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07110043 CITY OF CUPERTINO ��* BUILDIN(+ DIVISIG:^I PERMIT . .:: ;. :_ . : :.:: ; , . .......:. PERMIT NO. BUILDINGADDRESS: TBD — TO BE DETERMINED 07110043 10294 MINER PL � PERMIT LSSUE DATE �+NER'S NAME: LOGAN RAM � 11/08 2007 SANTCARY NO. CONTROL NO. PHONE: BUiLDING PERMIT INFO ARCHITECT/ENGiNEER: RNj�J & REPLACE FURNACE 9Z� BLDG ELECi PLUMB MECH � � � � u p � LICENSED CONTRACI'OR'S DECLARATION ' �ab ,I�eSCTj{�tjOn ,"� C I Macby aflicm that ! am liccnscd undcr provisions o[ Chap�cr 9 (commcncing - -^- ^ _�^ � —� _ � — ^ ^^ ^ ^ ` _�� wiih Sccdon 7000) of Division 3 of thc Business and Profcssions Code, and my ticensc is '� y in full force and f G`�� 6(� � ,v� Z Licensc CJa�s � a �' ��• x n F- � Dalc r - Contractnr � � ARCHITECI'S DECLARA ON 1 undcrsund my plans sha116c used ss public rccords �yU 4 o y Licenud Profcssional y 3 OW NER-BUILDER DECLARATION ' I hcrcby affrm ihat 1 am cxcmpt Ctim �hc Cantractor's Liccnsc Law for tbc � p O following sason. (Scction 7031.5, Husincss and Profcssiunt Cadc: Any ciry or county K,°, Pi which rcquiccs a pctmit ta conswct, ahcr, im{ttavc, dcmalish, or repair any sWCtmc '� Z y prior w i�s issuancc, alw reyuires ihc applicant for such permit w filc a signcd s�a�emcni Ft. Floor Area Valuation � _ � that hc is liccnscd pursuant lo Ihc pmvisions of thc Conuacta�'s Liccnsc Caw (Chaptcr 9 S q• y t- $ (commencing wiW Scnion 7000) of Division 3 of ihc Busincss and Profcssions Cade) or y �.., �hat he ia exempt thecefrom and the bssis for t6e allegcd exempuon. Any violadon of Section 7031.5 by any applicant for a petmit subjccu the applicant to a civil penalty o( APN Number Oecupancy Type not more �an five hundred dollars (5500)• ❑ i, u owner of ttie property, or my emp�oycea wi[h wages u the'v sole compensation, will do the wark. and the stcucwre is not intended or otCaed far sale (Sec. 7044. Business Required Inspections snd Profeuions Code: The Conuactor's License I..aw dacs not apply to an owner of property who builds w improves �l�em.on, and who das such work himael[ or tlwugh his awn employces, provided Uiat wch improvemen�s ue not intended or olCeced Cor sale. I[, however, the building or impmvement is sold wi�hin ane yesr of compleuon, �he owner builder will have U�e burdui of proving Wat he did not build or improvc tor puryose of sa�J. ❑ I, u awna of �he property, am exclusively conuaMing wi�h licensed rnnuactors W wnsuuct the peojea (Sec. 7044. Business and Protessions Code:) lhe Coauacwr's Li- cense Law docs no� apply to an owner of property who builds or improves IheROn, and , who conuac�s [or such pmjects wiW a comractor(s) licensed pursuant w the Contractofs License [.aw. ❑ 1 am exempt under Sec. . B dc P C for this rcason inu Date WORKER'S COMPENSATION DECLARATION I heroby afGcm under penalty af pery'ury one o( the following declarations: ❑ I hsve and will mtinuin s Cenificam of Conscnt to self-insure for Worker's Compen- sation, u provided far 6y Secdon 3700 of the Iabor Code, for the perfarmance o[ the woric for which this pertnit is issucd. I havc and will maimain Worker's Compensation Insunnce, as required by Scceion . 3700 of �he Labor Code, Cw ihe pedormanee of the woric for which �his permit is issued. My Workd C In� nrcicr and Policy numbu are: Camer: �`�'d"�'�-y/�'�,J�, PolicyNo �Ca�r , io 6 yl�Y��G CE FICATE OF EXEMP'1'[ON FROM WORKERS' ' COMPENSATION INSURANCE (i]�is scction necd not be completed if the permit is for onc hundred dollars (5100) or Icu) I cenify �htt in We performance af ihe work for which �his permi� is issucd, 1 shall not employ any person in any manncr so az to bccomc subject �o ihe Workcrs' Compensation Laws o( Cali(omia. Datc Applicant NOTICE TO APPLICANT: I(, a(�cr making �his CcniCcatc of Exempuon, you should become subjcct to thc Worlcer's Compcnsation provisions of thc Labor Codc, you must � O foMwith comply with such pravisions or this permi� shall bc dccmcd revokcd. � ""' CONSTRUCTION LENDING AGENCY E.r � I hucby a[firm ihat there is a consuuction knding agcncy for thc perfurtnancc uf . pC � ihc work fur which ihis pertnit is issued (Scc. 3097, Civ. C.) , W� A Lendcr's Namc Ltnder's Addreu V 0 I certify ihat 1 have read �his application and siatc U�a� �hc above informatiun is w� cortcct I agree w comply wi�h all city and counry oNinances and sute laws relating w 0 U building consuuction, and hercby authorin repreuntativcs of �his ciry w cn�cr upon ihc W above-menuoned propertyforinspecUon pmposea a (Wc) ag¢e W save, indcmnify and keep harmless �he Ci�y of Cupcnino against �� liabiliues, judgmenls, costs and expeRSes which may in any way accruc againsl said City V z in consequence oC thc granting of Ihis permiL Date `�'" � �"� APPLIC NT UNDERS7'ANDS AND WILL COMPLY WITH ALL NON-PO1NT Issued b�i: '� � SOU EGULATIONS.� l-� � �''�= > Re-roofs ��..-' Signuure of ApplicanUC n r Datc OUS MA7ERIALS D[SCLOSURE T}�� Of ZOOf % Wi11 ihe appticant or future building acupant storc or handlc ha•rardous materisl dcfined by the Cupertino Municipal Codc. Chap�cr 9.12. and thc Hcallh and Safcty �. Section 25532(a)? � All roof:; shall be inspected prior to any roofing material being installed. � If a roof is installed without first obtaining an inspection, I agree to remove wll the applicant or future building occupant use eyuipment or devices which emi� ha•r.ardous air con�aminants ss cicfincd by �he Bay Area Air Quality Managcmcnt all new i naterials for inspection. ��s�;�� Q Ycs �u 1 haw mad ihe ha�ardouus maierials requircmcn�s undcrChap�cr 6.95 of the Glifor- �` � � �� s nia Hcalih & Safcty Code. Sectioat 25505, 25533 anJ 25534.1 undcrstand tha� iCthe 6uilding � - J does not curtcntly havc s �enan4 Ihat it is my responsibiliry to notiCy �hc occupant of U�c � reyuircmcnts hxh muu be me� riorw � cc o[a Cenificam of OccupancY. SI$i13iIIC � of Applieant Date ��`�'-� All roof coverings to be Class "B" or better Owncr or authori�c agcnl �� CITY OF CUPERTINO 7 ITEMS OF 10 PERMI�' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl]:: Lot: APN ......... 31ii46023.00 DATE ISSUED.......: 11�08/2007 RECEIPT #.........: BS�)00003197 REFERENCE ID # ...: 07L10043 SITE ADDRESS ..... 10.?94 MINER PL SUBDIVISION ....... CITY .............. CU?ERTINO IMPACT AREA ....... OWNER ............. L03AN RAM ADDRESS ........... 10�94 MINER PL CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: EDaARD A GREGORY CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBD - TO BE DETERMINED ADDRESS ........... CITY/STATE/ZIP ...: , TELEPHONE ......... FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------------- ---------- ---------- ------ BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BREMFURN NO UNIT 1.00 14.31 0.00 14.31 0.00 BSEISMICRE VALUATION 2,594.00 0.50 0.00 0.50 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 279.04 0.00 279.04 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------ 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTIl'�TO �� I n o�?, �`��.�.�� CUPEf�,TINO PERMIT APPLICATION FORM APN # � / ^ � / � � 2 � �1 Date� 8 W � � f �L� l.p � J� LJ Building Address: /d � y �/ �2�1. � �.•-- '�l� c � Owner's. Name: Phone #: � L.�� J-- /� � � � �S� �( /- Z �; � Confracto Phone: I.�cense #:_ �� ► ��, � �.�- �� - �S % d�/// �3��6 � Conta� , Phone: Cupertino Business License #: �� t�S J�. �o �_ y j �_��// Building Permit Info: Bldg ❑ Elect L�' ]'lumb � Mech Job Description�� ,� ��' -. ,- ��r ��ic� '7 Z `% �i � Residential Commercial ❑ For Residential I llations: Attic � 1 St floor� 2 floor � Adhere to min set back requirement ❑ �� or Commercial Installations: Replacement same weight 0 Additional weight (st�ctural calcs) � Structural Calculations required for new installation New installation Planning Ap roval Re uired ❑ Cost of Project:��-� Y Type of C�� c:tion: Occup� cy�oup: Strapped On Platform ❑ Bonded Sq.Ft. Floor Area: New Location � Re lacement� Qty. if A plicable Fee ID Fee Description Fee Grou BENERGY E c�ergy BUILDING gREMF'URN F zmace MECHANICAL BREMACOVER A/C Unit > 10,000 cfin MECHANICAL gREMAIRHAN A/C Units <= 10, 000 cfin MECHANICAL BREMRECEPT R ecp�l, Switch & Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG f EPERMITFEE Elec Permit Issuance ELECTRICAL ( MPERMITFEE N[ech Permit Issuance MECHANICAL � PPERMITFEE P'.umbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK P'�an Check Fee BUILDING BPGAS C as Piping System Fee PLUMBING BUSLIC Business License BUILDING