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07050073 777777 CITE'OF CUPERTINO BUIL©ING DIVISION PERMIT � � R IMATI�1 : BUILD N DRESS: PERMIT NO. ���ll NOVEMBER DR APS ROCTER 07050073 OWNER'S NAME: PERMIT ISSUE DATE PUREET ANAND 2693 WHISPERING HILLS RD. 05/09/2007 3NE: SANITARY NO. CONTROL NO. (408) 274-5277 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 !0p LICENSED CONTRACTOR'S DECLARATION Job Description %U p 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing C z m with Section 7000)of Division 3 of the Business and Professions Code.and my license is COPPER RE P I P E INCLUDES 3 FIXTURES. s"'ein full force and cff �? j Z License Class Lle- t Date Contractor ARCHITECTS DECLA A ION 2 eC"t 1 understand my plans shall be used as public records )yd Ol- Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the CCoo following reason.(Section 7031.5,Business and Professions Code:Any city or county ,Off which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to rile a signed statement othat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation f (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $4200 rthat 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 ofNumber Occupancy Type not more than five hundred dollars($500). 3 6 2 1 6 0 2 3 � ❑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 docs not apply a 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, 7 however,the building or improvement is sold within one year of completion,the owner- d builer will have the burden of proving that he did not build or improve for purpose of y sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to q r construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- cense Law 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 declaration: ❑I have and will maintain a Certificate of Consent to self-insure for Workees 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 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 m enation Laurance carrier and Policy number am. Carries:� Polity N..496A 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 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 Qforthwith comply with such provision or this permit shall be deemed revoked. z 2CONSTRUCTION LENDING AGENCY rA I hereby alarm that there is a convection lending agency for the performance of CG > the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name Z Lender's Address U O 1 certify that I have read this application and state that the above information is [t i r correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building convection,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. Q. (We)agree to save,indemnity and keep harmless the City of Cupertino against tF'.t V) liabilities,judgments,costs and expenses which may in any way accrue against said City U 2 in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by. SOURCE R'EC#ULAT7 �.� ���1 Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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. C-]YesI�No 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 IT aterials for inspection. District? ❑Yes Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Section 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements w'h m t prior to issuance of a Certificate f OC Signature of Applicant Date 7 All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT' RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: B11: Lot : APN 36216023 .00 DATE ISSUED. . . . . . . : 05/09/2007 RECEIPT #. . . . . . . . . BS000001254 REFERENCE ID # . . . : 07050073 SITE ADDRESS . . . . . : 1O87 NOVEMBER DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PUREET ANAND ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1030 RECEIVED FROM RECEIPT INTERFACE CONTRACTOR . . . . . . . : KILN T. VO LIC # 26535 COMPANY . . . . . . . . . . : APS ROOTER ADDRESS . . . . . . . . . . : 2693 WHISPERING HILLS RD. CITY/STATE/ZIP . . . : SAM JOSE, CA 95148 TELEPHONE . . . . . . . . : (408) 274-5277 FEE ID UNIT QUANTITY INOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPREPIPE NO OF FIXTURE 3 . 00 27. 00 0 .00 27.00 0.00 PPERMITFEE FLAT RATE 1 .00 38 .37 0.00 38 .37 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 65.37 0 . 00 65 .37 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 65.37 1485-APS ROOTER --------------- TOTAL RECEIPT 65.37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/S ` V ;.I _S/MAIN SERVICE 52_3 4CITY CUPEkTINO PERMIT APPLICATION FORM APN # Date: Building Address: 1,�o'7 Owner's Name: Phone Contractor: Ap ,Qp�gl Phone: fpm �'27,54 License#: Contact: Phone: ;p� - 5�02� ��7fz Cupertino Business License#: Building Permit Info: e:5� �es Bldg ❑ Elect ❑ Plumb ❑ Job Description: Residential Commercial Commercial ❑ Cost of Project: , 9pD Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE 13ldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE ]'lambing Permit Issuance PLUMBING BPREPIPE .Zepipe of Fixtures PLUMBING BPFIXTURE :?blg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC 3usiness License BUILDING