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10110088 - . CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: NILE DR BLDG J CONTRACTOR:AXIS CONSTRUCTION,INC PERMIT NO: 10110088 OWNER'S NAME: CUPERTINO WATERFALL HOA 2566 BARRINGTON CT DATE ISSUED: 11/15/2010 VER'S PHONE: 4084483080 HAYWARD,CA 94545 PHONE NO:(510)732-6111 ❑ LICENSED CONTRACTOR'S DECLARATIONr /,, BUILDING PERMIT INFO: BLDG ELECT PLUMB License Clasa Lic.# VL MECH r RESIDENTIAL r COMMERCIAL r Contractor Date I hereby affirm that I am licensed under the provisio s of C apter 9 JOB DESCRIPTION:CUPERTINO WATERFALL-NILE DR BLDG J REPLACE (commencing with Section 7000)of Division 3 of the Business&Professions STAIR STRINGER&WALL ABOVE STRINGER Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,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 pro v' ed for by Section 3700 of the Labor Code,for the performance of the wo f which this Sq.Ft Floor Area: Valuation:$2102 permit is issued. APPLICANT CERTIFICATION APN Number:36948000.) Occupancy Type: I certify that I have read this application and state that the above' ormation is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source egulations per the Cupertino Municip 1co), od , tion 9.18. Issued by: Date;/- Signaturei Date �` / i Li OWNER-BUI 411 DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(See.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Co e,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety ode,Sections 25505,25533,a 255 Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must O n o auth d 31 /l forthwith comply with such provisions or this permit shall be deemed revoked. vt/ Date: !' U C NSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save ',�mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address ,and expenses which may accrue against said City in consequence of the r,,nting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36948000 .J DATE ISSUED. . . . . . . : 11/15/2010 RECEIPT #. . . . . . . . . : BS000012008 REFERENCE ID # . . . : 10110088 SITE ADDRESS NILE DR BLDG J SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CUPERTINO WATERFALL HOA ADDRESS C/O CORNERSTONE COMMUNITY MGMT CITY/STATE/ZIP . . . : SAN JOSE, CA 95125-5635 RECEIVED FROM . . . . : AXIS CONSTRUCTION CONTRACTOR . . . . . . . : CHRISTOPHER DURKIN LIC # 32093 COMPANY . . . . . . . . . . : AXIS CONSTRUCTION, INC ADDRESS . . . . . . . . . . : 2566 BARRINGTON CT CITY/STATE/ZIP . . . : HAYWARD, CA 94545 TELEPHONE . . . . . . . . : (510) 732-6111 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 102 . 00 1 .00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 2, 102 . 00 0 .50 0 .00 0 .50 0 .00 1SUPINSFEE HOURS 1. 00 126 . 00 0 .00 126 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127 .50 0. 00 127.50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 510 .00 #20566 --------------- TOTAL RECEIPT 510 . 00 i y CITY OF C-UPERTINO c1TY of cUPE TING GENERAL BUILDING - - PERMIT APPLICATION FORM ,, �- � � APN# (L AJ t, � �ILE � � Date: \ Building Address: Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No HOA: (Exterior work only) Yes 0 No ❑ If Yes, provide letter from HOA Owner's Name: Phone#: n(l I IM 0 quio - 40 -306"D ' Co tractor: A Phone: S-10- 3)--to(t Fax: 5-10-7,3Z- (PZ Z 7- Contractor License-* (o Cupertino Business License#: zol'3 Contact: ,, Phone:_ U Fax: ..S /b 3 .esidential ] Commercial ❑ Job Description: �l'41{ ;�%( ••��>✓ 1` -� P��tLt. f� l�+ �Y►/`'(f�! ie Building Permit Info: Bldg Vf Elect ❑ Plumb ❑ Mech ❑ Type o Construction (Usage Class): Occupancy Type: 1-A, 1-B U II UV-A ❑ II/III B, IV-HT, V-B Valuatio I ., e I Square Footage: Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Muilding/LEED Checklist & attach it to the application or if applicable, include in plan set& the sheet index. ''lints Achieved: ,r help, contact Build it Green at www.builditzreen.org Revised 07/14/09 . 3