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07050242BUILDING DIVISION PERMIT BUILDINfj19 6 6 MI CKSBURG DR OWNER'S NAME: DIANE DIAMOND jNE: ARCHITECT/ENGINEER: i p p LICENSED CONTRACTOR'S DECLARATION U F I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z w with Section 70(X)) of Division 3 of the Business and Professions Code, and my license is < a in full force and effect. j z License Class Lic. N p Date Contractor _,4 rARCHITECTS DECLARATION i a < 1 understand my plans shall be used as public records )WU UO y Licensed Professional OWNER -BUILDER DECLARATION } I hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason. (Section 7031.5, Business and Professions Code: Any city or county <0 which requires a permit to construct, alter, improve, demolish, or repair any structure o Z } prior to its issuance, also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 2 F (commencing with Section 7000) of Division 3 of the Business and Professions Code) or i 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 of not more than five hundred dollars (5500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business 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 We. 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 trust 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. �ORKE'RSCOMPENSATIONDBCLARATION ❑ Iam exempt ' B & P C for this reason OwnerDa I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, 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 Worker's Compensation Insurance carrier and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for crit hundred dollars ($100) or less.) I certify that in the per ormance of the work for which this permit is issued. I shall not employ any persan i y manner soas come subject t Workers' Compensation Laws of Califor ' Applicant NOTICE TO PLICANT: If, a r making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I 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 building construction, and hereby authorim 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 in consequence of the gr1riting of this permit. APPLICANT D STANDS AND WIL OMPLY WITH ALL NON -POINT SOURCE R 5� Signatu Applican ontrac r Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Mu 'cipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑Yes No Will the applicant or uture building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Ycs I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & S etyCode, Sections 25505.2553�and 25534. I understand that if the building does not cu Uy have a tenant. that it and to rti the occupant of the reyuiremc hjch rtlGst be rny�crrjtlrca f Occsrpancy. Date PERMIT NO. TBD - TO BE DETERMINED 07050242 PERMIT ISSUE DATE 05/23/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ELECT PLUMB MECH Job Description NON ELE(:TRONIC STEEL GATE 7'@ FRONT OF HOUSE. BAY AREA WI14DOW GUARD NEEDS BUS LIC. Sq. Ft. Floor Area 3 6 9 0 8 01 7 AUbT Number Issued by: Re -roofs on $15895 Required Inspections Type of R )of All roofs :,hall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new In iterials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better F. r'��l�,T� -ile Edit Actions Details Links Favorites Help _crn `!ntorrn=-tiun Permit Number' 07050242 Status ' C Closed IQI Master Number DO NOT USE �QI Notes Project DWL-WREM IQI Apply Date' '05/23/2007 Operator Permit Issue Date 05/2312007 Operator Certificate Issued 06!16/2007 Operator Certificate Type 0131 Certificate Number 434 �QI Permit ' Property Permit Details gni_.;; h.i•�il lid ,rfi�P101- Address' I 19661 VICKSBURG DR City/State/Zip CUPERTINO 0 APN 36908017.00 Q� Unit suety ri'rniniahon suety I Owner Name'I DIANE DIAMOND PALM Use Default Address Home - Zoning Applicant Contractor' Defined Fields Permit Type SFDWL-REM IQI DO NOT USE Usage Class' DWL-WREM IQI DWELLING TYPE5 WOOD REM Applied Value ' 15895 SQUARE FT. 0 Calculated Value 0131 US C-404 Type 434 �QI ALT: RESIDENTIAL Permit Form' AUTOPERM -PERMIT Ownership 1 -Private Project Size 'ermit issued 05/2312007 anter the purpose or any special conditions for this permit City/State/Zip CUPERTINO CA CA 95014 95015 Purpose/Special Conditions NON ELECTRO14IC STEEL GATE 71@ FRONT OF HOUSE FILMED 6120111 I[OAdd Default T OK I+# Back Imo, Contractors Fees kl ; Plan Reviews '-y p I nspections Print Permit 3 t_� Adjustments Holds i F1 Copy Permit IJ Close Permit „.Overrides i i �=t_ Supplemental Fields i Notes !]Attachments BUILDING DIVISION PERMIT PERMIT NO. CKSBURG DR TBD — TO BE DETERMINED 07050242 OWNER'S NAME: DIANE DIAMOND ARCHITECT/ENGINEER: z LICENSED CONTRACTOR'S DECLARATION C F- I hereby affirm that I am licensed under provisions of Chapter 9 (commencing w with Section 7000) of Division 3 of the Business and Professions Code, and my license is a in full force and effect, Z License Class Lic. N p Date Contractor ARCHITECT'S DECLARATION a � 1 understand my plans shall he used as public records 'J ty Licensed Professional j OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from Ore Contractor's License Law for the O following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure y prior to its issuance, also requires the applicant for such permit to file a signed statement a that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 o(commencing with Section 7000) of Division 3 of the Business and Professions Code) or . m 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 of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business 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 forsale. If, however, the building or improvement is sold within one year of compiction, the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). 1, as owner of the property, am exclusively contracting with licensed contractors to . `co tmct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law docs 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. ❑ 1 am exemptj� der. c , B & PP C/for this reason Owner � Date,4 �— WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers Compen- sation, 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 Workers Compensation Insurance carrier and Policy number are: PERMIT ISSUE DATE 05/23/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description NON ELECTRONIC STEEL GATE 7'@ FRONT OF HOUSE. BAY AREA WINDOW GUARD NEEDS BUS LIC. Sq. Ft. Floor 36908017AR Number Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (S 100) or less.) I certify that in the performance of the work for which this permit is issued, 1 shall not employ any personiy�ny mannerso as t ecome subject t fie Workers'Compensauon Laws of Califor �te. Applicant �t: NOTICE TO�APPL.ICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must z forthwith comply with such provisions or this permit shall be deemed revoked. C) V1 CONSTRUCTION LENDING AGENCY r�r I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) QLenders Name z Lender's Address Q 1 certify that I have read this application and state that the above information is '—' correct. 1 agree to comply with all city and county ordinances and state laws relating to Ubuilding construction, and hereby authorise rcpmscntativcs of this city to enter upon the CI-) above-mentioned property for inspection purposes. a (We) agree to save, indemnify and keep harmless the City of Cupertino against v) liabilitics.judgmcnis,cosis and expenses which may in any way accrue against said City Z in consequence of the ting of this permit. APPLICANT , D STANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: SOURCE R QNS. SignaturV Applicam<ontractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Mu pal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 ❑Yes r No Will Ore applicant or uture building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? L% E3 Yes QQ tau_ I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health &S etyCodc,Scctions25505.2553�and75534.1understandthatifthe building docs not cuqe tly have a tenm that it ys. responsibility to noti�y the occupant of the retluiremcuL hick m6st be meV4bpor,l6j 6a6oc of4oCcrt ficattvbf Occupancy. Date Re -roofs Type of Roof Valuation $15895 Occupancy Type Required Inspections Date ?e_-> All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. of Applicant Date All roof coverings to be Class "B" or better CTf Of CUPEkTINO CITY OF CUPERTINO PERMIT APPLICA'T'ION FORM APN # / Q Fee Group Date: Building Address: MECHANICAL Maili g Addr ss (if Offerent from building address): Boiler <= 100,000 Btu // BBOILER2 Owner's Name: MECHANICAL BBOILER3 Phone #: Z �� I rn Boiler> 1M to 1.75 M Btu S- 53% Contractor: Boiler > 1.75M Btu MECHANICAL License #: Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi Contact: BCONSTAXBQ Phone: upertino Business License#: /13& % 5 G.+li f Fax: BCONSTAXR Building Permit Info: OY l0/t/ 14 �A/c 6 7e, l Z � X a4 Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Elec 600V > 1000A ELECTRICAL Residential 9 Elec Svcs 600V <= 200A Commercial ❑ Sq.Ft. Floor Area: Energy Sq.Ft.: Energy Add Multi s� BINVESTIGA Investigation fee Cost of Project: Ub Occupancy Group: Type of Construction: Please check this box if the project is a P second -story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY Of CUPEQTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: / 1?4W .0 r PERMIT # 0 7 U - OWNER'S NAME: PHONE # � s'2, S 3 'c o GENERAL CONTRACTOR FAX # � ✓�� eqe2itee P I am not using any subcontractors: Signature Date Please check ar)Dlicable subcontractors and complete the following information: t7e7r S retractor ignature Date 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 t7e7r S retractor ignature Date