BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue i am Cupertino CA 95014 Telephone(408)777-3228 OF Fax(408)777-3333 Cfflf '7UPEKTIN0 Buildin , De artment JOB ADDRESS: PERMIT# 0 Al A C41 OWNER'S NAME: 4l/A-;,,-c J', PHONE# GENERAL CONTRACTOR' w• FAX# -- 2 I am not using any subcontractors: ` ��' Signatare Date Please check applicable subcontractors and comTete the followin information: SUBCONTRACTOR BUSINES 3 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 He d 1Datewner/Contractor Signature