Loading...
09020069 CITY OF CUPERTINO BUILDING DIVISION PERMIT � �ZI� ' PERMIT NO. BUILDING ADDRESS: 10324 STPIU4BTN PERMIT ISSUE DATE OWNER'S NAME. SA .Oki. CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH SEWER :SINE REPLCMNT PIPE aIx pp LICENSED CONTRACTOR'S DECLARATION BURST :METHOD) Job Description to I herebyaffirm that I am licensed under provisions of Chapter 9(commencing Z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is Z<y in full force and effect Z 16 ? License Class 3 Lle.ff nF p Datc Contractor gg ARCHITECTS DECLARATION et< 1 understand my plans shall be used as public records Dwd 4 C y Licensed Professional N OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county Q Pi which requires a permit to construct,alter•improve,demolish,or repair any structure _ prior to its issuance,also requires the applicant far 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 YF (commencing with Section 7010)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 arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). ❑I,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 docs 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.). O 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- ccnse 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 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: I have and will maintain a Certificate of Consent to self-insure far Worker's Compen- ,.ation,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 Compenson Insurance carrier and Policy number are: Carrier. ryrS Cr_—JPolicyNo.: WEN–00302 1 Z CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,l 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*" CONSTRUCTION LENDING AGENCY (� I hereby affirm that there is a construction lending agency for the performance of p�A✓ the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name Z Lcndees Address V C) 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 0 V building construction,and hereby authorize representatives of this city to enter upon the 0 a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against „H,t to liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the grantin %Ljy permit. APPLICANT UND AND WILL COMPLY WITH ALL NON-POINT Issued b,r: Date SOUR Re-roofs (V — Sign onuactor Dare T of]roof HAZARDOUS MATERIALS DISCLOSURE Type 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 roof: shall be inspected prior to any roofing materiaIng installe ❑Yes j`�No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agrees-to remove it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. :strict? ❑Yes L�kNo 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cork:,Sections 25505.25533 and 25534.1 understand that if the building docs not currcndy ha�gn&w,�h%atltis responsibility to notify dtC occupant of thereyuiremcnts ca of a Certificate of Occupancy. SlgnatUUr:of Applicant Date All roof coverings to be Class" '`or better Owne r authorized agent Date -A 0 (--�&p 19 CITY OF CUPERTINO 0q0, REPIPE/SEWS R/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # _ Date: Building address: Owner's Name* Phone#:C6150 3 C3 -- Co L- � rf Contractor: Phone#: qL �} 6— 3 z�6 ��.-,�� Fax 3CO Ct 6 Contact: Phone#: 4G� 6 C--3z616 Fax #: 36p 4,G Contractor License#: 9` 6 3 Z � Cupertino Business License#: Job Description: D_-6_4 -s� Residential Commercial ❑ Valuation: Project Size: Express Standard ❑ Large 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 brilding 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 Stanc.ards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 CITY OF C UPERTINO 0 REPIPE/SEWER/MAIN SERVICE CUPEI,TINO FEE SCHEDULE Quantity Fee ID Fee Descriptki 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 sevier 1PRREPIPE Residential re-pip,;per fixture P 1RPRP 1BPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage D.sposal System P 1 PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas P.ping System P 1-4 Outlets 1BPGAS Gas Piping Syster.i 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Ct.eck P 1PLMBINSP Other Plumbing/gas Insp. P 1 TRAVDOC Travel & Documentation Fee B 1 BUSLIC Business License B Community Development 10300 Torre Avenue a; Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ';UPEkTIN0 Building Department JOB ADDRESS: PERMIT # (o3z4 5&ctc' ,{; v 2 0 6 OWNER'S NAME: �� PHONE f4o G46 —3ZZ'6 GENERAL CONTRACTOR: FAX # 2-26— 3 34- I am not using any subcontractors: Z 13 U �1 et, ature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets &Millwork -�p 0?a dye 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 _ aZ(I �ucI Owner/Contractor Signature Date