07050046 CITY OF CUPERTINO
BUILDING DIVISION PERMITI1` ' 'R�tTCI I� RMTI�N '
BUILDING ADDRESS: PERMIT NO.
11742 TRINITY SPRING CT COLD CRAFT INC 07050046
OWNER'S NAME: PERMIT ISSUE DATE
SWENSON JOHN F AND BETH M 1660 ]JELL AVE 05/07/2007
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
INSTAL-, A/C AND CHANGE OUT BLDG ELECT PLUMB MECH
!0z0 LICENSED CONTRACTOR'S DECLARATION Job Description
%U P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and Professions ode_and my license is
t y in full force and effect. 3
? License ClaAs Lie•8
C'
3 t-w Date 2 'ARCHrfEcrS DDEECCLARATION
7 C< 1 understand my plans shall be used as public records
)yU
Oti Licensed Professional
n OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License law for the
00 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 structure
Zprior to its issuance,also requires the applicant for such permit to rile a signed statement
=a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 iq.Ft.Floor Area Valuation
21- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
L 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 APN Number Occupancy Type
not more than five hundred dollars(5500).
E]I,as owner of the property,or my employees with wages as their soft 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 trot 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.).
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 Li-
ccnse Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to the contractor's
License Law.
Q I am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 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 Wo r is compensation Insurance ear/riicpdannd,PP�olicy number am:
rut IL �tM1�ifJuf fa41t P ��NM61fc�i No.: r
CERTIFICATE OF EXEMPTION FROMWORKERS'
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,1 shall not
employ any person in any manner so as 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 Codc,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(See.3097,Civ.C.)
ALender's Name
.7Lender's Address
U Q 1 certify that 1 have read this application and state that the above information is
Iy►-+ 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
W
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
U Z in consequence of the granting of this permit. Date '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE GUL TIONS.
01
Re-roofs
Signature of AppliantlConttactor 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(a)? All roofs ;hall be inspected prior to any roofing material being installed.
❑Yes WN.
WIf 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 materials for inspection.
District?
❑Yes PNu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth&Sations 25505,25533 and 25534.1 understand that ifft building
dtxa not FLUant.that it is my responsibility to notify the occupant of the
requiremel prior to issuance of Certificate of Occupancy. Signature of Applicant Date
� All roof coverings to be Class"B"or better
Owner or authariled agent Dae
CITY OF CUPERTINO
L
8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: Bll : Lot:
APN . . . . . . . . : 36E53038 . 00
DATE ISSUED. . . . . . . : 05/ 07/2007
RECEIPT #. . . . . . . . . : BS(100001228
REFERENCE ID # . . . : 07050046
SITE ADDRESS . . . . . : 11"42 TRINITY SPRING CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SWENSON JOHN F AND BETH M
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5146
RECEIVED FROM . . . . : REC:EIPT INTERFACE
CONTRACTOR . . . . . . . : PENNING, KENT LIC # 18644
COMPANY COLD CRAFT INC
ADDRESS 166.0 DELL AVE
CITY/STATE/ZIP . . . : CMIPBELL, CA 95008
TELEPHONE . . . . . . . . : (4(18) 374-7292
I Ft
FEE ID UNIT QUANTITY ILMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 .00 34 .86 0. 00 34 .86 0. 00
BREMAIRHAN NO.UNITS 1.00 10.26 0.00 10.26 0. 00
BREMFURN NO UNIT 1.00 14 .31 0. 00 14 .31 0.00
BREMRECEPT NO. OUTLETS 1. 00 1.20 0. 00 1 .20 0. 00
BSEISMICRE VALUATION 8, 914 . 00 0. 90 0 .00 0 . 90 0. 00
EPERMITFEE FLAT RATE 1.00 38 .37 0 .00 38 .37 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 176 .64 0. 00 176 .64 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 176 .64 10254
---------------
TOTAL RECEIPT 176.64
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 508 FINAL MECHANICAL