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07080085 CITY OF CUPERTINO �T��I BUILDING DIVISION PERMIT � � '� - - PERMIT NO. BUILDINIfflEds:BONNY DR JONES M%SONRY 07080085 j PERMIT ISSUE DATE OWNER'S NAME: LIPMAN PETER H AND CORINNE S 1049 DEL SANITARY NO. CONTROL NO. 4083777512 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description FDatc___CA_q_L6_�__1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ` tion 7000)of Division 3 of the Business and Professions Code,and my license is CHIMNEY REPAIR REBUILD Fqrce and effe Claz cc.� n_ onlractor ARCHITECTS DECLARATI I understand my plans shall be used as public records :J �- Licensed Professional j OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the rY following reason.(Section 7031.5,Business and Professions Code:Any city or county ti which requires a pemtit to construct,alter,improve,demolish,or repair any structure Valuation N prior to its issuance,also requires the applicant for such permit to Gln a signed statement c Ft. Floor Area .Q o that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 $2 4 0 0 e (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of A Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3591404 5 . 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 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.). p 1,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 Contractors License Law. ❑I am exempt under Sec B&P C for this reason owner----------------- Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: LJ I have andwill maintain a Certificate of Conant 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. ❑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 m . In �jpnycc c 'er and Policy r numberaree:` –11Cam'er V, Policy No..W " L CERTIFICATE OF E EMPTION FROM WORKERS' COMPENSATION 114SURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) L certify drat 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.Dale - 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 Z 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.) a Q Lender's Name + Lender's Address - � Z 0 1 certify that I have read this application and state that the above information is E-" correcCl 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 y i-U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against yliabilities,judgments,costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit. Date r, APPLICANT NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE L Re-roofs - Signatu of pplican Contractor Dale Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material az defined by the Cupertino Municipal 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 If a roof is installed without first obtaining an inspection,I agree to remove Will the applicantT...."building occupant use equipment or devices which -mit hazardous air contaminants defined by the Bay Area Air Quality Management all new r)aterials for inspection. District? ❑Yes ❑ o I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and25534.I understand that if the building does not u en y h a tenant,that it is my responsibility to notify the occupant or the Date requi cot. is met prior toissu ceOraCcnificateof pan - /1 Signaturo:ofApplicant / All roof coverings to be Class"Br' or better Owncr or authm—C.agent Date CITY OF CU PERTINO U 7 CRY OF PERMIT APPLICATION FORM I� CUPERTINO ,PN# 5 9 1 ,* y Yr- G Date: �,) 6-7 Building Address: Mailing Address (if different from building address): Owner's Name: Phone#: In R_ �% IY)4� o2S�- 109� Contractor nes Lice e #v: s a5 Contact: Phone: V�'S'77 7s7 Cupertino Business License#: US�'l �oe S Fax: 3-77 7_-(3 2,615 Building Peennit Info: (( Y Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description:/ Residential E Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: � � Occupancy Group: Type of o struction: (J[� Please check this box if the project is a second-story addition: ❑ roject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID ]Tee 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 Boile-> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX IncVOff/Comm/Quasi BUILDING BCONSTAXBQ Cosi. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC 1000 Eloc 600V <= 1000A ELECTRICAL BELEC1001 El ec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA [nvestigation fee BUILDING 1 of 3 CITY OF CUPERTINO •2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35914045 .00 DATE ISSUED. . . . . . . : 08/09/2007 RECEIPT #. . . . . . . . . : BS000002320 REFERENCE ID # 07080085 SITE ADDRESS 10326 BONNY DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER LIPMAN PETER H AND CORINNE S ADDRESS . 10326 BONNY DR CITY/STATE/ZIP . . . : CUFERTINO, CA 95014-2908 RECEIVED FROM JOI\ES MANSONRY CONTRACTOR JOrES, GREG LIC # 21205 COMPANY JONES MASONRY ADDRESS 1049 DELL AVE CITY/STATE/ZIP . . . : CM[PBELL, CA 95008 TELEPHONE 40f3777512 FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL ---------- ----------- ---------- BPERMFEE VALUATION 2, 400. 00 83 .16 0. 00 83 .16 0. 00 BSEISMICRE VALUATION 2, 400. 00 0.50 0. 00 0_ ------ 50 0_00 ----- TOTAL PERMIT 83 . 66 0. 00 83 .66 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------------- .CHECK 83 . 66 17401 --------------- TOTAL RECEIPT 83 . 66 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ----------------------- - 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 514 FINAL PUBLIC WORKS Community Development 10300 Torre Avenue ;$ Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 � UPE�TINO MjildingDepartment JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE VY 3 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: -7-(rJ Si ature Date Please check applicable subcontractors and complete 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 /a Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile f� 7-e9 Owner/eon ar gnature Date