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09010093 77577777 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � � � ' PERMIT NO. BUILDING ADDRESS: 1026n qrrnmynAT,F, T)R -IM MAJOR OWNER'S NAME: PERMIT ISSUE DATE 2089 A CONTROL NO. '7 BUILDING PERMIT INFO ARCHr EcT/ENGINEER: BLDG ELECT PLUMB MECH a 0 o a a 0 C LICENSED CONTRACTOR'S DECLARATION Job Description V 1 hereby affirm that 1 am licensed under provisions or Chapter 9(commencing with Section 70()0)of Division 3 of the Business and Professions Code,and my license is Min full force and effect- INSTL NEW GAS METER z License Class Llc•# F O Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records �yU y O H Licensed Professional rn OWNER-BUILDER DECLARATION 1 hereby alTnm that 1 am exempt from the Contractors License Law for the O Oa following reason.(Section 7031.5,Business and Professions Code:Any city or county �0.e6 which requires a permit to convect,alter,improve,demolish,or repair any mctum _ permit prior to its issuance,also requires the applicant for such 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 yF$ (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 Occupancy Type not more than five hundred dollars(5500). 32637027 . 00 ❑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(See.7044.Business Required Inspections and Professions Code:The Contractors 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 or proving that he did not build or improve for purpose of Vsec y L-- 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 themon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑lam exempt un B&P C Or this ason Owner Date /o WORKER'S MPENSATTON DECLARATION �;mdbwvill y affirm under Wally of perjury one of the following declarations: I maintain a Certificate of Consent to self-insure for Workers Compen- .don,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 mquired by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number arc: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is formic hundred dollars($100) or less.) I certify that in the performance of ich this permit is issued,l shall not employ ay prso nen in any m to bject to rte Workers'Compensation Laws of California Date Applicant NOTICE 7O APPLI :I,after making this Ce ficatc of Exemption,you should become subject to the o s Compensation provisions of the Labor Code,you must Z forthwith comply with provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY [~-tom-+ I hereby affirm that there is a construction lending agency for the performance of �.d> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name Lenders Address U 0 1 certify that I have read this application and stale that the above information is V." correct.I agree to comply with all city and county ondinanees and state laws relating to 8 U building convection,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. C6 (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way accrue against said City _ V Z in consequence of the ranting of this permit. ►'. APPLICANT UN STANDS AND WILL COMPLY WITH ALL N-POINT Issued by: _ Date SOURCE D Re-roofs — nrincd of Applicant/Con r ata T of Roof OUS MATERIALS DISCLOSURE Type ll the applicant future building occupant store or handle hazardous material by the Cupertino Munt al Code.Chapter 9.12,and the Health and Safety Cole,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. C3 Yes 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 it hazardous air contaminants as do ed by the Bay Area Air Quality Management all new materials for inspection. strict? ❑Yes m 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building ;Own t currently he tc tit is my responsibility to no dee pant of the rr�nyvvlh m primrtoissmanccmracertinc�atcmr ley. 0 Signature of Applicant Date All roof coverings to be Class" `'or better or a orized agent are CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32637027 . 00 DATE ISSUED. . . . . . . : 01/21/2009 RECEIPT #. . . . . . . . . BS000007011 REFERENCE ID # . . . 09010093 SITE ADDRESS . . . . . : 10260 STONYDALE DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JO MAJOR ADDRESS . . . . . . . . . . : 10260 STONYDALE DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1030 RECEIVED FROM . . . . : JOE MAJOR CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY JO MAJOR ADDRESS 10260 STONYDALE DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1030 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 500 .00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 500 .00 0 . 50 0 . 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 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 83 . 08 0 . 00 83 . 08 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 83 . 08 #6769 --------------- TOTAL RECEIPT 83 . 08 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING 0qo1 o�3 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN# 20, (,e 3 0.2 0 C7 Date: Building Address: /D O �^ ��Ye— Owner's Name: -�v A Phone#: Contractor: Phone#: Fax#: &S`O 2G l S-46d S Contact: Phone#: Fax#: Contractor License #: Cupertino Business License#: Job Description: Residential Commercial ❑ Valuation: �SOo Project Size: Express Standard R Large El Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICR Seismic Residential P 1PRSEWER Residential building P 1RPSS sewer/sanitary sewer 1PRREPIPE Residential re-pipe per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1 PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1 PGASRES Residential Gas Piping System P 1-4 Outlets 1 BPGAS Gas Piping System 5+Outlets P f 1PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1 PLMBINSP Other Plumbing/gas Insp. P / 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B Community Development 10300 Torre Avenue ,, > Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '7,UPEkTINO Building Department JOB ADDRESS: 7>ri'Ve- PERMIT #Oq O ( cog 3 OWNER'S NAME: ��4cJ7i� PHONE # 09 -733- �� To -7 GENERAL CONTRACTOR• 6WE46 '//-. ,F4C FAX # I am not using any subcontractors: Signa e Date Please check applicable subcontra s 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 Owner/Contractor Signature Date