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07080218 CITY OF CUPERTINO BUILDING b1VISION PERMIT CNT]fTQR Z 'QRM�TION' tt�� PERMIT NO. BUIL10�i7ESNORTHRIDGE SQ TBD — TC, BE DETERMINED 07080218 PERMIT ISSUE DATE OWNER'S NAME: /2007 KLARA TURNER AN 24 SANITARY NO.. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH x Z LICENSED CONTRACTOR'S DECLARATION Job Description 0 Lu p I hereby affirm that I am licensed under provisions of Chapter 9(commcneing Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is REMODEL MASTER BATHROOM NO STRUCTURAL Z En in fun a Cl and effect }� Lic p S A&S PAID FOR BL 08/24/Q7 ,n? License Class l� Conlrador q Date gRCHITECTS DECLARA ON i oc a I understand my plans shall be used as public records iaV U.H Licensed Professional N OWNER-BUILDER DECLARATION r I hereby affirm that 1 am exempt from the Contractor's License Law for the 1 :00 following reason.(Section 7031.5,Business and Professions Code:Any city or county %$Li which requires a permit to construct,alter,improve,demolish,or repair any structustatement Valuation t z rn prior to its issuance,also requires the applicant for such permit to Glc a signed Chaps e 9E63 j Ft.Floor Area -Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9q $7200 i E_-q (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 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of3 (4 Number P y yP not more than five hundred dollars(3500). ❑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 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contracines Li- ccnse Law docs not apply to an owner of property who builds or improves thereon.and. who contracts for such projects with a contractors)licensed pursuant to the Contractors License Law. B&P C for this reason ❑I am exempt under Sec Owner----------------- Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Workers Compen- s�tion,as provided for by Section 3700 of Elie 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 Workers Compensation Insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for anc hundred dollars(SI00) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ anyperson in any in r to hcome subject to the Workers'Compensation Laws of Califomi Applicant NOTICE TOA PLICA .If,after making this Certificate of Exemption,you should become subject to the rker s Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY [~CA I hereby affirm that there is a construction tending agency for the performance of Sx> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lenders Name a Lenders Address U C) I certify that 1 have read this application and state that the above information is GI. correct.I agree to comply with all city and county ordinances and state laws relating to O U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Lia (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 the granting of this permit. Date ►- APPLICANT 10N . AND WILL COMPLY WITH ALL NON-POINT Issued b SOURCE R /t72�` Re-roofsSignature ofApplicaDateT e of hoof S MATERIALS DISCLOSUREYPWill the applibuilding occupant store or handle hazardous material as defined by the Cucipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(x)? All roof;shall be inspected prior to any roofing material being installed. ❑Yeso Will the applicant or fultr building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove - emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? Cl Yes o I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building does not currently ha a tcnan that it is my responsibility to notify the occupant of the "Date requirements whi prior to issuance of a Certificate of Occu V Z Signatw e of Applicant All roof coverings to be Class"B or better Owner o authorized age Datc Community Development � 10300 Torre Avenue `'` Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ',UPEkTINO Building Department JOB ADDRESS- PERMIT # JD 834 oc4 toles k&4t (;u41',vo baa Z OWNER'S NAME: axa, 'r(x V-V-t,r I PHONE # (k08) 3$ —4 V4--�- GENERAL CONTRACTOR w4r. i4e I FAX # I am not using any subcontractors: w v 8,- 2 N ii tore 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ ontractor Signature Date ai'a CITY OF C'UPERTINO CITY OFPERMIT APPLICATION FORM CUPE��IN0 Glob 621p, PN # Date: S -z ` � 4 ,;(o6 � � - o v 97 Buildin Address- h Mailing Address (if different from building address): 1083 No�T� r o f -e Cl-� �-�n o Owner's Name: K Gt Phone#: Contract r: License #: b918 S3Y Cont c ,F J Phone: Qr39 -u ops Cupertino Business License#: �C pot bV10 KlL► Fax: Building Permit Info: I'Ylq g est' A ti vD R-eW clef o .94rAe1-�,r� Bldg Elect Plumb Mech ❑ Job Description: Residential k Commercial El Sq.Ft. Floor Area: (! Sq.Ft.: Cost of Project: 42Zn Occupancy Group: Type of Cotruction, p Please check this box if the project is a KGo c�2Ci� second-story addition: El •oject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Dther 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 E oiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX In JJOff/Comm/Quasi BUILDING BCONSTAXBQ Cc n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax —Resi/Mobile BUILDING BELEC 1000 El ec 600V <= 1000A ELECTRICAL BELEC1001 Flec 604V> 1000A ELECTRICAL BELEC200 Elea Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD -Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING ] of 3 ! � f \ 1 #� r � ��„ ��,1�C(:ti ,� Ci a .. ��t 11 � \� ��1�0• til� (� All ILI X1.4,�`" �� ,��'•S C,t � ,.c11'.,2 Ao t` t$ `11 \,L 't VA Ar yh to s f C3 i sso o � a V-1 IOL- ALI r INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: CathyS Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 31636033 . 00 INVOICE DATE. . . . . . : 06/24/2007 REFERENCE ID # . . . : 07080218 SITE ADDRESS . . . . . : 1C837 NORTHRIDGE SQ SUBDIVISION . . . . . . CITY CLPERTINO IMPACT AREA . . . . . . OWNER KIARA TURNER ADDRESS 1C837 NORTHRIDGE SQUARE CITY/STATE/ZIP . . . : CL-PERTINO, CA 95014 CONTRACTOR . . . . . . . : TLD - TO BE DETERMINED LIC # 00096 COMPANY TESD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- --------- ------- ---------- ---------- ---------- ENERGY APPLICATION 71 .02 71. 02 0. 00 BLDG PERMIT FEES PRINTING PERMIT 147 .96 147. 96 0. 00 PBLG FIXTURE PRINTING PERMIT 27 . 00 27. 00 0. 00 LIGHTING FIXTURES PRINTING PERMIT 6 . 00 6. 00 0.00 RCPTL, SWITCH &OUTLETS PRINTING PERMIT 6 . 00 6. 00 0.00 VENT FAN SINGLE DUCT PRINTING PERMIT 45 .39 45.39 0.00 SEISMIC FEE RES PRINTING PERMIT 0.80 0. 80 0.00 ELECTRICAL SQ FOOT PRINTING PERMIT 0.00 0. 00 0 .00 MECH PERMIT ISSUANCE PRINTING PERMIT 40.79 40.79 0.00 PLUMBNG PERMIT ISSUE PRINTING PERMIT 40.79 40.79 0. 00 ---------- ---------- ---------- 385 .75 385.75 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ----------------------------- -------- ---------------------------- 101 FOUNDATION 102 PIERS 103 UFER 104 REBAR 105 ANCHOR BOLTS 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL 204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION 301 ROUGH PLUMBING 302 TUB & OR SHOWER 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 305 FRAME 306 HOLDOWNS 307 INSULATION 308 SHEETROCK Community Development t 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE # �( - c GENERAL CONTRACTOR: FAX# I am not using any subcontractors: -� f ignature - Date Please check applicable subcontractors and cont 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 Owner/Cori actor ignature Date