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06100198 CITY OF CUPERTINO T�T NFOR BUILDING DIVISION PERMIT O "''� � it\ MLQN� BUILDING ADDRESS: PL ERS ON CALL PERMIT NO.06100198 10501 N PORTAL AV PERMIT ISSUE DATE OWNER'S NAME: MURRAY W S AND SUSAN H 520 MEGLIACY LANE #12 10/27/2006 iNE: SANITARY NO.' CONTROL NO. (408) 879-9416 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 O p LICENSED CONTRACTOR'S DECLARATION Job Description V P l hereby affirm that I am licensed under provisions of Chapter 9(commencing e Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is RE-PIPE GALVANIZED TO COPPER s y in full force and effect 7 �� j ? License Class Lic.M t,La Date o Contractor 9—N t ARCHITECTS DECLARATION WU 1 understand my plans shall be used as public records .4 y Licensed Professional O 0 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the p Oa following reason.(Section 7031.5,Business and Professions Code:Any city or county $7324 <m V 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 CEO_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area ut-• (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 r Occupancy Type not more than five hundred dollars(5500). ❑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 Required Inspections 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.). ❑1,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 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: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compcn- 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 Ca pensanon Insurance carrier and Policy number are: Cartier. /-z Ac 471O Polity No.: 4-7/7& CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is far 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 R CONSTRUCTION LENDING AGENCY [~-t I hereby affirm that there is a construction lending agency for the performance of .7 the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name Lenders Address U O 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 Vbuilding construction,and hereby authorize representatives of this city to enter upon the a 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 V Z in consequence of the granting of this permit. ►" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ',- SOURCE REGULATIONS. .11:;"yrf J / &)1271u Re-roofs Signature of ApplianUContractor 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 shall be inspected prior to any roofing material being installed. ❑Yes LJ No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? Cl Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafclyCodc,Sections 25505.25533 and 25534.1 understand that ifthc building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prio w issuance of a Certificate of Occup Signature of Applicant Date '�--� /CI7�'o� All roof coverings to be Class"B"or better Owner or authorized agent Date Community Development 10300 Torre Avenue .` Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY bf `,UPEkTIN0 Buildin De artment JOB ADDRESS: PERMIT # ,s N �G,- 1 eve 0 61,° v (/ ? S- OWNER'S NAME: Q PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: 1& -Z 7A-6 Signature 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 v Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO Im 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN 31630101 . 00 DATE ISSUED. . . . . . . : 10/27/2006 RECEIPT # . . . . . . . . . : 36588 REFERENCE ID # . . . : 06100198 SITE ADDRESS . . . . . : 10501 N PORTAL AV SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER MURRAY W S AND SUSAN H ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : PLUMBERS ON CALL CONTRACTOR . . . . . . . : ROBIE DOBKINS LIC # 27158 COMPANY . . . . . . . . . . : PLUMBERS ON CALL ADDRESS . . . . . . . . . . : 520 MEGLIACY LANE #12 CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 879-9416 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - - - - - - - -- - - --- - - - ---- - - ------ --- ---------- ---------- ---------- --- ------- BPERMFEE VALUATION 7 , 324 . 00 147 . 96 0 . 00 147 . 96 0 . 00 PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 ----- - ---- ---------- -------- -- ---------- TOTAL PERMIT 186 . 33 0 . 00 186 . 33 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - - - -- - - - - - --- - - - - - ------ - --- - ----- - - - --- ------- CHECK 186 . 33 13361 TOTAL RECEIPT 186 . 33 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING CITY OF CUPERTINO Cho 9 8 REPIPE/SEWS S/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # Date: / -5IC-0- — I C\ le'l? Building Address: Owner's Name: L Phone#: Contractor: Phone: License #: Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ Plumb 0" Job Description: e G Residential Commercial ❑ Cost of Project: -332 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING