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07020155 CITY OF CUPERTINO BUILDING DIVISION PERMIT w; N� � I �RMAt'TI€IN, PERMIT NO. BUILDING ADDRESS: 7624 DE FOE DR STANFORD PLUMBING HEATING 07020155 PERMIT ISSUE DATE OWNER'S NAME: ALLEN LUNIEWSKI 1965 KYLE PARK COURT 02/28/2007 SANITARY NO. CONTROL NO. INE: (408) 286-8931 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description u I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADD A/C t=y in full force and fee. 1 "'�' ? License Class • p Date Contractor � RCHITECTS DECLA i a a l u r n y p ons shall be used as public rccnrds >yU u.H Licensed Professional < OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the COOp� following reason.(Section 7031.5,Business and Professions Code:Any city or county <,�,Ii which requires a permit to construct.alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement „ Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 rq.Ft.Floor Area 5 O O 0 2 t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type net more than five hundred dollars(M). 35925031 ❑1,as owner of the property,or my employers with wages as their sale 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 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 Sea ;$&P C for this reason _ Owner - Date WORKER'S COMPENSATION DECLARATION hemby am under penalty of perjury one of the:following declarations: - I and will ffirmaintain a Certificate of Consent to self-insure for Worker's Compen- tj ,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 peas on hrsuran carrier and Policy number am: // �� Cartier. Policy No.:/7/0/J Mly}.//flS` C RTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for anc hundred dollars($100) or Icss.) I certify that in the performance of the work for which this permit is issued,I 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 C!+r7 the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name 0Z Lender's Address U J 0 1 certify that 1 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 Jbuilding construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of Gia granting of this permit. Date APPLICANT U DERSTANDS g WILL COMPLY WITH LL NOWOINT Issued by: SOURCE REMAT O Re-roofs Signatutc of A or ate T e Of Roof — HAZARDOUS MATERI LOSURE yp Will the applicant or future building occupant store or handle hazardous material as defined by the Cu 1`1 Muni al 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 the applicant or future building occupant use equipment or devices which If a roof i>installed without first obtaining an inspection,I agree to remove emit hazardous air contamina(No defined by the Bay Area Air Quality Management all new materials for inspection. District? 1 hav the hazardous materials requirements under Chapter 6.95 of the Califor- / n calth aft: Code, 25505,25 33 and 25534.1 understand that if the building oesnot 56rren vCa nt,that it is my nsibtlity to noury occupant of the _�— require tits tc met prior to i cc a Cerufic upanc. Signatu>'epp leant Da All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 8 ITEMS OF 14 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 35925031 .00 DATE ISSUED. . . . . . . : 02,'28/2007 RECEIPT #. . . . . . . . . : BS000000565 REFERENCE ID # . . . : 07020155 SITE ADDRESS . . . . . : 7624 DE FOE DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ALLEN LUNIEWSKI ADDRESS . . . . . . . . . . . 7624 DE FOE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : TR:_LLO, STEVE LIC # 4269 COMPANY . . . . . . . . . . : STi1NFORD PLUMBING HEATING &AIR ADDRESS . . . . . . . . . . : 1965 KYLE PARK COURT CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408) 286-8931 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 BREMAIRHAN NO.UNITS 1. 00 10.26 0. 00 10 .26 0. 00 BREMRECEPT NO. OUTLETS 1. 00 1 .20 0. 00 1.20 0. 00 BSEISMICRE VALUATION 5, 000. 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 38 .37 0. 00 38.37 0. 00 MPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38 .37 0. 00 PPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38 .37 0. 00 -•--------- ---------- ---------- ---------- TOTAL PERMIT 268 . 93 0. 00 268.93 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 433 .71 8528 --------------- TOTAL RECEIPT 433 .71 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL F Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIIY Of Fax(408)777-3333 7UPEt�TINO Building Department JOB ADDRESS: PERMIT# 4 P e C r- o,(70211J:� OWNER'S NAME: yl j e g-t (i -e ,-L PHONE # GENERAL CONTRACTOR: AA — 0 �k V A C FAX# r I am not using any subcontractors: Signature Date Please check applicable subcontractors and com-:)lete 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 0w--rter,/ACbvfractor Si ature Date CITY OF CUPERTINO 070`a0 155 I NLCE/ AC CUPERT. INO PERMIT APPLICATION FORM APN # _ 2 � Date: VJ Building Address:. moi' P Owner's Nape. Phone#: C o tractor: Phone: OSS License #: fl 3 � /10 E L I/�4C' � � - 612 L Contact: Phone: L Cupertino Business License#: n Building Permit Info: Bldg ❑ Elect Plumb , Mech Job Description: , lLid V�k Residentia Commercial ❑ For Residential Inllations: Attic ❑ Is' floorJ2�12°a floor❑ Adhere to min set back requirement For Commercial Installations: _eplacement same weight ❑ Additional weight(s uctural calcs) ❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Pimlect. Type of Construction: 1 Occupancy group: O , Strappe On Platform ❑ Bonded ❑ Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Fl mace MECHANICAL BREMACOVER A,C Unit> 10,000 cf n MECHANICAL BREMAIRHAN Aj C Units<= 10, 000 cfin MECHANICAL BREMRECEPT Ri;cptl, Switch & Outlets ELECTRICAL BSEISMICRE Svismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC B-zsiness License BUILDING