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06100131 CITY 0I'1[_UPERTINO B ILDING DIVISION PERMIT �� BUILDING ADDRESS: NORMAN ABRAMOV I T Z PERMIT NO.06100131 10303 MINER PT, PERMIT ISSUE DATE OWNER'S NAME: NORMAN ABRAMOVITZ SANITARY NO. CONTROL NO. ONE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description Lu 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 Cade,and my license is �y in full force and effect. REPLACE EXISTING FURNACE t v�Z License Class Lic.x o Date Contractor ARCHITECTS DECLARATION C< I understand my plans shall be used as public records rA.0 ' U.y Licensed Professional h OWNER-BUILDER DECLARATION } 1 hereby affirm that 1 am exempt from the Contractors License Law for the :00 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires 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 Valuation _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area t— (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 1%&a&.r 0 0 Occupancy Type not more than five hundred dollars(5500). ❑I,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 docs 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 Sal 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 ameze t der Sec. B&P C for this aeon Owner Q "��/lP •tn y►Lf�l(� __Date `0 ~ WORKER'S COMPENSATION CLARATION I hereby affirm under penalty of perjury one of the following declarations: J i have and will maintain a Certificate of Consent to self-insure for Workees Compen- 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 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 be completed if the permit is forone 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 soto come subject to the Workers'Compensation Laws of Califomjaa Datc Applicant o NOTICE TOAPPLICANT:If.after making this Certificate o cmption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. z R CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of fyr> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name Z Lender's Address U C I certify that l have read this application and state that the above information is L>~ correct.1 agree to comply with all city and county ordinances and state laws relating to 0 V 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 Hto liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. 7 ►-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date X = — I ( 'zJ SO RCE AEG L TIONS B� 4Z/0Re-roofs ignaturc of Applicant/Contractor Date HAZARDOUS MA ALS 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 shall be inspected prior to any roofing material being installed. ❑Yes C�No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which -mit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes 0Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Code,Sections 25505.25533 and 25534.1 understand thatif the building does t currently have a tenant,that it is my responsibility to notify the occupant of the rcy men which m t be met prior to issuance qS a Certificate of Occupancy. signature of Applicant Date /0 / All roof coverings to be Class"B"or better Owner or authorized agent a, CITY OF CUPERTINO m 1 bf 1 PERMIT RECEIPT OPERATOR: suem COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31646031.00 DATE ISSUED. . . . . . . : 10/17/2006 RECEIPT #. . . . . . . . . : 36477 REFERENCE ID # . . - : 06100131 SITE ADDRESS . . . . . : 10303 MINER PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : NORMAN ABRAMOVITZ ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2012 RECEIVED FROM . . . . : RACHEL ABRAMOVITZ CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : NORMAN ABRAMOVITZ ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2012 TELEPHONE . . . . . . . . : EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 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 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BSEISMICRE VALUATION 1, 800.00 0.50 0.00 0.50 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38 .37 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 ---------- ---------- ---------- ---------- TOTAL PERMIT 175. 04 0.00 175.04 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 175.04 8368 TOTAL RECEIPT 175.04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Community Development 10300 Torre Avenue as Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '"UPEkTINO Building Department JOB ADDRESS: PERMIT # O/ I � �U3 171c�k� viae (L�/ OWNER'S NAME: PHONE # 0'K -y GENERAL CONTRACTOR: otla FAX # 7 � I am not using any subcontractors: t Signature Q Date Please check applicable subcontractors and complete the following information: 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile C� /) V Owner/Contractor Si tune ate OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform: A. All the work authorized by this permit B. — A portion of the work C. _ None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. All of the work B. _ A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to L ._....c...._,e 3. — I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. PersorVFirm Address/City . Phone Number Type of work to be performed ........................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reve e side). Property Owner's Signature: Date: Job Address: )0 5 U ✓1 C� +'�l a G _ Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. CITY OF CUPERTINO FURNACE/AC aCE CUP IST NO I PERMIT APPLICATION FORM APN # Date: l �- 4 -031 �o - -7 -C4 Building Address: ) 0-603 aer 'PI ac,e. Owner' Name: Phone#: Contractor: v Phone: License #: Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect 21, Plumb [T Mech Job Description: C�P— --fur v\(xc.,� Residential Commercial ❑ For Residential Installations: Attic E3 I" floor Q'2"d floor❑ Adhere to min set back requirement❑ For Commercial Installations: Replacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: l p Type of Construction: Occupancy group: Strapped ❑ On Platform a Bonded Sq.Ft. Floor Area: New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A/C Unit> 10,000 cfin MECHANICAL % BREMAIRHAN A/C Units<= 10, 000 cfin MECHANICAL BREMRECEPT Recptl, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING