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07050288p0 ?UU t<s I F—� 0. a rLU 7 u, y .o aha �q0 ^ H :Za 00 z� CITY OF CUPERTINO BUILDING DIVIMN PERMIT ARALLONE DR OWNER'S NAME: UNDERWOOD PHILIP G AND MARCIA NE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force andeff �� y/ Licen sa Lic. # Date _ — Contractor00r ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following mason. (Section 7031.5, 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 Lir:ensc Law (Chapter 9 (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 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 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 Conuactor's U- cenx 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. E]I am exempt under Sec. B & P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L] I have and will maintain a Certificate of Conscnt to self -insure for Worker's 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 are: CarieGIG69/# 1565--/J PolicyNo.:/412*2 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. 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 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.) L.endces Name Lender's Address I certify that I have read this application and state that the above information is cored. 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 above-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 COMPLY WITH ALL NON -POINT CE REGULATIONS. Signature of ApplicanUContractor Date 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 Code, Section 25532(a)? ❑ Yes z"No 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? ❑ Yes (1No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements w�ust W meI or to i arse of a Certificate of Occupancy. Owner or Date TBD — To BE DETERMINED PERMIT NO. 07050288 PERMIT ISSUE DATE 05/31/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description ADD GAS LINE TO EXISTING KITCHEN. MCMAHON'S PLUMBING PD FOR BL #01000038058 3q. Ft. Floor Area I $1400 Valuation 36931013! Issued by: Re -roofs Occupancy "lype Required Inspections Type of Roof All roofs : hall be inspected prior to any roofing material being installed. If a roof iE installed without first obtaining an inspection, I agree to remove all new materials for inspection. >ignatureAApplic t Date All roof coverings to be Class "B" or better 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36S31013.00 DATE ISSUED.......: 05/31/2007 RECEIPT #......... BSC00001509 REFERENCE ID # ...: 07C50288 SITE ADDRESS ... 10325 FARALLONE DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: suew COPY # : 1 OWNER UNLERWOOD PHILIP G AND MARCIA ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO CA, 95014-3102 RECEIVED FROM ....: MCNAHONS PLUMBING CONTRACTOR .......: TBE - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBE - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: , TELEPHONE ........: FEE ID UNIT QUANTITY FMOUNT PD -TO -DT THIS REC NEW BAL ----------------------- BPGAS OULETS ---------- 1.00 -------------------- 5.40 0.00 ---------- 5.40 ---------- 0.00 BSEISMICRE VALUATION 1,400.00 0.50 0.00 0.50 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 TOTAL PERMIT ---------- ---------- 44.27 0.00 ---------- 44.27 ---------- 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- CHECK 44.27 -------------------- 9646 --------------- TOTAL RECEIPT 44.27 CIN OF CUPEkTINO CITY OF C'UPERTINO PERMIT APPLICATION FORM APN # 369 LJ ,� Date: �✓? - % a � Building Address: Mailing Address (if different from building address): !v 3.2-5- ,,eA l L, iv&' A le, Owner's Name: f��->r�• //•rte 44"k pe4 t.voop Phone #: �0k -P- S, % Contractor: License #: MECHANICAL -V/67// Contact: Phone: ti419 Cupertino Business License#: Fax: SdI-10605G d d0,9 O go _r F - Building Permit Info: Alal , �''y" ` q4v e- he /--/0'- Bldg ❑ Elect ❑ Plumb 2i� Mech ❑ Job Descriptio Residential Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Construction Tax BUILDING Type of Construction: Please check this box if the project is a BUILDING second -story addition: ❑ Project Size:Standard ❑ Large ❑ Ma or ❑ BUILDING Quantity Fee ID Fee Description Fee Group BAPPLOTHER ether Appliances MECHANICAL BBOILERI Boiler <= 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 Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co Zstax — Resi/Mobile BUILDING BELEC 1000 El , -c 600V <= 1000A ELECTRICAL BELEC1001 Elee 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD I?nergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CvUPERTINO CUPEI,TINO PERMIT APPLICATION FORM '2uantity Fee ID Fee Description Fee Group BREMSIGNAD Rm4ll Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Veit Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD `>cb Specific Plan BUILDING BSEISMICOM Se smic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elf c Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Merh Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 A 3 CITY OF 7UPEkTIN0 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # f, OWNER'S NAME: PHONE # -Zr? GENERAL CONTRACTOR: FAX # I am not using any subcontractors: —��• i1' s'�e�� Si;: nature Date Please check applicable subcontractors and complete the following information: - 01 - ,4'3a -o7 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 < gl,: Ploy Roofing Septic Tank Sheet Metal Sheet Rock Tile - 01 - ,4'3a -o7 Owner/ Contractor Signature Date