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07050064r0ee 0 m 2ZUJ -nz F'm iaQ )yU u' vfi :o Lp0 L1n^y _zea VFX, Ll BUILDING DIVISION PERMIT BUILDjT9 9T1� STARRETT CT OWNER'S NAME: TERRY DONN iNE: ARCHrMCT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION 1 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 ( ^ 4 Lice Lic. ► Date Contractee ARCHITECISDECLA A I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors 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 strunme 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 (5500). 0 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 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, die 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 Contractors 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 Contractors License Law. 0 I am exempt under Sea . B & P C for this tcsson I Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 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. 0 I have and will maintain Worker's 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`kees Compensation Insurance camfr and Policy number are: Cartier: V 1 i lir- ti-IPolicy Nci.:UJ4600,aa o "l CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section reed 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 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 .•� W? Q. A aZ UO OU U 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. 1 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 ccQpnsequettce of the granting of this permit. APRLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Signature of Applicant/Contractor . Qatc 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)? J 0Yes w 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? 0 Yes 8rou 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 n currently have a tenant, that it is my responsibility to notify the occupant of the require nLt which t be met prior to issuance of a Certificate of Occu \.. -% �-� Owner or authorized axcni Date BELL PLJMBING SOUTH BAY 3 710 YA �E WAY (408)273-8824 PERMIT NO. 07050064 PERMIT ISSUE DATE 05/08/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description REPLACE MAIN SEWER LINE—BELL PLUMBING SO BAY RENEWED BL 5/8/7 ;;q. Ft. Floor Area 37526013 Issued by: Re -roofs Type of R.)of $4000 Required Inspections AIL All roofs., hall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature if Applicant Date All roof coverings to be Class "B" or better CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT' RECEIPT Sec: Twp: Rng: Sub: B1}:: Lot: APN ........: 37526019.00 DATE ISSUED.......: 05,'08/2007 RECEIPT #.......--: BS000001245 REFERENCE ID # ... 07050064 SITE ADDRESS .....: 18631 STARRETT CT SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: TEI:RY DONN ADDRESS ..........: 18631 STARRETT CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: suew COPY # : 1 RECEIVED FROM ....: RECEIPT INTERFACE CONTRACTOR .......: PE -ER DUMLAO LIC # 26329 COMPANY ..........: BELL PLUMBING SOUTH BAY ADDRESS ..........: 37-.0 YALE WAY CITY/STATE/ZIP ...: FREMONT, CA 94538 TELEPHONE ........: (408)279-8824 FEE ID UNIT QUANTITY ILMOUNT PD -TO -DT THIS REC NEW BAL ----------------------- BPSEWER SEWER SYSTEM ---------- 1.00 ---------- 21.58 ---------- 0.00 ---------- 21.58 ---------- 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 TOTAL PERMIT - -------- 166.95 ---------- 0.00 ---------- 166.95 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 166.95 --------------- 166.95 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING REFERENCE NUMBER -------------------- 1328-BELL PLMB S BAY VOICE ID DESCRIPTION -------- ---------------------------- 202 UNDERFLOOR PLUMBING 302 TUB & OR SHOWER 506 GAS TEST " alF „CUPERT INO CITY OF CUPERTINO REPIPE/S ' �.S/MAIN SERVICE PERMIT APPLICATION FORM D�Dsrn�v APN # � �5 `�� D� i ICS BlIding Address: II b ,q. (Jas Piping System Fee PLUMBING PPERMITFEE O ner's Name: PLUMBING BPREPIPE Phone #: 4?i�s —goo (D Contractor: BPFIXTURE Phone: 5)0 - 4�S--9CXDQ License #: Sa Contact: Plain Water Service Phone: Cupertino Business icense #: 'Sewers PLUMBING BPSEWAGE 'Sewage Disposal Building Permit Info: Bldg ❑ Elect ❑ Plumb Ltd' Job Description: Residential Commercial ❑ Cost o Project. p wo — Qty. if PPP TT) Fee Descrintion Fee Grow BPERMFEE Bldg. Permit Fees BUILDING BPGAS (Jas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE I'blg. Fixture PLUMBING BPWSVCS Plain Water Service PLUMBING BPSEWER 'Sewers PLUMBING BPSEWAGE 'Sewage Disposal PLUMBING BUSLIC Business License BUILDING