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06100105CITY OF CUY>;xi LIN" ��TRACT �M�A1�JN: BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: HANKINS CONSTRUCTION INC 06100105 . OWNER'S NAME: JIVE: ARCHMCT/ENGINEER: LICENSED CONI -KAI. rUta 3uea..u+nnrevr� I 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. License Class i Lic. # Date ' ° Contractor ARCHTTECI'S DELLA AT1UN tt �dcrstand my plans shall be used as public records Licengcd Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the 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 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). ❑ 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, 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. ❑ 1 am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: �z 0 Z Lia ? Q.i Q az UO OU >' W a U ] I have and will maintain a Certificate of Consent to self -insure for Workces 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 Worker's Compensation Insurance carrier and Policy number are: Carrier. (r 7 vf� j 1"e Policy No.: _42"a CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('osis 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, I shall not employ any person in any manner so as to become subject to the Workcrs' Compensation Laws of California. Dare 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a convection lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I 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-mennioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgmcns, toss and expenses which may in any way accrue against said City in consequence of the granting of this pe it. APPLICANT UNDERSTAND AN ILL MPLY WITH ALL NON -POINT SOURCE REGU ATIONS Siinift& of Appli or Djdc H RDOUS MATERIALS DISCLOSURE Will the applica t 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)? ❑ Yes No Will she applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑Yes IyJ�ro 1 have read the hazardous materials requirements under Chapter 6.95 of the Califon nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant it is y responsibility to notify the occupant of the requirements whicl ptust be pli r or V issuance a( a Certificate of Occupangy. authorized PERMIT ISSUE DATE SANITARY N13 CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description RUN GAS LINE TO THE FIREPLACE Ft. Floor Area HE Issued by: Re -roofs Type of Roof Required Inspections Valuation Date All roofs shall 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 of Applicant All roof coverings to be Class "B" or better Date y CITY OF ''UPEkTIN0 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE #- BUSINESS LICENSE # GENERAL CONTRACTOR:. ; FAX # 6e)�C - I am not using any subcontractors: G /� Signature Date Please check applicable subcontractors and complete the followinz information: Ov�efr/ Signature Date 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 Ov�efr/ Signature Date CITY OF CUPERTINO n 1 of 1 PERMIT RECEIPT OPERATOR: bethe COPY # : 2 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34255018.00 DATE ISSUED.......: 10/13/2006 RECEIPT #......... 36432 REFERENCE ID # 06100105 SITE ADDRESS 23200 VIA ESPLENDOR #33 SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER THE FORUM APTS ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: MARK HANKINS CONST CONTRACTOR .......: MARK A HANKINS LIC # 26518 COMPANY ..........: HANKINS CONSTRUCTION INC ADDRESS ..........: 38227 FREMONT BLVD CITY/STATE/ZIP ...: FREMONT, CA 94536-6020 TELEPHONE ........: (510)795-9654 v'EE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW -------------------- ----- BAL ---------- BPGAS ----------------------- OULETS 1.00 ---------- 5.40 0.00 5.40 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 ---------- ---------- ---------- 0.00 TOTAL PERMIT ---------- 43.77 0.00 43.77 0.00 METHOD OF PAYMENT AMOUNT NUMBER ------------------ ----------------- OTHER ------------ 43.77 VISA TOTAL RECEIPT 43.77 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- 202 --------------------- UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO to REPIPE/SE VERS/M.AIN SERVICE CUPEkTINO PERMIT APPLICATION FORM opQU1 05 Qty. if plicable Fee ID Fee Description Fee Group P BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Re i e of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING