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09010113 CITY OF CUPERTINO �r BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 10687 MTNFTTR PT, AT,T, V OWNER'S NAME: PERMIT ISSUE DATE m~O A CONTROL NO. 510) 376-4816 ARCHr1ECT/ENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 000 LICENSED CONTRACTOR'S DECLARATION to I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description Z 6 with Section 7000)rf Dtvision 3 of dtc Business and Professions Code,and my license is <�y in full force and eff WATER HEATER RE PLCMNT 5 rg 3 Lic.M Qd y E wo Date Contractor t AR HITECCS DECLARATION 0 U l understand my plans shall be used as public records O H Licensed Professional n r 3 OWNER-BUILDER DECLARATION .4 Z I hereby affirm that I 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 K s;Pi which requires a permit to construct,alter,improve,demolish,or repair any structure y Z y prior to its issuance,also requires the applicant for such permit to file a signed statement 4`e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation y t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of $700 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of anC APN Number Occupancy not more than five hundred dollars(5500). P y Type ❑I,as owner of the property,or my employees with wages as their sole compensation, 37532041 . 01 will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law dors not apply to an owner of Required Inspections 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- 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. ❑1 am exempt under Sec. B&P C for this mason Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 'have and will maintain a Certificate of Consent to self-insure for Worker's Compen- .m,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ave 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 Workees Compensation insurance carrier and Polity number am: Cartier. A ) � Policy No.: 4E6 Z V e i•.b 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 D O forthwith comply with such provisions or this permit shall be deemed revoked. ti t" CONSTRUCTION LENDING AGENCY r.. I hereby affirm that there is a construction lending agency for the performanLc of 3i> the work for which this permit is issued(Sec.3097,Civ.C.) ALendces Name Z Lcndees Address J Q 1 certify that I have read this application and state that the above information is y correct.I agree to comply with all city and county ordinances and state laws relating to DV "construction,and h y authorize representatives of this city to enter upon the W above-mentioned props or inspection purposes M4 a (Wc)agree to ve,indemnify and keep harmless the City of Cupertino against "rA liabilities,judgra ,costs and expenses which may in any way accrue against said City JZ inconsequence the granting of this permit. / �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE Date R a• 2-2 Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof G 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 awo— Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. ict? ❑Yes RKo 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 have a tenant,that it is my responsibility to notify the occupant of the L Z-—2 1 Q S. requircm us (prior w issuance of a Certificate of Occup cy. f p; �"a�l� Signature of Applicant Date Owner or authorixcd agent Date All roof coverings to be Class',Af 'or better CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 37532041 . 01 DATE ISSUED. . . . . . . : 01/27/2009 RECEIPT #. . . . . . . . . BS000007045 REFERENCE ID # . . . : 09010113 SITE ADDRESS . . . . . : 10687 MINETTE PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PEARL CALDWELL ADDRESS 10687 MINETTE PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ALL VALLEY PLUMBING CONTRACTOR . . . . . . . : MARY SANDBRINK LIC # 23015 COMPANY ALL VALLEY PLUMBING ADDRESS 3345 SELDON CT CITY/STATE/ZIP . . . : FREMONT, CA 94539 TELEPHONE . . . . . . . . : (510) 376-4816 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 700 . 00 1 . 00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 700 . 00 0 .50 0 . 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00 1PRWHEATR UNITS 1 . 00 24 .48 0 . 00 24 .48 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 107 .56 0 . 00 107 .56 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 107 .56 #1940 --------------- TOTAL RECEIPT 107 . 56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER CITY OF CUPERTINO WATER HEATER CITY OF !.--UPEkT1N0 PERMIT APPLICATION FORM APN # 134 Date: Building Address: c/L CP Owner's Name: Phone #: P,e Contractor: Phone Fax #: '5t C (o L-;,I — C,-9t 7 Cupertino Business'License #: Contractor State License #: C, Contact: Phone 1< Fax #: �IC- �-4-r Coei 7"-/ Building Permit Info: Bldg ❑ Elect Plumb MechE]"--- Residential Commercial ❑ Job Description: -4- Strapped F❑I On Platform F-1 Bonded ❑ New Location El Replacement Valuation (cost of project): Project Size: Express Standard 0 Large F-1 major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points achieved: Revised 6/16/08 CITY OF CUPERTINO aclof WATER HEATER JkINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1PCWHEATR Commercial Water B PCWHEATR HeaterNent 1BSEISMICOM Seismic Commercial B 1 PRWHEATR Residential Water B PRWHEATR HeaterNent 1BSEISMICRE Seismic Residential B 1 PPERMITFEE Plumbing Permit P 1 TRAVDOC Travel & B Documentation 1 BUSLIC Business License B w4 . Community Development 10300 Torre Avenue a= ,; Cupertino CA 95014 Telephone(408)777-3228 xCIT1l OF Fax(408)777-3333 ` MkTINO Building Department JOB ADDRESS: PERMIT # B!c ? A9 - 7 10 OWNER'S NAME: C PHONE # -V08-2-52- S GENERAL CONTRACTOR: FAX# I am not using any subcontractors: en 11.2? Log 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 ! 12--7 Jos Owner/Contractor Signature Date