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07050018
CITY OF CUPERTINO BUILDING DEVISION PERMIT BUILD,( d f lSr$LEODARA DR TBD TO BE DETERMINED 07050018 l�J f J PERMIT NO. OWNER'S NAME: PERMIT ISSUE DATE DION LOY 05/02/2007 NE: SANITARY NO. CONTROL NO. ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION Job Description V(: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing °zw ith Section 7000)of Division 3 of the Business and Professions Cc&,and my license is POOL DE110—DISCONNECT CTAS & REMOVE BREAKERS FROM ' w in full fo and effect. z License Llc. PANEL. Date A CHITECTS DEC AT10N I understand my plans shall be used as public records >yV U.inLicensed Professional O.0 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the `p O following reason.(Section 7031.5,Business and Professions Code:Any city or county <$0! which requires a permit to construct,alter,improve,demolish,or repair any structure y 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 Eq.Ft.Floor Area Valuation ul-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $9700 L 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 ofNumber Occupancy Type not more than five hundred dollars($500). 3 16 3 0 0 4•r '�1: U ❑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 Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of 9 ns 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.). as owner of the property,am exclusively contracting with licensed contractors to or"touct 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. ❑I am exempt uB&P C for this reason Owner Date , O nder ee I 'S COMPENSATION DECLARATION hereby Arm u er 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 Code,for the performance of the work for which this permit is issued. ❑1 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 Workees Compensation Insurance carrier and Policy number ate: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This 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 beco Z je o the W rkcrs'Compensation Laws of California.Date Applicant per NOTICE TO APPLICANT:If,after making this Cco Exc tion,you should stona of c become subject to the Worker's Compensation proviLat4w Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z"" CONSTRUCTION LENDING AGENCY E.r I hereby affirm that there is a construction lending agency for the performance of pC > the work for which this permit is issued(See.3097,Civ.C.) aA Lendces Name Z Lcndees Address U 0 I certify that 1 have read this application and state that the above information is Li.►'r correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction.and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. 0. (We)agree to save,indemnify and keep harmless the City of Cupertino against ,F. rrA liabilities,judgments,toss and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Dale APPLICANT UNDER TANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATI S. vZ 0# Re-roofs Signature of AppUcifiXonlilLcior Date PAZAADOUS MATERIALS DISCLOSURE Type of Roof 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 Cole,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes $[No Will the applicant or flruturc building occupant use equipment or revises which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes W-0 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 docs not currendyhave a tenant,that it is my responsibility to notify the occupant of the requircmentoissuanceofaCertificateof Signature efApplicant Date tsw h ttubemet 'r ©,�/0Z to All roof coverings to be Class"B"Or better owtit d agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk . Lot: APN . . . . . . . . : 31630047. 00 DATE ISSUED. . . . . . . : 05/02/2007 RECEIPT #. . . . . . . . . : BSC00001186 REFERENCE ID # . . . : 07C50018 SITE ADDRESS . . . . . : 10511 DEODARA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DICN LOY ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : SUISNYVALE CA, 94089- RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : TBE - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBT- - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 9, 700 .00 169.56 0 .00 169 .56 0. 00 BSEISMICRE VALUATION 9, 700 .00 1.00 0 .00 1 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 170 .56 0 .00 170 .56 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 170 .56 1084-DION LOY --------------- TOTAL RECEIPT 170.56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO CITY OF C'UPERTINO DEMO _ rCuK TiNO PERMIT APPLICATION FORM SOS OD/� APN# -, _ Date: 3D C%� ' Building Address: D,$1 I Eo�Ugrt� �2 Owner's Name: Phone#: Contractor: LP CoLicense#: Nsz2vc7to,� Contact: LEO ACo[.ko 4tff 234 Cupertino Business License #: Building Permit Info: POO L T-)t--.40 Job Description: POOL Flu- M ov 4L 4/7 S !1)vv' Residential: Commercial: ❑ Sq.Ft. Floor Area: Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group _ BPERMFEE Bldg Permit Fees BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Uldg Permit Fees BUILDING BPLANCHK F Ian Check Fee BUILDING BUSLIC Lusiness License BUILDING