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07050175 CITY OF CUPERTINO BUILDING WVISION PERMIT � .G �l I Q tMATIOIY .:..: .....::.. BUILD DD ESS: PERMITNO. X44 STEVENS CREEK BLVD TBD TO BE DETERMINED 07050175 OWNER'S NAME: PERMIT ISSUE DATE GUBERMAN, ALEX 05/18/2007 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p O LICENSED CONTRACTOR'S DECLARATION Job Description ,U F I hereby affirm that I am licensed under provisions of Chapter 9(commencing :z w with Section 70(x1)of Division 3 of the Business and Professions Code,and my license is REPLACE WATER HEATER in full force and efte�rC�_ G Lic.n 7 FIELD VERIFY BONDING r License Class F^m Date Contractor IT P3095 RCHrrECTS DEC N i z a 1 understand my plans shall be used as public records )yV U.H Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the a0 following reason.(Section 7031.5,Business and Professions Code:Any city or county (Li which rcquires a permit to construct,alter,improve,demolish,or repair any structure Z y 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 .3q.Ft.Floor Area 2 5 O Valuation ZF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or lu 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 Number Occupancy Type not more than five hundred dollars($500). 3421202 7:l�U' ❑1,as owner of the property,or my employees with wages as thew 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 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 We.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- 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 See. B dt P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: sve and will maintain a Certificate of Consent to self-insure for Worker's Compcn- a n,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 arc: _ Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he comptcd if the permit is for one hundred dollars(S 10(1) or less.) I certify that in the perforttadcc f rk f rch ermit is issued,I hall of employ any person in any r be a t¢ on Laws of Californ' Ah Applicant NOTICE TO AP A :1 ki th' a ate of Exempti ,you ould become subjeSS(to the or is C pe tion rovisi ns of the Labor Code,you must Oforthwith co ply with s pr tsions this permjt'shall be deemed revoked. z" CONSTRUCTION NDING AGENCY E-r I hereby affirm that there is a construction lending agency for the performance of _ ai > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Lender's Address U 0 I certify that 1 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 Ubuilding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property f r inspection purposes. a (We)agree to ,indc ify and keep ess e-City of Cupertino against r to Iiabilities,judgmeatf,c tsa penes may;a against id City V Z in conscqucnc¢o ran this Date APPLI S N e I PLY W HALL N -P NT Issued by: Sou GU i, Re-roofs S46ai ture of ppl'anVC Lr or Dail Type of R sof / H D US LS D[SCLOSURE Will thlf applicant or future 'Iding 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)? All roofs:;hall be inspected prior to any roofing material being installed. ❑Yes If a roof i:.installed without first obtaining an inspection,I agree to remove 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 all new m 3terials for inspection. District? u ❑Yes (y tuts I have read the.ha;.40 `materials re uire iso*r C(taptcr 6.95 of the Califor- niaHealth&SafctyCode, ns 505.2 3 nd25534;fundcrstan the uildi g docs not cu_rt��g��99 have ant, a it' my r ?j'}i y c occu (of c rcquitcllfi``otvCvhich st metprio e;siu crtificamof cu Signature of Applicant Date /( ( All roof coverings to be Class"B"or better O r or authoriz agent:' Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Bll-.: Lot: APN . . . . . . . . : 34212027. 00 DATE ISSUED. . . . . . . : 05/18/2007 RECEIPT #. . . . . . . . . BS000001374 REFERENCE ID # . . - : 07050175 SITE ADDRESS . . . . . : 22745 STEVENS CREEK BLVD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER GULERMAN, ALEX ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5628 RECEIVED FROM . . . . : STPEET PLUMBING CONTRACTOR . . . . . . . : TBI> - TO BE DETERMINED LIC # 00096 COMPANY TBI► - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY I,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34 . 86 0. 00 34 . 86 0. 00 BPWHEATER PER HEATER 1.00 10.79 0. 00 10 .79 0 . 00 BSEISMICRE VALUATION 250.00 0.50 0 .00 0 .50 0.00 BUSLIC FLAT RATE 1 .00 107. 00 0.00 107 . 00 0 .00 MPERMITFEE FLAT RATE 1 .00 38 .37 0 . 00 38 . 37 0 .00 PPERMITFEE FLAT RATE 1 . 00 38.37 0.00 38 .37 0 .00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 229. 89 0 .00 229. 89 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 229. 89 17429 --------------- TOTAL RECEIPT 229. 89 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING j CITY OF C UPERTINO CnOF PERMIT APPLICATION FORM CUPEkTINO 0-7050/75 .PN # Date: IF 07 3142- .2-oa 7 Building Address: 4a-iling Address (if different from building address): X74 S c5S7—PO !S 0- Ul) Owner's Name:,, Phone#: —�' ozltra .tE�r License#: s�2z, 7 ContactM/;& Phone: -/455`�� Cupertino Busiine s License#: 1� Fax: *96 `6355 Building Permit Info: Bldg ❑ Elect E� Plumb Mech erl Job Description: LA-ib( _ , t10 ezr-0 GYN d � AD Residential �T -4 C0b4Ce'�7` Commercial ❑ i �,► Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: � Please check this box if the project is a.. second-story addition: ❑ Project Size: Standard ❑ Large ❑ Maj or ❑ Quanti Fee ID ]Tee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler > 10 KK to 500K Btu MECHANICAL BBOILER3 Boilor> 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 In(Voff/Comm/Quasi BUILDING BCONSTAXBQ Co:1. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC 1000 El,-,c 600V <= l OOOA ELECTRICAL BELEC1001 E lec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Imergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO PERMIT APPLICATION FORINT CUPEkTINO Quantit Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP Ni;w Comm Plumb PLUMBING BOVERTIME In,pection Overtime BUILDING _ BPBACKFLOW Atriospherlic Vactium PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE BldR Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK flan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee . BUILDING BPREPIPE RE: i e Of Fixtures PLUMBING BPSEWAGE c ewa a Disposal PLUMBING BPSEWER Sewers PLUMBING BPSpgINK Lawn SprinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain&Vent PLUMBING BPWATER InstER/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT R eins ection Fee BUILDING BREMACOVER A/C'Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cf n MECHANICAL BREMAPPLI .appliance Install MECHANICAL BREM 3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Re.ocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEATHeater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rerr.Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Ropair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF C'UPERTINO C ��I ® PERMIT APPLICATION FORM 47uanti Fee ID lee Description Fee Group BREMSIGNAD Rmc-1 Signs Add Branch ELECTRICAL BREMSIGNS Rem Adel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S cb Specific Plan BUILDING BSEISMICOA1 Seiimic Car-nmeircfaP BMLDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL S 3ecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem)orary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE M-1chanical sq. foot MECHANICAL MPERMITFEE Mec h Permit Issuance MECHANICAL PPERMITFEE Pluio-ibing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3