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09070024�Op 'v3 ? � u. -.0` �V3_ IC •cm�+ yZi EFC 0 A Z c -- CO I a" W a UC wF C) � H � r.i U U'e CITY OF CUPERTINO777777777�- G DIVISION PERMIT�'�ITRC)Z BUILDIf BUILDING ADDRESS: PERMIT NO. 1032 AMERICM RESIDENT AL_ 09070024 `uNER'SNAME: SERVICES OF CA PERMIT LSSUEDATE RICHARP t; AND PHO f. - TI ),FT -B nl W S A CONTROL NO. f1 T ATT", T P' (408) 982-0405 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job D6SCnptlOn I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code and my license is in full forceandt!f� Co�Lle. r�ty REPLC SEWR LATERL FM 2' OUTSIDE FNDTN UP TO 1 FT _ License Class Date Contractor Date AV B4 CITY SIDEWALK & INSTL PROPTY & HSE CLEAN—OUT ARCHITECTS DECLARA ON Iun crstandmyplansshallbeusedaspublicrecords ACCESS; REPLC MNWATER LINE FM METR TO HSE Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 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 to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 1 O O O 0 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (s500). 36204019 .00 ❑ I, as owner of the property, or my employees with wages az their sole compensation, Required Inspections e will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conuactoes License Law docs not apply to an owner of q P 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 contractors) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec. B & P C for this mason ^nerDate WORKER'S COMPENSATION DEC-9—RATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 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 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 Compensation Insurance carrier and Policy number am: a Cartier. I'In%X 111 S9 (ahCf.G7Poliey No.: — (Q3 U31 CERTI CATS OF EXEMPTION FROM WO ERS' 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. ) ' 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.) Lender's Name — Lendees Address I certify that I have read this application and state that the above information is ' corrccL I agree to comply with all city and county ordinances and state laws relating to 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 of Cupertino against j liabilities, judgments, costs and expenses which may in any way accrue against said City r inconsequence of the granting of this permit. " APP CAM UND RSTANDS AND Wl COMPLY WITH A'L NO POINT Issued by: Date SOU D U MATERIALS DISCLOSURE are Type of Roof will the applicant or future building occupant store or handle hazardous material as dencd by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety ',de. Section 25532(a)? All roofs ;;hall be inspected prior to any roofing material being installed. ❑ Yes If a roof i.; 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 dcfi by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sections 15505, 25533 and 25534.1 understand drat if the building docs not cturently have a tenant that it is my nsihility to notify occupant of the re . men ch ust et 'o to, u of a Certifies panty. Signature of Applicant Date All roof coverings to be Class''`' or better o n gen Date . CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: g,-7 U 771-4 �/ PERMIT # �, OWNER'S NAME: PHONE # GENERAL CONTRACTOR: /' FAX # I am not using any subcontractors: Si, mature Please check applicable subcontractors and complete the following information: •7— dCo - 2cx� Date VAN0991V,�� r.7.— 60 —206,9 Owner/ Contractor Signature Date 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 VAN0991V,�� r.7.— 60 —206,9 Owner/ Contractor Signature Date CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B11:: Lot: APN ......... 36204019.00 DATE ISSUED.......: 07/06/2009 RECEIPT #.........: BS000008125 REFERENCE ID # ...: 09070024 SITE ADDRESS .....: 10:32 BUBB RD SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: SA`.'TERLEE RICHARD J AND CANDAC ADDRESS .......... CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4939 RECEIVED FROM ....: AMERICAN RES SVCS L CONTRACTOR .......: DONALD KARNES LIC # 21504 COMPANY ..........: AMERICAN RESIDENTIAL SERVICES ADDRESS 965 RIDGE LAKE BLVD STE 201 CITY/STATE/ZIP ...: MEMPHIS, TN 38120 TELEPHONE ........: (408) 982-0405 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ---------- 1BCBSC ------------- VALUATION ---------- 10,000.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BPWSVCS WATER SERVICE 1.00 21.00 0.00 21.00 0.00 1BSEISMICR VALUATION 10,000.00 1.00 0.00 1.00 0.00 1PPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1PRSEWER UNITS 1.00 21.00 0.00 21.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 128.00 ---------- 0.00 128.00 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 128.00 --------------- 128.00 VOICE ID DESCRIPTION -------- ---------------------------- 106 SEWER & WATER 507 FINAL PLUMBING REFERENCE NUMBER -------------------- #8128004959 VOICE ID DESCRIPTION -------- ---------------------------- 301 ROUGH PLUMBING CITY OF CUPEkTINO CITY OF CUPERTINO REPIPE/SEWS R/MAIN SERVICE PERMIT APPLICATION FORM (0�01 0 0;)-q APN # cor Rbqolq- Date: , i a 009 Building Ad ess: ponag a0pe -M70 Fee OwneL' /� Phone #: Contractor: „A► ScV Phone -- Q #10 Fax #: Contact: 4,,:. Phone #: C you) 3Lfg —(PLB0 /x/11 PpIF, L Fax #. Contractor License #: -7s%5% P Cupertino Business License #: 2ir2 d )(/0 - " 31 2-6W Job Description: -� -,� L4TE' ' L— f Y'UcX7 Z- ', d T�v1.0-)1--17 v 6JEff4 " GITV 51A�W46-t-- pa j t�1 s )-:3 PRS �y �ftjr�� -� - ' •v( 4: ,��E MAI to Residential Commercial ❑ Valuation: � UUV Commercial re -pipe per fixture Project Size: Express Standard ❑ Large [ Major 1CPRP 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. P Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary s -.Wer 1BPREPIPE Commercial re -pipe per fixture P 1CPRP 1PGASCOM Commercial Ga; Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standzrds Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 01/07/09 ITY of CUPEI,TINO CITY OF CUPERTINO REPIPE/SEWEIUMAIN SERVICE FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Resident: al P �J 1PRSEWER 'Residential building sewer/sanitary sever P 1RPSS 1PRREPIPE Residential re -pipe per fixture P 1RPRP t 1BPWSVCS Water Service P 1CPWS or 1RPWS IPPRSEWG Private Sewage Disposal System P 1 PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1 BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System 1-4 Outlets P I BPGAS Gas Piping System 5+ Outlets P 1 PPERMITFEE Plumbing Permit Fee Issuance P 1 PLMBLNCK Plumbing Plan Check P 1PLMBINSP Other Plumbing/gas Insp. P I TRAVDOC Travel & Documf ntation Fee B 1 BUSLIC Business License B