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07060102 -77 CITx OF-, CPERTINO ILD DIVISION PERMIT DIVISION +CL1 'T'RAC?R ICIRMI4TI�lY' ...... :.. .:..:.:,. PERMIT NO. ""IJNf�,ADQQF'hMBER DR A & A PLUMBING 07060102 y'S N 1E V V PERMIT ISSUE DATE OWNER'S NAME: JAMES HARRAH 924 E FFEMONT AVE 06/13/2007 SANITARY NO. CONTROL NO. ME: (408) 73E-8878 BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH 0 ce o LICENSED CONTRACTOR'S DECLARATION Job Description uF I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is WATER HF,ATER REPLACEMENT. t y in full force and ect O 3 t v�Z License ass � V L1C•� l p Date .r9 7 Contractor M ARCHITECT S DFCLARAfW i a< I understand my plans shall be used as public records tyU a y Licensed Professional OWNER-BUILDER DECLARATION 3< 1 hereby affirm that I am exempt from the Contractors License Law for the p0 following reason.(Section 7031.5,Business and Professions Code:Any city or county 91 which requires a permit to construct,alter,improve,demolish,or repair any structure Z a prior o its issuance,also requires the applicant for such permit to file a signed statement I;q.Ft.Floor Area Valuation that he is licensed pursuant to the provisions of Contractor's License Law(Chapter 9 (1 $1250 ate- (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 of 36213045 Number 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.). ❑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 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 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: L]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. ❑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 In,st/��once carrier and Policy number are: Cartier. Xx(4Q�✓V PolicyNo.:aW 1 (y CERTIFICATE OF EXEmn ION FROM WORKERS' COMPENSATION INSURANCE (Chis 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 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 Labor Code,you must ,J z forthwith comply with such provisions or this permit shall be deemed revoked. Z O 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.) W Q Lender's Name Z Lcndees Address U 0 1 certify that 1 have read this application and state that the above information is V.", correct.1 agree to comply with all city and county ordinances and state laws relating to OU building construction.and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indcmmi(y and keep harmless the City of Cupertino against �+ Cn liabilities,judgments,costs and expenses which may in any way accrue against said City Date U Z in consequence of the granting of this permit APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. ^1 Re-roofs 12 Signature of Applicant/Con r Dao Type of F.ovf HAZ OUS MATERIALS DISCLOSURE yP 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. ❑Yex N"° Will the applicant or future building occupant fisc 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? ❑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 not currently ha tenant that it is my responsibility to notify the occupant of the , 11 Date requirements whit t be met prior o issuance of a Certificate of Occupancy. S lgnatur( of Applicant ✓`''"' All roof coverings to be Class 'B or better Owner or aur zed agent Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN . . . . . . . . . 36213045.00 DATE ISSUED. . . . . . . : 06/13/2007 RECEIPT #. . . . . . . . . : BSC00001640 REFERENCE ID # . . . : 07C60102 SITE ADDRESS . . . . . : 96_` NOVEMBER DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . JAYES HARRAH ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4120 RECEIVED FROM . . . . : A S A PLUMBING CONTRACTOR . . . . . . . : MIF.E FOX LIC # 25401 COMPANY . . . . . . . . . . : A b A PLUMBING ADDRESS . . . . . . . . . . : 924 E FREMONT AVE CITY/STATE/ZIP . . . : SUDNYVALE, CA 94087 TELEPHONE . . . . . . . . : (4C8)738-8878 FEE ID UNIT QUANTITY 714OUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BENERGY PERMIT FEE 38.37 34 . 86 0. 00 34 . 86 0. 00 BPWHEATER PER HEATER 1. 00 10.79 0. 00 10.79 0. 00 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 84.02 0. 00 84 . 02 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 84 . 02 #5359 --------------- TOTAL RECEIPT 84 . 02 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING CITY OF CUPERTINO 0-70( CD 1 WATER HEATER CUPEkTINO PERMIT APPLICATION FORM APN# C5(0 I v - O o Date: Building Address Owner's Narrlel� Phone Contractor: Ph e License#: Contact: Phone: Cupertino Business License#: FcySEG 1f - orfs? Building Permit Info: �� 1� � )r-� Bldg ❑ Elect 'r Plumb Mech Job Description: Residential Commercial ❑ Cost of Proje1(n50 Strapped On Platform Bonded New Location ❑ Replacement Qty. if Applicable Fee ID Fee Description Fee Group BPWHEATER Water Heater/Vent BUILDING PPERMITFEE :11lumbing Permit Issuance PLUMBING BENERGY Energy BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue r, a Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 "UPEkTINO Buildi ti Department JOB ADDRESS: vv�`"'"' f''" PERMIT # -?D 6010 OWNER'S NAME: o we e S G.r rc PHONE # / Q£f ? -S8' 3-FS7 GENERAL CONTRACTOR: v FAX # I am not using any subcontractors: Signature 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 Own r/Contractor Signature Date