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07090194 CITY OF CUPERTINO BUILDING DIVISIJN PERMIT � T]f�� TC�R � � � � PERMIT NO. BUILDI,Nfa�offs ULA LA TBD - T J BE DETERMINED 0 7 0 9 019 4 l�J PERMIT ISSUE DATE OWNER'S NAME: HOFFMAN JENAY A AND JAMES C 09/26/2007 SANITARY NO. CONTROL NO. INE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 � 0 p p LICENSED CONTRACTOR'S DECLARATION Job Description W P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z w with Section 70(10)of Division 3 of the Business and Professions Code,and my license is REPLACE SIDING W STUCCO ON ENTIRE EXT E R OF HOUSE H in full force and effect. License Class Lic•8 F Date Contractor ARCHITECT'S DECLARATION i a< t understand my plans shall be used as public records )WU Qti Licensed Professional H OWNER-BUILDER DECLARATION '> 1 hereby affirm that 1 am exempt from the Contractor's License Law for the :Q0 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 Z r prior w its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation _� that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $29500 ut (commencing with Section 7000)of Division 3 of the Business and Professions Code)or c 5 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 3 5913104:ti Cl' Number Occupancy Type not more than rive hundred dollars($500) 0 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- seasbuilder ill have the burden of proving that he did not build or improve for purpose of L as owner of the property,am exclusively contracting with licensed contractors to construct the project(See.7044,Business and Professions Code:)The Conawtoes u cense Law does not apply to an owner of property who builds or improves thereon.and. whocontracts f such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑I am pt under Sec B&P C for this reason Owner Date _0 ORK 's C MOp ON DECLARATION I mby affirm under penalty of perjury one of the following declarations 0 I 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. 0 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 it issued My Workers Compensation Insurance carrier and Policy number am: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any man so be b' t to rkers Compensation Laws of Calif- '.Date Applicant NOTICE TO OCANT:If,after making Wcrtificatc of Exemption,you should become subjecT to the Worker's Compensation provisions of the Labor Code,you most 0 forthwith comply with such provisions or this permit shall be deemed revoked. z, CONSTRUCTION LENDING AGENCY Fr rA I hereby affirm that there is a construction lending agency for the performance of r7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 2 Lcndees Address U 0 1 certify that I have read this application and state that the above information is w►" correct.I agree to comply with all city and county ordinances and state laws relating to Q U building construction,and hereby authorize representatives of this city to enter upon the W ahovc-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against ,F to liabilities,judgments,costs and expenses which may in anyway accrue against said City U z in consequence of the granting of this permit. Date e- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 2 SOU ERE GULATIONS -o.7 Re-roofs �---- Serre of App rcanUCcimract Dae Fal Of?:OOf HAZARD MATE-RIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as 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. 0 Yes !o Will the applicant or future building occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes PfNI. 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant that it is my responsibility to notify the occupant of the rcquiremc which must be me prio t ssu of a Certificate OfOccvp�: Signature of Applicant Date Mw7ti Owns r authorized agent Date All roof coverings to be Class"B"or better CITY OF C'UPERTINO CUPEI�F PERMIT APPL[CATION FORM Date-, L 0 Building Address: Mailing Ad ess (if ' ferent from building address): L40 Y4. 1 DISC Owner's Name: P one# Contracto _ cense#: ms- b 13/1 Co tact* / Phone ,�U , �/�7�S� Cupertino Business License#: /� Building Permit Info: Bldg E;�(/+ Elect ❑ Plumb ❑ Mech ❑ Job Description: .moi V� ' P�lDl " Residential l Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of P ject. Occupancyoug; Type of Construction: Please check this box if the project is a second-story addition: El Project Size: Standard 03 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 IM Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BBOILER5 F oiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX In 3/Off/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<= l OOOA ELECTRICAL BELEC1001 Flee 600V> 1000A ELECTRICAL BELEC200 Elec: Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD =energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING ', of 3 CITY OF CUPERTINO CITY OF PERMIT APPL:[CATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME N,.w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP IS,ew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW At-nospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Uldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Ga:,Piping System Fee PLUMBING BPINTERCEP Incl Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plaal Check Repeat Fee BUILDING BPREPIPE R,3i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING -BPSTORM-- tor-r/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT A!t of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER W ater Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C.Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Re'.ocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT f[eater Installation MECHANICAL BREMINHOOD In itallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Po le/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rcp J, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT RE:pair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO C W OF PERMIT APPL:[CATION FORM CUPEkTINO '?uantity Fee ID Fee Description Fee Group BREMSIGNAD Rindl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Veat Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD :� cb Specific Plan BUILDING BSEISMICOM Se smic Commercial BUILDING BSEISMICRE ;3eismic Fee Res BUILDING BSPECIAL SpecialInspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Idg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC :electrical sq foot ELECTRICAL EPERMITFEE Elm Permit Issuance ELECTRICAL MPERMFEE A(echanical sq. foot MECHANICAL MPERMITFEE Me-h Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plhnnbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 of 3 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl{: Lot: APN . . . . . . . . . 35313104 . 00 DATE ISSUED. . . . . . . : 09/26/2007 RECEIPT #. . . . . . . . . : BSD00002793 REFERENCE ID # . . . : 0790194 SITE ADDRESS . . . . . : 10260 TULA LA SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HOFFMAN JENAY A AND JAMES C ADDRESS . . . . . . . . . . : 10260 TULA LN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2900 RECEIVED FROM . . . . : JAKES C HOFFMAN CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 29, 500. 00 367 .20 0. 00 367 .20 0. 00 BSEISMICRE VALUATION 29, 500. 00 3 . 00 0. 00 3 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 370.20 0. 00 370.20 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 370.20 #2514 --------------- TOTAL RECEIPT 370.20