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07050217 .77777 CITE'OF CUPERTINO BUILDINGDIVISION PERMIT CIgGTOR IUM�TI(IN• PERMIT NO. BUILQ,IhJ(i,i�IZ9"h ESTATES DR DRAIN DCCTOR 07050217 l U l`��$ PERMIT ISSUE DATE OWNER'S NAME: JENKINS CLAUDE L AND INEZ C 1775 WITCHESTER BLVD 05/22/2007 )NE. (408) 37C-3082 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i p p LICENSED CONTRACTOR'S DECLARATION Job Description iU t= I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing z 8 with Section 7000)of Division 3 of the Business and Professions Code,and my license is CITY CLEAN OUT/PROPERTY LINE CLEAN OUT 7 y in full force and effect, ? Lice60'1/3 L/S , NEED SAYITARY RELEASE LETTER nse las Lam•8 -t p Datc ��' Contractor i� j)0 e," ARCHITECTS DECLA ATION i a a 1 understand my plans shall be used as public records .,u u.F Licensed Professional j OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the 00 following reason.(Section 7031.5,Business and Professions Cotte:Any city or county e_� which requires a permit to construct,alter,improve,demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement cFt.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q is F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or , 8 it 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 3 6 9 0 7 0 3 C �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 isnot intended oroffered 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- 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. r-11 am exempt under Sec. B&P C for this reason Owner Date ' ARY 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 Workces Compen- sation,as provided for by Section 3700 of the Labor Code,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 Workers Compenution Insurance carrier and Policy number are: Cartier T /i�rC/CPolicy No.:;R/9/S03FP'S CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars 1$100) or less.) I certify that in the performance of the work for which this permit is issued,1 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. z " CONSTRUCTION LENDING AGENCY (~-t►�. I hereby affirm that there is a construction lending agency for the performance of Qn the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name az Lender's Address U C) I certify that I have read this application and state that the above information is Lt.— correct.1 agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorize representatives of this City to enter upon the Uabove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,ju gments,costs and expenses which may in any way accrue against said City U Z in consequ ce of the granting of this permit. Date Z h" APPLIC NDERSTANDS A D WILL COMPLY WITH ALL NON-POINT Issued by: S R ULATI 2 S:2?0 Re-roofs STgnature of Applicant/Contractor Date Type Of Roof 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,Section25532(a)? All roofs shall be inspected prior to any roofing material being installed. C]Yes 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 maerials for inspection. District? ❑Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Heal Safety Code,Sections 25505.25533 and 25534.1 understand that if the building does no curt ntly have a tenant.Uh itis my responsibility to notify the occupant of the ui en which m st a uancc of a Certificate of upancy. Signature of Applicant Date All roof coverings to be Class"B"or better wner or authorized agent Date' CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN . . . . . . . . : 36S07030 . 00 DATE ISSUED. . . . . . . : 05/22/2007 RECEIPT # . . . . . . . . . BSC00001420 REFERENCE ID # 07C50217 SITE ADDRESS . . . . . : 10398 E ESTATES DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : JEDRINS CLAUDE L AND INEZ C ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014 RECEIVED FROM . . . . : DRP.IN DOCTOR CONTRACTOR . . . . . . . : JOFN H. LIM LIC # 24784 COMPANY . . . . . . . . . . : DRF.IN DOCTOR ADDRESS . . . . . . . . . . : 17i5 WINCHESTER BLVD CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (4C8) 370-3082 FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPSEWER SEWER SYSTEM 1.00 21 .58 0 .00 21 .58 0. 00 PPERMITFEE FLAT RATE 1.00 38.37 0 .00 38 .37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 59. 95 0 . 00 59 . 95 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 59. 95 13970 --------------- TOTAL RECEIPT 59. 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 CITY OF CUPERTINO REPIPE/SERVE .S/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM 6705o.21 '7 APN # Date: 3�q - Q7-o3a 5 `G2 'o Building Address: /Cf Az on Owner's Name: P /-Z/2- 5Ct,a,,tor: Phone-, Le e3 e23 n e #: Contact: Plpne: Cupertino Busines License#: 'building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: << � C (r<� - G" 1-/- Residential Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gras Piping System Fee PLUMBING PPERMITFEE F lumbing Permit Issuance PLUMBING BPREPIPE F.epi e of Fixtures PLUMBING BPFIXTURE Fblg. Fixture PLUMBING BPWSVCS Vain Water Service PLUMBING / BPSEWER c ewers PLUMBING BPSEWAGE c ewage Disposal PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEkTINO Building Department JOB ADD SS- PERMIT# OWNER'S NAME: ,_.. /o ES 61,-62 2'7on PHONE # 7C�'3f323 GENERAL CONTRACTOR: i 7 ,2 FAX# 22 I am not using any subcontractors: g�L � ,o� Signature Date Please check applicable subcontractors and complete the following information: 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