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07050061 CITY OF CUPERTINO * BUILDING DIVISION PERMIT BUILD Qi P�DD�ESSERMIT No. LINDY LA CUPERTI LTO PLUMBING P07050061 OWNER'S lN`jA(MSE: PERMIT ISSUE DATE MOORE JAMES A AND SUSAN M 1300 DELL AVE, STE C 05/08/2007 iNE: (408) 253-0618 SANITARY NO. CONTROL NO. ABUILDING PERMIT INFO RCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 o a a i O p LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing 2 i with Section 7000)of Division 3 of the Business and Professions Code,and my license is COPPER RE P I P E-NO FIXTURES R in full force and cff j�2zLicense CI ��' Lle•N 9 0 15 F p Datc Q Contractor r V ARCHITECTS DECLARAM N 1 understand my plans shall be used as public records >yU a H Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county m 9 which requires a permit to conswct,alter,improve,dcmolLsh,or repair any structure Zy prior to its issuance,also requires die 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 Sq.Ft.Floor Area Valuation uF-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5000 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 of �p Number Occupancy Type not more than five hundred dollars($500). 3 5624012:'(7 ❑1,as owner of the property,or my employees with wages as their sale 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 q 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.). ❑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 Contractors License Law. Ti— ❑I am exempt under Sec B&P C for this reason "NOWL ARY Owner Date WORKER'S COMPENSA71ON DECLARATION oAt4 I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Conscnt to self-insure for WorkeesCompen- 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 Workers Compensation Insurance,as required by Section 3710 of the Labor Code,for the performance of the work for which this permit is issued. My Wor sCompensation Insur ace carrier and Policy number are: Carrier t f I— Policy No.:7—�a �Z 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 is to become subject to the Workcrs'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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z OCONSTRUCTION LENDING AGENCY (�ice■ 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.) W Q Lenders Name Z Lenders Address (�0 1 certify that I have read this application and state that the above information is ►-� 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 a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against C�rj liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. ? APPLICANT UND NDWD LL COMPLY WITH ALL NON-POINT Issued by Date OURC 07 L+ U v ' Re-roofs SignaA6ofApplr eOnlract0 Date HAZARDOUS 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 Code,Section 25532(x)? All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building occupant use equipment or devices which If a roof i;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 OIC I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25W.25533 and 25534.1 understand that if the building docs not currently have a tcnan a is my nsi '' to notify the occupant of the requ tsw be riorwiss acertiricatcera Signature of Applicant Date r� b? All roof coverings to be Class"13 or better Owner or razed agent Date CITY OF CUPERTINO ITEM 3 OF 3 PERMIT' RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: B1}:. Lot: APN 356124012 . 00 DATE ISSUED. . . . . . . : 05/08/2007 RECEIPT #. . . . . . . . . BS000001243 REFERENCE ID # . . . 07050061 SITE ADDRESS . . . . . : 211)62 LINDY LA SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MOORE JAMES A AND SUSAN M ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4813 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR CAFDIA, FRANK L LIC # 612 COMPANY CUPERTINO PLUMBING ADDRESS 1300 DELL AVE, STE C CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE (408) 253-0618 FEE ID UNIT QUANTITY 11MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- PPERMITFEE FLAT RATE 1.00 38.37 0 . 00 38.37 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 38.37 0.00 38 .37 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 85.74 1300-CUPERTINO PLMB --------------- TOTAL RECEIPT 85.74 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/S ` VE -S/MAIN SERVICE `CUPEkTINO PERMIT APPLICATION FORM APN # Date: 5 v-, Building Address: Ig 6 ed, L) lam . Owner's Name: Phone#: 1- 2�'3-� y57y vl� �.UV�t� C ntractor: Phone: _ License#: Conta t: Phone: Cupertino$usiness License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb L�- Job Description: n Residential Commercial ❑ Cost of Project: i Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE I'blg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING