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09040060 777777777:7777 77 7 77,77 CITY OF CUPERTINO BUILDING DIVISION PERMIT XJ. PERMIT NO. BUILDING ADDRESS: , ROOTERS ON DEMAND 10320 PHAR LAP DR PERMIT ISSUE DATE OWNER'S NAME: S A CONTROL NO. 'TONE: (510) 475-8271 BUILDING PERMIT INFO Fforce GINEER: BLDG ELECT PLUMB MECH u p QLICENSED CONTRACTOR'S DECLARATION Job Description Uffirm that I am licensed under provisions of Chapter 9(commencing U., )of Division 3 of the Business and Professions Code.and my license is RP LC S EL JR LINE AP PRX 5 0 F T TRENC H L E S S yeffect. Lcense ass Lic•# t-0 Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records 3 W J `wO y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the C a O following reason.(Section 7031.5,Business and Professions Code:Any city or county C m ff which requires a permit to constmct,alter,improve,demolish,or repair any structure H prior to its issuance,also requires the applicant Cor such permit to file a signed statement �q Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 xF (commencing with Section 7000)of Division 3 of rho Business and Professions Cade)or $3250 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not more than fire hundred dollars(M). 3 2 6 3 9 0 3 ) . 00 ❑L as owner of the property,or my employees with wages as their sole compensation, will do the work.and the structure isnot intended oroffered for sale(See.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.). ❑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. ❑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 for Worker's Compen- ..ion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 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 Workees Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss) 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 `j,., forthwith comply with such provisions or this permit shall be deemed revoked. z, CONSTRUCTION LENDING AGENCY [.r►. I hereby alarm that there is a construction tending agency for the performance of p; the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name ►7 z Lender's Address V 0 I certify that I have read this application and state that the above information is LL C~ correct.I agree to comply with all city and county ordinances and stale laws relating to 0 V building construction,and hereby authorin representatives of this city to enter upon the s W above-mentioned property for inspection purpose 6l~ (we)agree to save,indemnify and keep harmless the City of Cupertino against F.t liabilities,judgments,costs and expenses which may in any way accrue against said City V z in consequence of the granting of this permit. Date h--h APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b): SOURCE REGULATIONS. Re-roofs — Signature of Applicant/Contractor 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 ❑No Will a roof s installed without first obtaining an inspection, agree to remove ll the applicant or future building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Strict? ❑Yes ❑Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safely Code,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of Occupancy. Slgnatur( of Applicant Date All roof coverings to be Class'."or better \ Owner or author! -d agent Date oc?oLlvv c� CITY OF ��UPERTINO REPIPE/SEWEIR/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APNCv�D o v Date: Y— A2 - ©C1 Building Address: LJr Owner's Name: Phone#-�Ok 41%, 1%/ 0/l AQ rI,' Ct Or- -7 �j CXoLe-ef act r: Phone#: -,*L4h Fax #: Contact: �q� �v� Phone#: �- /J Fax #: Contractor License#: Z O Cupertino Business License#: Job Description: CSC cc/b r C 1 4 Yt Residential Commercial ❑ Valuat4 Project Size: Express atndard FLarge [ 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 Newer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial GiLs 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/SEWERIMAIN SERVICE too OF CUPEkTiNO FEE SCIH:EDULE 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 1PPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P 1PPERMITFEE Plumbing Permit Fee Issuance P 1PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P 1TRAVDOC Travel & Documentation Fee B 1BUSLIC Business License B Community Development 10300 Torre Avenue It,k�u SCupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 rUPEkTINO Building Department JOB ADDRESS: PERMIT # 0 761&'�'60 OWNER'S NAME: PHONE #'5I0 Z S; O GENERAL CONTRACTOR: CI Qyj /I( FAX # I am not using any subcontractors: 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date