07030130 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � C1R Z QRM�TI�lY
PERMIT NO.
OUILDING A�tD ESS:
1041 OAKVILLE AV STEVE ALBRECHT 07030130
PERMIT ISSUE DATE
OWNER'S NAME:
STEVE ALBRECHT 03/19/2007
SANITARY NO. CONTROL NO.
NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
i p z LICENSED CONTRACTOR'S DECLARATION Job Description
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 RE-PIPE TO COPPER. NO FIXTURES I NVO LVED.
r N in full farce and effect
t ? License Class Lk•#
t p Dam Contractor
LU ARCHITECTS DECLARATION
5-1
i a a I understand my plans shall be used as public records
)qU
u.ti Licensed Professional
a OWNER-BUILDER DECLARATION
j< I hereby affirm that 1 am exempt from the Contractor's License Law for the
_p o 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
ti prior in is issuance.also requires the applicant for such permit to file a signed statement Valuation
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;>q.Ft.Floor Area 4 O 00
e o (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i
3�° 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 6 913 0 0 a (4 Number Occupancy Type
not more than five 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 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.).
0 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-
ccnse Law docs not apply to an owner of property who builds or improves thereon,and
who contracts Car such p ' s with contractors)licensed pursuant to the Contractor's
License La
❑I to �t unde C. B&P C fo this on
Ow Da
IF WORK 'S 0 PENSATISN DEC RATION
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 Workcrs 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 is issued.
My Worker's Compensation Insurance carrier and Policy number arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' SANITA
COMPENSATION INSURANCE RY
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that' perfo once of thew k for which this permit is issued,!shall not
cmplo in anner so as t to the Wo on
Law,( C
Appli
NOTICE TO AP CAN :if,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J. O forthwith comply with such provisions or this permit shall be deemed revoked.
Z , CONSTRUCTION LENDING AGENCY
Er►�-� 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 A Lenders Name
a z Lender's Address
I certify that I have read this application and state that the above information is
O correct.1 agree to comply with all city and county ordinances and state laws relating to
building construction,and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspccuon purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
C/] liabilities,judgments,costs and expenses which may in anyway accrue against said City j
U Z in consequence of the ranting of this it. Date
►. APP NT UND STANDS AN W MPLY WITH LL NON-POINT Issued by:
CE GUL NS.
� Re-roofs
rgnature o pplicant/Conuwtor Date
HAZARDOUS MATERIALS DISCLOSURE Type of F.00f
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
Cole.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yesturc
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant orbuilding occupant use equipment or devices which
nazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
-restrict?
0 Yes QIIu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Heal th&Safety Codc cnors25505,25533and25534.1understandthalifthcbuilding
d cu ntly ha tenant that it m risibility to if occupant of the
firemen hick t be met prio f a Certifi cu �r Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner or athorizcd agent Dam
CITY OF CUPERTINO
REPIPE/ I�WEI / MAIN SERVICE
3 0 130
clu'P RYINO PERMIT APPLICATION FORM
APN# _ 1 3,QCfl Date:
Building Address: . D b O • // Ale,
Owner's Name: Phone #:
em Alb recO 4&3 Ci -5464
Contractor: License #:
Contact: Cupertino Business License #:
Building Permit Info: —/
Bldg ❑ Elect ❑ Plumb �J
Job Description:
epi Re, -+r-> A)a �t• YPS v�,��f
Residential 1;4 Commercial ❑
Cost of Project:
4DOO
Qty. if
Applicable Fee ID Fee Description Fee Group
PPERMITFEE Flumbing Permit Issuance PLUMBING
BPREPIPE F_e i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE F bl . Fixture PLUMBING
BPWSVCS main Water Service PLUMBING
BPSEWER 'ewers PLUMBING
BPSEWAGE E ewa e Disposal PLUMBING
BUSLIC Business License BUILDING
CITY OF CUPERTINO
2 ITEMS OF 2 PERMI" RECEIPT OPERATOR: kiersaw
COPY # 1
Sec: Twp: Rng: Sub: Blh: Lot :
APN . . . . . . . . : 36913009 . 00
DATE ISSUED. . . . . . . : 03119/2007
RECEIPT # . . . . . . . . . BS000000716
REFERENCE ID # . . . : 07030130
SITE ADDRESS . . . . . : lOo30 OAKVILLE AV
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : STEVE ALBRECHT
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4519
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : STEVE ALBRECHT
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4519
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
BPERMFEE VALUATION 4, 000 . 00 104 .76 0 . 00 104 .76 0 . 00
PPERMITFEE FLAT RATE 1.00 38 .37 0 .00 38 .37 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 143 . 13 0 . 00 143 . 13 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 143 . 13 1938
---------------
TOTAL RECEIPT 143 . 13
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY
507 FINAL PLUMBING
OWNER-BUILDF R VERIFICATION
1. (Check one) I or my immediate family iparent,spouse or child) will perform
A. All the work author ized by this permit
B. _ A portion of the we rk
C. _ None of the work
If B or C is checked,c:)mplete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City. Phone # State License # Type of work to
3. _ I will utilize unlicensed person(s) other than my immediate fan-&y to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' con ipensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
...............................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse side .
�
Property Owner's Signature: _ Date:
^
�� kv-Lf Permit#
Job Address:
4
_Ani changes to the information provided oii this form shall be submitted to the City of Cupertino Build
Department.
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: �� v„iN Ve� PERMIT
(�2a 0 1 30
1
OWNER'S NAME: ,�C,kf PHONE # � V 6 -,3 -S40 4
GENERAL CONTRACTO : FAX #
I am not using any subcontractors: 1R
Signature Date
Please check applicable subcontractors and co m 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
ir
Owner/Contractor Signature Date