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07050071 CITY OF CUPERTINO BUILDING DIVIS[-ON PERMIT � � � * BUILD D ESS: PERMIT NO. � �� LINDA VISTA PL PLUMBERS ON CALL 07050071 OWNER'S NAME: PERMIT ISSUE DATE KRAKER ROBERT AND KATHLEEN 520 MEG ,IACY LANE #12 05/09/2007 iNE: SANITARY NO. CONTROL NO. (408) 879-9416 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH (_ 0 0 i p LICENSED CONTRACTOR'S DECLARATION Job DeSCnptlon u I hereby affirm that I am licensed under provisions of Chapter 9(commencing 2 z M with Section 7000)o(Division 3 of the Business and Professions Code.and my license is RE P I PE HOUSE AND MAIN LINE - ADD LAUNDRY SINK AT r=y in full force and cff, Lica a� GARAGE GARAGE 2 0 X 2 0 j�? License Class - S Ae r Con(rar:lor�� A1tcHrrECrS DECLARATION Z C4 1 understand my plans shall be used as public records )WU n.H Licensed Professional O.0 OWNER-BUILDER DECLARATION a 2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county is ff which requires a permit to conswct,alter,improve,demolish,or repair any structureo Z y prior to its issuance,also requires the applicant for such permit to file a signed statement t, =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ,rq.Ft.Floor Area $8000 8 O O O Valuation F (commencing with Section 7000)of Division 3 of Ute Businessand Professions Code)or i 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). 35608012 .1b ❑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 docs 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 arc 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.). ❑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 U. 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 Ute Contractor's License Law. C]I am exempt under See B&P C for Utis reason Owner — rECLADare TAR 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 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. MyCom eazat Worker's ion Insurance icr and Polity number ate: Cartier Policy No., r�21 Z CER FI ATE OF EX PITON 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 az 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 Er►�-� I hereby affirm that there is a construction lending agency for the performance of 5 the work for which this permit is issued(Sec.3097,Civ.C.) Wit,A Lender's Name 2 Lender's Address U 0 I certify that I have read this application and state that the above information is [>~r--' correct.I agree to comply with all city and county ordinances and state laws relating to UU building construction,and hereby authorise representatives of this city to enter upon the � above-mentioned properly for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against t) liabilities,judgments,costs and expenses which may in any way accrue against said City C.>Z in consequence of the granting of this permit. Date APPLICANT UNDER TANDS AN COMPLY WITH ALL NON-POINT Issued by: SOU U A S. Iz/ J 74 91 9 1 Alf— D Re-roofs Signature pp NConraotor Dare HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material az defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs:hall be inspected prior to any roofing material being installed. ❑Ycs Nu , 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 emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes 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 cure596E�ff risibility o notify the occupant of the rcyuirc rats f a Certificate of occupancy. Signature �f Applicant Date L „-0 Owner or thorixcd agent T Dare All roof coverings to be Class"B"or better INVOICE INVOICE INVOICE INVOICE IPIVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT' INVOICE OPERATOR: christya Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 35608012 . 00 INVOICE DATE. . . . . . : 05,'09/2007 REFERENCE ID # . . . : 07050071 SITE ADDRESS . . . . . : 22:.15 LINDA VISTA PL SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER KRAKER ROBERT AND KATHLEEN ADDRESS CITY/STATE/ZIP . . . : CU13ERTINO CA, 95014-4022 CONTRACTOR . . . . . . . : R013IE DOBKINS LIC # 27158 COMPANY . . . . . . . . . . : PLUMBERS ON CALL ADDRESS . . . . . . . . . . : 521) MEGLIACY LANE #12 CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (41)8) 879-9416 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- --------- ------- ---------- ---------- ---------- REPIPE OF FIXTURES PRINTING :?ERMIT 9 . 00 0.00 9 . 00 MAIN WATER SERVICE PRINTING :?ERMIT 9 . 00 0.00 9 . 00 PLUMBNG PERMIT ISSUE PRINTING :?ERMIT 38. 37 0. 00 38 .37 ---------- ---------- ---------- 56 .37 0 . 00 56. 37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------ ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: christya COPY # 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN . . . . . . . . . 35608012 . 00 DATE ISSUED. . . . . . . : 05,"09/2007 RECEIPT #. . . . . . . . . : BS000001256 REFERENCE ID # . . . : 07050071 SITE ADDRESS . . . . . : 22:.15 LINDA VISTA PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : KRAKER ROBERT AND KATHLEEN ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CU:?ERTINO CA, 95014-4022 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : RO'.3IE DOBKINS LIC # 27158 COMPANY . . . . . . . . . . : PLUMBERS ON CALL ADDRESS . . . . . . . . . . : 52 ) MEGLIACY LANE #12 CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (4 )8) 879-9416 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPREPIPE NO OF FIXTURE 1. 00 9.00 0. 00 9 . 00 0.00 BPWSVCS WATER SERVICE 1.00 9 . 00 0. 00 9 . 00 0. 00 PPERMITFEE FLAT RATE 1. 00 38. 37 0.00 38.37 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 56.37 0 .00 56 .37 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 56.37 1304 --------------- TOTAL RECEIPT 56 .37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ----------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING