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08120136 CITE'(3F CUPERTINO BUILDING DIVISION PERMITTR�lI ��# � : BUILDING ADDRESS: PERMIT NO. 20655 NANCY CT STARBURST CONST CO 08120136 OWNER'S NAME: PERMIT ISSUE DATE .TGIF KA'T Z eHONE: SANITARY NO. CONTROL NO. ARCHITEC IFNGINEER: BUILDING PERMIT INFO TEMP POWER BLDG EO PLUM 0 u0p LICENSED CONTRACTOR'S DECLARATION 0firm that I am licensed under provisions of Chapter 9(commencing Job Description m with Section 7000)of Divi ion 3 of the Business and Professions Code,and my license is y in full force and effect.• 7t ? License Class Lie.N V &—a Date - YContractor ARCHITECTS DECLARA71ON a U I understand my plans shall be used as public records G y Licensed Professional 03 y', OWNER-BUILDER DECLARATION <M I hereby affirm that 1 am exempt from the Contractor's License Law for the 3.00 following reason.(Section 7031.5•Business and Professions Code:Any city or county t m Pi 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 license)pursuant to the provisions of the Contractor's License law(Chapter 9 S Ft.Floor Area o x o P P P q Valuation a t (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y .. 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 not more than five hundred dollars(S500). Occupancy Type ❑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 Contractors License Law dors not apply to an owner of Required Inspections 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 Contractors 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 Contractors 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: ❑I have and will maintain a Cer ificate of Consent to self-insure for Workers 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 W40FEMPTION ensation Insurance,as required by Section 3700 of the Labor Code,for thof the work for which this permit is issued. My Worker Co penaa'on Inr and Policy number aS Carrier. - —� Policy No.:,[ ICA FROM WORKERS' 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 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 O forthwith comply with such provisions or this permit shall be deemed revoked. r i EA CONSTRUCTION LENDING AGENCY + I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) a Lender's Name Z Lenders Address C) I certify that I have read this application and state that the above information is Vcorrect.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 inspectingg purposes. L>r (We)agree to save,indemnify I keep harmless the City of Cupertino against s rn liabilities,judgments,costs and ex s which may in any way accrue against said City Z in consequence of the granting oC i permit. h'+ APPLICANT UNDERSTA D WILL MPLY WITH ALL NON-POINT Issued by: Date t2 -Z �-e f' SO TIONS. y Signature o pp r nractor ate Re-roofs H DOU MA ALS DISCLOSURE Type of Roof Will the appl' t r fasturqbuildi#g occupant store or handle hazardous material as defined by Uta , pertino Mun opal ode.Chapter 9.12,and the Health and Safety Code,Sector 2552(a)? ❑Ya All roofs shall be inspected prior to any roofing material being installed. 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 Area Air Quality Management all new materials for inspection. District? 777777 ❑Yes �No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25 J 25534.1 understand that if the building does not currently have a tcnan4 that it' y risibility to notify the occupant or tic requirements which must be met fa C i nate of Occupancy. Signature of Applicant Date All roof coverings to be Class W'or better Owner or aulhorixcd agent Date g !T Al CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 35915027 . 00 DATE ISSUED. . . . . . . : 12/23/2008 RECEIPT #. . . . . . . . . . BS000006879 REFERENCE ID # . . . : 08120136 SITE ADDRESS . . . . . : 20655 NANCY CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . JOE KATZ ADDRESS . . . . . . . . . . : 20655 NANCY CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2913 RECEIVED FROM . . . . : STARBURST CONST CONTRACTOR . . . . . . . : CAREY, PHIL LIC # 21428 COMPANY . . . . . . . . . . : STARBURST CONST CO ADDRESS . . . . . . . . . . : 1207 REDCLIFF DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95118 TELEPHONE . . . . . . . . : (408) 448-1328 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 300 . 00 0. 50 0 . 00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00 1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1ERT<200 UNITS 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 236 . 87 0 . 00 236 . 87 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 236 . 87 8159 --------------- TOTAL RECEIPT 236 . 87 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO TEMP POWER CUPEkTINO PERMIT APPLICATION FORM Deis �� APN # z� Date: Ig- 9.3 J Building Address: ., ,0GV1c- Owner's Name: Phone#: <1 CA #: Contractor: Phone j Fax#: ^ � 5 Contact: Phone #: Contractor License #: Cupertino Business License #: G Job Description: Lj Residential Commercial Valuation (cost of roject): Type of C nstruction• N/A �--�- 3 Quantity Fee ID Fee Description Fee Group Permit Type IERT>1K Res. Temp Power>1K E 1REAP14 Amps IERT<200 Res. Temp Power<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps IEPERMITFE Electric Permit Issuance E 1 ELCPLNCK Electric Plan Check E 1BSEISMICR Seismic Residential B I TRAVDOC Travel & Documentation B / Fee C", Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ,,UPEkTINO Buildin De artment JOB ADDRESS: �-- PEE , A CJ D f ltea! 1 ,� OWNER'S NAME: -- l� PHONE # c3 3 GENERAL CONTRACTOR: FAX # J� y I am not using any subcontractors: Date ignature Please check applicable subcontractors an lete th ollowin information: SUBCONTRACTOR B NES AME 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 ------------ Owner/Contractor Signature Date