The URL can be used to link to this page

07100085 CITY OF CUPERTINO � ' ` ' �7 ` BUIY,DING DI31S10N �El\1v11T ��`�� €��? >. ;.. ,:: . ,;. ,.:: .:.:.:. _ _ _:. ... PERMIT NO. BUtLD �� n �� ss �ASCOIGNE DR PLUMBEFS ON CALL 07100085 . PERMIT 15SUE DATE OWNER'S NAME: JANET SHIFLETT 520 E NCGLINCY LN � 10/10/2007 SANITARY NO. CONTROL NO. NE: (408) �79-0483 BUILDING PERMIT INFO ARCHI'IECT/ENGINEER: BLDG ELECT PLUMB MECH � 0 0 0 i p p LiCENSED CON'fRACTOR'S DECLARAT[ON JOb DeSCilptl0❑ � v� I hcrcby affirm that 1 am liccnsed unJcr provisions oC CAaptcr 9(commcncing ; z� with Sccuon 700U) oC Division 3 of ihc Busincss and Profcssians Codc and my liccnx is C 0 P P ER R E- P I P E �� y in full Corce and effect � Z � v� z Licensc �l s Lic. A . : F r p pa� D Conuacwr � ARCHITECI'S DECLA A 7 a a 1 undcrsWnd my plans shall bc uscd as public records )yU ' u. F" Liccnsed Pn�fcuional � y � OWNER-BUILDER DECI.ARATION 1 hcrcby atTirm that 1 am cxcmpt Crum ihc Caniraaor's Liccnsc Law fo� thc � p o following muoa. (Sccuon 7(Y! 1.5, Busincss and Profcssions Ca1c: Any ci�y or county �,°, � which rcqui�cs a permit to conswct, al�cr, improvc, dcmolish, or repair any swctum ° Z} priar u� i1s issuancc, alsa rcquires ihc applicant for such permit to filc a signed stalemcn� Valuation a �hat he is liccnscd pucsuant lo thc provisions of �hc Contrxtor's Liccnsc Law (Chap�cr 9 Sq. Ft. Floor Area � 4 O O O x t� z - $(commcncing with Section 7000) o( Division 3 of �hc Busincss and Profcssians Cadc) or y�.. tha� he is ezemp� the+etrom and We bazis for the allcgcd exempiion. Any violation oC Section 7031.3 by arry applicant for a peimit subjccu Uu applicani to a civil penalty af /�R Number Occupancy Type not more than five hundred dollars (SS00). 3 7 5 2 2 �[ 5 ❑[, u owner of tt�e property. or my employces with wages u the'v solc compensation, will do Urc woric, and �he stmauce is not intended or uftered torsale (Sec.7044. Business Required Inspections and Professions Code: The Contcactor's Licenu Law does noe apply w an ow�r af property who builds or impraves thercon, and who does such work himselCor thcough 6is awn employces, pmvidcd that such improvementc are not in�e�ed ar oQered [or sale. I[, however, the building or improvement is wld within one year oC complcdon, the owner builder wiil have the burden of proving �hat he did not build ar improvc Cor pu�pose ot sa1cJ. ❑ I. as awner of �he property. am ezclusively conuacting with licensed convutars w const�vct ihe project (Sec. 7044. Busineu and ProCcssions Cade:) Thc Conuutnr's Li- ccnse [aw docs not apply to an owner of propeny wha builds ar improves �hereon, and . who conuacts Cor such projects with a contnctoKs) licensed pursuant to the Comextofs License Law. ❑ I am exempt under Sec . B 8c P C for �his rcaton Owner Date _. . WORKER'S COMPENSATION DECLARATION 1 hereby affirtn under penalty of pe�jury onc of the falbwing declazuions: ❑ I hsoe and will maintain a Ceni6cate o( Conunt to sel(-insuec for Workefs Compen- sation, as provided for by Section 3700 of the Labor Code. (ar the performance o[ the work for whicd this pertnit is issucd. ❑ I havc and will maintain Workcfs Compensation Insunna, az myuimd by Scction 3700 0( �he Labor Code, for �he pecformance of the work for which [Ais pertnit is issued. My Warkers ompensati Insuranc carticr and Poticy numbcr are: Cartier. Policy No.: 2 �9 ��i� � CE FICATE OF EXEMPI'ION FROM WORKERS' COMPENSATlON INSURANCE (This section nccd not bc camplc�cd if the permit is foronc hundred dallus (5100) or Icss.) I certi[y thxs in thc perfortnancc af thc work for which �his pertnii is issucd. 1 shall noc employ any person in any manncr so as to becomc subject to ihe Workcrs' Compensation Laws of Califomia. Datc Applicant NOT(CE'I'O APPLICAM: If, alYcr making �his Ccrtifcatc of ExcmpGon, you should 6ecome subject w Ne Workcr's Compenszaon provisions of the Lalwr Code, you must � O forthwith comply with such provisions or this pecmit shall be dccmed ecvokcd. z ""' CONSTRUCTION LENDWG AGENCY F r r�-. I hcre6y aIf rm �hat �hcre is a conswcdon Icnding agcncy far thc per(armancc uf . �Y., � ihc wurk fur which Utis pertnit is issued (Sec. 3097, Civ. CJ W Q Lendcrs Narnc � � L.ender's Address V � 1 certify that 1 havc rcad �his application and s�a�c �hat ihc abovc informatiun is w ►� corrcct. I agcce to comply with alI city and county onlinances and state laws rcla�ing to 0 U building conswction, and hcrcby authori�e represcnutivcs of ihis ciry to cntcr upon thc � W abovc-mcntioncd property for inspcction purposes. a (Wc) agree to save, indcmni(y and kecp harmless Ihc City of Cuperlino against ' H, y � liabiliva, judgmcnts, costs and expenscs which may in any way ucruc against said City (� z in consequencc oC Urc granting o( this permit. �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date — 7�� SOURCE REGULATI S • Re-roofs ��/ Signature Applican ntrac a� HAZAR U ATERIALS D[SCLOSURE Type of F.00f Will 1hc appliwnt or building occupant storc or handk hvardous matcrial az�fincd by the Cupenino Municipal Codc. Chap�cr 9.12. md thc HcalU� and Salcty c� Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Y� �° . wIl thc applicant or fuwrc building occupant usc cquipmcnt or dcviar whicA If a roof � s installed without first obtaining an inspection, I agree to remove cmi� harardous air con�aminants az dcfincd by the Bay Arca Air Quality Managcmcnt all new n �aterials for inspecr.ion. Disirict? � � ❑ Ycs 1 havc rcaJ the haiardcws matcrials rcquircmcn�s umicrChaptcr6.95 of �hc Califor- nia Hcal�h & Safcry Codc, Sections 25505, ZS533 and 25534. I undcrstvid ihat iC ihc 6uilding docs not currcntly havc a �cnnan4 �at il is my respansibility �o notify thc occupan pf �he rc ' which m t prior to issuancc of a Ccnifica�c of OC �Y- O Signature of Applicant Date ��" All roof coverings to be Class "B" or better Owncr or thorizcd agcnt �� o�/�oo�� : '"� CITY OF ��UPERTINO }::. : REPIPE/��/MAIN SERVICE CUPE�TINO PERMIT APPI,ICATION FORM APN # Q �� v Date: �!� o � � ' Building Address: l06 C as Go ► �.-t' . Owner's Name: � Phone #: � f a�nrc_T �� .� � ��" � Z - � O Contractor: Phone: License #: � I 2R t �' � D ��- p � Contact: Phone: Cupertino Business License #: A�� la � - � -o �l �3 Building Permit Info: Bldg ❑ Elect ❑ Plumb Job Description: � Residentia� ommercial ❑ Cost of Proj ect: � Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE F�ldg. Permit Fees BUILDING BPGAS C�as Piping System Fee PLUMBING PPERMITFEE F lumbing Permit Issuance PLUMBING BPREPIPE F.epi e of Fixtures PLUMBING BPFIXTURE Fblg. Fixture PLUMBING BPWSVCS r'Iain Water Service PLUMBING BPSEWER � ewers PLUMBING BPSEWAGE � ewage Disposal PLUMBING BUSLIC F;usiness License BUILDING CITY OF CUPERTINO ITEM 1 OF 1 PERMI�' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN ......... 37��22025.00 DATE ISSUED.......: 10,'10/2007 RECEIPT #.......... BS()00002951 REFERENCE ID # ...: 07:.00085 SITE ADDRES5 .....: 10Ei12 GASCOIGNE DR SUBDIVISION ....... CITY .............. CU]'ERTINO IMPACT AREA ....... OWNER ............: JAI7ET SHIFLETT ADDRESS ..........: 10�i12 GASCOIGNE DR CITY/STATE/ZIP ...: CUI�ERTINO, CA 95014 RECEIVED FROM ....: PLITMBERS ON CALL CONTR.ACTOR .......: ROl3IE DOBKINS LIC # 27158 COMPANY ..........: PLiTMBERS ON CALL ADDRESS ..........: 52�) E MCGLINCY LN CITY/STATE/ZIP ...: CAI�PBELL, CA 95008 TELEPHONE ........: (4�)8) 879 FEE ID UNIT QUANTITY :�'IOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 40.79 0.00 40.79 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 40.79" #15304 --------------- TOTAL RECEIPT : 40.79 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING Community Development � ``` � :'°�� 10300 Torre Avenue �� ' �'� � Cupertino CA 95014 Telephone (408) 777-3228 C(lY OF Fax (408) 777-3333 ';UPEt�TINO Buildin De artment JOB ADDRESS: PERMIT # �� o �� b � �Z � � OWNER'S NAME: �,rue� PHONE #�-f FS -� 3 GENERAL CONTRACTOR: �,�j.�, � �„ FAX # I am not using any subcontractors: t� ►� o Si e te Please check a licable subcontractors and com lete the followin information: SUBCONTRACTOR BUSIl1ESS 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