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07050019BUILDING DIVISION PERMIT BuILD19 9�9PEAR TREE CT OWNER'S NAME: GRANT TERRY L riONE: ARCHIIECTIENGINEER: 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 and effect. License Class Lia M Date Contractor ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requites 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 License 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 offend for sale (Sex. 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.). 0'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 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 the Contractor's License Law. ❑ I am exempt under Sec. B & P C for this reason Owner 44 Date ~ RKER0 INE ATMM RATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 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 Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis section need not be completed if the permit is for anc 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 man to subject to the Workers' pensatign Laws of Calif Applicant NOTICE TO A PLI f, aftc aking is Certificate of Exemption, you should become subject to the Worker's C mpensation 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.) Lender's Name Lender's Address 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 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 VIjITH ALL NON -POINT ,PHAZARDOUS 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)7 ❑ Yes vw 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 1 have read the hazardous materials requirements undcrChaptcr 6.95 of the Califor- nia Health & Safety Code, Sections 25505.25533 and 25534.1 understated that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requirements which mast be met prior to issuance of a Ccrdfrtxle of Occupancy. _ , authorized PERMIT NO. TBD — PO BE DETERMINED 1 07050019 PERMIT ISSUE DATE 05/03/2007 SANITARY NO. CONTROL NO. BUILDING PERMR'INFO REPLACE ALL GALVANIZED PIPE,I �, JliIIVV" Job Description Issued by Re -roofs Type of Roof 3q. Ft. Floor Area Num Required Inspections Valuation Occupancy Type All roofs ;hall be inspected prior to any roofing material being installed. If a roof i; installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better 2 ITEMS OF 2 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31E30088.00 DATE ISSUED.......: 05/03/2007 RECEIPT 4.........: BSC00001189 REFERENCE ID # ...: 07C50019 SITE ADDRESS .....: 19S75 PEAR TREE CT SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER GR7NT TERRY L ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO CA, OPERATOR: bethe COPY # : 1 95014-2318 RECEIVED FROM ....: REC'EIPT INTERFACE CONTRACTOR .......: TBI - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBIl - TO BE DETERMINED ADDRESS ........... CITY/STATE/ZIP ...: , TELEPHONE ........: FEE ID UNIT QUANTITY 114OUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- BPREPIPE NO OF FIXTURE -------------------- 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 ---------- 47.37 ---------- 0.00 47.37 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 47.37 --------------- 47.37 VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING 507 FINAL PLUMBING REFERENCE NUMBER -------------------- MASTERCARD VOICE ID DESCRIPTION -------- ---------------------------- 502 FINAL PLUMBING ENERGY C CUPEkT1NO CITY OF CUPERTINO REPIPE/S WE14.S/M.AIN SERVICE PERMIT APPLICATION FORM APN # ,3iW -3f Bldg. Permit Fees Date: Y15 Aa 7 Building Address: Gas Piping System Fee G �.e pit/ Owner's Name: PLUMBING Phone #: Re i e of Fixtures PLUMBING BPFIXTURE Contractor: Phone: a -;_' 2 7 Z License #: J/8 -777Z Contact: Phone: Cupertino Business License #: 49; D 8 - 2 - viewers Building Permit Info: BPSEWAGE Bldg ❑ Elect ❑ Plumb PLUMBING Job Description: 94 L L 6, 4-1, V -Al ` 7 6F—%J 1.11,Re rR L5,'01CAQ ALG VAGVCS 1 V -'A1:00045 A"4 .4, CF.D Residential Commercial ❑ Business License Cost of Project: Qty. if A I;ica bl Fee ID Fee Description Fee Group pp e BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER viewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # .—Z GENERAL CONTRACTOR: /l FAX # I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date 60 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 V PlumbingI)OeAl Roofing Septic Tank Sheet Metal Sheet Rock Tile _ S ,Xrne'r/Con'tractor Signature Date