07100043 CIT�' OF CUPERTINO Y? ' '
H1IILDINC TJIV1S10N pE�VIIT 4��� •C'JC�'1� Z�����TI€�N :
, .,'; ,..;::. _ . . ...
: <:r:� ... _::::. .....
BUILD GADDRESS: PERMITNO.
U�REENLEAF CT LOT 1 NEXGEN BUILDERS, INC. 07100043 �
pERMIT LSSUE DATE
OWNER'S NAME:
JIM HARDCASTLE 225 DEM ETER ST 10 04 2007
SANITARY NO. CONTROL NO.
,NE:
(650) 322-5800
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
� 0 0 0
i p p LICENSED CONTRACI'OR'S DECLARATION JOb DeSCilpt1011
: V� I hcreby affirm that I am liccnscd undcr provisions oC Chap�cr 9(commencing
; z� wim Sccuon 7ocw) otDivision 3 of ihc Business and Protcssions Codc, and my liccnsc is TEMP PO �TER POLE
�� y in full Corce and ct � 7��' a e
j�? Licensc C azs �M• �
: �, p Datc Conuac�or AI F. 6� rC
� ^ ` ARCHITECI'S DECLARATION
j a Q I undcrstand my plans shall bc uscd as pu6lic records
)aU
' a F' LicenseJ Pmfcssional
� a < OWNBR-BUILDER DECLARATION
'}� I Mrcby a17rm that t am cxcmpt Crum thc Contraaar's Liccnsc law Car thc
� p o following reason. (Sccuon 7031.5. Busincss and ProCcssions Ca1c: Any city ar county
< m� which rcquires a permit tu conswc4 alur, impmvc, dcmolish, or repair any structurc
� Z} priar w i�s issuancc, alsu requires ihc applicant for such permit to filc a signcd sta�cmcnt Valuation
< �hat hc is liccnscd pucsuan� to thc provisions of ihc Contracw�'s Liccnx Law (Chapicr 9 iq. Ft. Floor Area � 7 O 0
x t �(commencin g wi�h Sccdon 7000) of Division 3 oC�hc Busincss und Profcssions Cadc) or
i 3� �a� ���u�"P� ��from and Uu bazis Cor the allegcd exempdoa Any violation of
Sectian 7031.5 by azry applicant for a permit subjecu ihe applicant to a civil penalty of A� Number Occupancy Type
not moro �han fivc hundicd dollars (5500). 3 2 6 5 � 0 2 7: TJ �
�[. as owne� oC tlie p�opeety, or my employces with wages az the'v aolc compensaGon,
will do thc work and �he scructurc is not intendcd or otCe�ed (or sa� (Sec.7044. Businrss Required Inspections
and Professions Cadc: The Convuars License Law docs rrot apply W an owner o[
property who builds or improves thercon, and who does such work himseltor thmugh 6is
own employccs. provided that such improvemen�s are not in�ended or olTered far sale. it,
however, the building or improvement is sold wittdn one year oC comptction, dx owner-
builder will have the burden o[ proving U�ai he did not build or improvc (or pacpase o!
salc.).
� 1. as owner of the property. am racctusively conuacting with licensed convutars W
conswct the pcoject (Sec. 7044. Businus a� Pto[�ssions Code:) The Coalnctn�s Li-
ccnse Law docs not apply to an ownu of property wlw M�ilds or improves We�. and .
who conuacts Cor such projecis wi�h a conuacior(s) licensed pursuant to the Conuacto�s
License Iaw.
❑ 1 am exempt under Sec. . B& P C for �his icasoo
Owner Date _... _.
WORKER'S COMPENSATION DECLARATION
1 hereby at7irm under penalty o[ perjury om af We following declazations:
❑ I hsve and will maintain a CertiGcate of Consent lo xtf-insure Car Worker's Compen-
sation, u providcd for by Secdan 3700 oC the Labor Code, for �he perfarmarxe of the
work for which this permit is issued.
�[ havc and will maintain Workcr's Compensatian Insurance, az ra�uired by Scction
3 �o0 of thc Labor Codc, for thc perfarmance ot �he work for which this pe�mit is issued.
My Worker's Compensatian Insunnce rertier and Policy number arc:
Carrier. ��C �ou�/� PolicyNo.: �� ��OCi90�
CERTIFICATE EXEMPIfON FROM WORKERS'
COMPENSATION INSURANCE
(Iliis scction necd not bc completcd it �he permit is kx onc hundred dollus (5100)
or Icss.)
I cenify thas in thc performancc of �hc work fw which �his permit is issucd, t shill not
e�nploy any person in any manncr so as to bccomc wbjcct �u �he Workcrs' Campensation
Laws o(Califomia. Date
Applicant
NOTICE TO APPC.ICAM: If, af�cr making ihis Ccrtifteate of Ezcmption, you should
become subject to the Workcr's Compcnsadon provisions o( ihc La6or Codc, you must
� O forthwi� comply with such provisions or this permi� shall bc dccmcd revokcd.
z ""' CONSTRUC170N LENDING AGENCY
F r�-. 1 hereby affirm that there is a constnrctian lending agency Car the perCortnance of .
GY, � thc work for which this permit is issucd (Scc:. 3097, Civ. C.)
LL� Q L.endcr's Namc
a z L.cnder's Address
V 0 ! certify �hat I have read ihis appiieation and siatc �hat the abovc inCortnatiun is
�� cortect. 1 agrce io comply with all city and county oNinances and sute laws reladng lo
.J U building conswction, and hctcby authori�e rcprcscntativcs of this city to cntcr upon �c
� W abovc-mrn�ioncd property for inspccuon pu�oses.
a (Wc) agrce to save, indcmnify and kecp harmleu ihc Ciiy of Cupcnino agtinst
�� liahilitia, judgmcnts, costs and expcnscs which may in any way accruc againsl said City
U z in consequencc oC thc granung o( �his permit. DaCe `7
�—+ APPLICANT UND STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by ��
SOU EGU ONS.
O - .3 - � Re-roofs •�-
Sign of pp icanUConuacwr �'� T e of R oof
HAZARDOUS MATERIALS DISCLOSURE J�P
Witl lhc applicant or futurc buitding occupantstore or handlc harardous mauxial
az dc6ncd by Ihe Cupenino Municipal Codc. Chap�cr 9.12. and �hc Heal�h and SaCety
c� Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
�y� �INo ,
r` If a roof is installed without first obtaining an inspection, I agree to remove
Will thc applicant or futurc building occupant usc cyuipmcnt or iN.wices which
cmit haiardous air conuminan�t as dcfincd by the Say Area Air Quality Managcmen� all new rr aterials for inspecrion.
District?
❑ Ycs � Nu
1 havc mad the ha�ardcws matcrials requircmcn�s undcr Chap�cr6.95 o(ihc Califor-
nia Flcalth & Safcty Cadc, Scctions 25505.25533 arH125534.1 undcrstu�d �hat iCihc �fldioB
docs not curtcn�ly havc a tcnan4 �at it is my responsi6ility to noul'y ttre occupant n( tM
rcyuircmcn�s which ust bc mel prior issuanu oCa Ccnificate of Occupanry. Signature of Applicant Date
/O '� 3 �� 7 All roof coverings to be Class "B' or better
Own r authorizcd agcnt Datc -
CITY OF �UPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 32650027.00
DATE ISSUED.......: 10/04/2007
RECEIPT #.......... BS000002892
REFERENCE ID # ...: 07100043
SITE ADDRESS .....: GREENLEAF CT LOT 1
SUBDIVISION .......
CITY .............. CUFERTINO
IMPACT AREA .......
OWNER ............. JIN: HARDCASTLE
ADDRESS ..........: GREENLEAF CT LOT 1
CITY/STATE/ZIP ...: CUFERTINO, CA 95014
RECEIVED FROM ....: JAI�:ES W HARDCASTLE
CONTRACTOR .......: NOF:L CHAMBERLAIN LIC # 29430
COMPANY ..........: NE�.GEN BUILDERS, INC.
ADDRESS ..........: 22_` DEMETER ST
CITY/STATE/ZIP ...: E F'ALO ALTO, CA 94303
TELEPHONE ........: (6`0) 322
FEE ID UNIT QUANTITY �.MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- --
BTEMP FLAT RATE 1.00 62.10 0.00 62.10 0.0'0
EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00
--�-------- ---------- ---------- ----------
TOTAL PERMIT : 102.89 0.00 102.89 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 102.89 DISCOVER
---------------
TOTAL RECEIPT : 102.89
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -------------
103 UFER 304 ROUGH ELECTRICAL
� �����°�f3
~� CITY OF C,UPERTINO
" ;��� .�. �`�I�� ����'��
CUP�f�T1�10 PERMIT APPL:[CATION FORNI
APN # � Date:
��� - ���7 ��-3--��
Building Add ess: � /' � �
�"f
Owner's Name: r -� o � Phone #:
� -� � t�e 6s���� Z�S�'C�c7
�__��_�_ � c � �
— --- ------- --- - -- --- -- ___---- _- --_ _-- ,
�i Lontractor: Phone: � � License ��:
iv � � �'l�� �Sd 3z 2-�'�oG �� 9 ,C3 - 709�'� �
Contact: Phone: Cupertino Business License #:
�� u/� � 0. V� C 5��� ^ � V
Building Perr�it Info: � � �� � � � ,, ,� ( �
y � CI � h� ��1� d GSJ
Elect �OIU �
Job Description:
Residential [�], Commercial ❑
Cost of Project: � �
�
Qty. if
A licable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE El ;ct. Permit Issuance ELECTRICAL
BUSLIC Bi�siness License BUILDING
��;: Community Development
10300 Torre Avenue
�� . ? Cupertino CA 95014
Telephone (408) ?77-3228
C(TY OF Fax (408) 777-3333
CUPEI�TINO
Buildi.n De artment
JOB ADDRESS: L C� I � � � �� ( �'o C PERMIT # �`��' ('} � (� �
, �
OWNER'S NAME:3 ,,,,` „ �,t) � PHONE # SU � 3 Z Z- 5' ' c� fl
GENERAL CONTRACTOR: ,,� ,Q � Q vs FAX # ; �-�, . 3 z � - � � a �
I am not usin an subcontractors: ^� `� �� 7
g Y
Si gnature Date
Please check a licable subcontractors and com lete the followin information:
SUBCONTRACTOR BUSIIJESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
IIectrical
Excavation
Fencing
Flooring: Carpeting
Linolewn / 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