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07050040 CITY OF CUPERTINO BUILDING DIVISION PERMIT GNTTt)R I ' } MTIDN• PERMIT NO. BUILDING ADDRESS: 10668 CARVER DR KARAM GERGES & SAMIA GERGES 07050040 PERMIT ISSUE DATE OWNER'S NAME: KARAM GERGES & SAMIA GERGES SANITARY NO. CONTROL NO. 4E: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH ce z LICENSED CONTRACTOR'S DECLARATION Job Description i V P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z� with Section 70(10)of Division 3 of do Business and Professions Code,and my license is HOUSE DEMO H in full force and effect. K License Class Lic•# un Date Contractor ARCHITECTS DECLARATION i a< I understand my plans shall be used as public records >dV a Licensed Professional O a OWNER-BUILDER DECLARATION a1 hereby atTirm that I am exempt from the Contractor's License Law for the In O following mason.(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 r;q.Ft.Floor Area Valuation ?a that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 $8000 4 F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or A that he is exempt therefrom and the basis for the alleged exemption.Any violation of Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 37532011i AyV 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 Conuactors 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 s�ale�.). Cg t,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 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 COMMIOr s License Law. ❑I am exempt un sec B&PS�C for this reason Owner Date y_(_{c. / ECLARATION I It t oder penalty of perjury one or the fallowing declarations: Lj I have and will maintain a Certificate of Consent to self-insum 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. ❑I have and will maintain Workers 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 am: Cartier: 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,1 shall not employ any person in any m so becom bjcct to the Workers'Compensation Laws of California.Da ApplNOTICEt ertificate of Exemption,you should NOTICE TO APPLICA � P become subject to the Workers ompensation provisions of the Labor Code,you must O0 forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY FCA I hereby affirm that there is a construction lending agency for the performance of pC> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name z Lender's Address U C) 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 0 U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection Purposes. (We)agree to save,indemnify and keep harmless the City oC 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 2 -- ` 0" APPLICANT UNDER ND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCEREGU � Re-roofs Signature of A ran r Dare Type of Roof H DOUS MATERIALS DISCLOSURE 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. ❑Yes 'e If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection. District? ❑Yes 0-Ko I have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building docs not current] It a tenant,that it is.my responsibility to notify die occupant of the 11 Date requirements why met priorof a Certificate of Occupancy. Slgnaturc of Applicant All roof coverings to be Class"B or better Owner or updroriz cot Date 777777777�_77 CITY OF CUTERTINO BUILDING DIVISION PERMIT :� ` �`T�� * ....:.:..::..... BUILT►"BlEtASS PL A & H HEATING Meh55 111 PERMIT ISSUE DATE OWNER'S NAME: MCCARTHY MARYLIN M 770 CHESTNUT ST 06/19/2007 SANITARY NO. CONTROL NO. jNE: (408) 271►-0722 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 0 a a p C LICENSED CONTRACTOR'S DECLARATION Job Description ELI P I hereby affirm that I am licensed under provisions of Chapter 9(commencing CENTRAL A/C ADD-ON - 220 VOLT CIRCUIT. r w with Section 7010)of Division 3 of the Business and Professions Code,and my license is h y in full force and effect ZO O ? License Class C� Lic.S F D c (� —Contractor ARCHITECTS DECLARATI N i a< 1 understand my plans shall be used as public records >yU u y Licensed Professional a OWNER-BUILDER DECLARATION 3 a I hereby affirm that I am exempt from the Contractor's License Law for the no 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 prior w its issuance,also requires the applicant for such permit to file a signed statement 3q,FtFloor Area Valuation ?< that he is licensed pursuant to the pro .visions of the Contractor's License Law(Chapter 9 $4750 2 N (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 DCCU Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3 57 0103 I AW Number Occupancy Type 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 docs 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.). ❑I,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- cerise taw 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. ❑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: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3710 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 Stepp 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 am:�j'^ Carrier.��1 X.?5 Policy No.:ErV[L 1Q Z0U CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (rhis 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 manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the tabor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z'" CONSTRUCTION LENDING AGENCY (ter►�— I hereby affirm that there is a construction lending agency for the performance of LY > the work for which this permit is issued(See.3097,Civ.C.) W Q Lender's Name az Lender's Address U 0 I certify that I have read this application and state that the above information is vS correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against r/) liabilities,judgments,costs and expenses which may in any way accrue against said City p U Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. (�` /' 6 saG—�K/ � f (� ! Re-roofs Signature cf Appiicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Loof Will the applicant or future building occupantstore or handle harardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? f All roofs shall be inspected prior to any roofing material being installed. ❑Yes CJ ryo 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? Cl Yes o I 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 of currently have a tenant that it is my responsibility to notify the occupant of the reyui nts which must be met p' hssu ce of a 111 ate o Oceup Signature of Applicant. Date All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bll:: Lot: APN 3501039 . 00 DATE ISSUED. . . . . . . : 06/ 19/2007 RECEIPT #. . . . . . . . . : BS000001692 REFERENCE ID # . . . : 07060155 SITE ADDRESS . . . . . : 10159 CASS PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MCCARTHY MARYLIN M ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014"-2751 RECEIVED FROM . . . . : DALE PHELPS CONTRACTOR . . . . . . . : PHELPS, DALE LIC # 12079 COMPANY . . . . . . . . . . : A & H HEATING ADDRESS 770 CHESTNUT ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95110 TELEPHONE (408)279-0722 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ------ --- ---------- ---------- BENERGY PERMIT FEE 34 . 86 34 . 86 0. 00 34 .86 0. 00 BREMAIRHAN NO.UNITS 1. 00 10.26 0. 00 10.26 0. 00 BREMRECEPT NO. OUTLETS 1. 00 1.20 0. 00 1.20 0. 00 BSEISMICRE VALUATION 4, 750. 00 0.50 0. 00 0.50 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 MPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38 .37 0. 00 PPERMITFEE FLAT RATE 1. 00 38 .37" 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 161.93 0. 00 161 .93 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 161 .93 MC --------------- TOTAL RECEIPT 161. 93 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL 0706 0156 CITY OF CUPERTINO FURNA(.E/AC )PEkTINO PERMIT APPLICATION FORM "N � D N# 35 7o/ 03�.00 Date: Building Address:/0/ 5"9 eW N�- Owner's Name: Phone#:?736� Contract r Phone: License#: 9 ANG �� .X79-o2z� �o �� Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg_ ❑ Elect Phrnb � '� Mech 0� Job Description: Residential Commercial ❑ Foridential Ins allations: Attic 1 s`floor 2nd floor❑ Adhere to min set back re uirement r Commercial Installations: Replacement same weight ❑ Additional weight(structural talcs) ❑ Structural Calculations required for new installation New installation Planning Approval Required El Cost of Pro' ct: Type of Construction: Occupancy group: Strapped On Platform Bonded Sq.Ft. oor Area: New Location R lacement Qty. if Fee Grou Applicable Fee ID Fee Descri tion BENERGY Ent;r BUILDING BREMFURN Relocation of Furnace MECHANICAL BREMACOVER A/�:Unit> 10,000 cfin MECHANICAL BRE AX"Units<= 10, 000 cfm MECHANICAL BRENIRECEPT Rec tl, Switch& Outlets ELECTRICAL BSEISMICRE Se:.smic Fee Res BUILDING BSEISMICOM Se.smic Commercial BUILIDNG EPERMITFEE EIE:c Permit Issuance ELECTRICAL MPERMITFEE M(ch Permit Issuance MECHANICAL PPERMITFEE Plimibing Permit Issue PLUMBING BPERMFEE BldgPermit Fees BUILDING BPLANCHK Plum Check Fee BUILDING BUSLIC Business License BUILDING Community Development " 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '-UPEkTINO Building Department JOBI)DRES s _ PERMIT 70 G OC�_r OWNER'S NAME: b/iL PHONE # GENERAL CONTRACTOR: ► /(' FAX # qQ0 Z 0t I am not using any subcontractors: Si.mature 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/Contractor Signature Date