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07020087!o{o_- id :z rv�Z iaQ )yU W y .O` �co < °m V ^v, CITY OF CUPEK'11NU BUILDING DIVISION PERMIT BUILDING ADDRESS: 10126 ALPINE DR OWNER'S NAME: SUE CRAFTS DNE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70(10) of Division 3 of the Business and Professions Code, and my license is in full force and c t License Class Lir• # -7 9417L Date T1�_1 Contractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER - BUILDER DECLARATION 1 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 m 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 (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 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 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 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 .7 O z.. Qr A U OU Uz ter 1 hereby affirm under penalty of perjury one of the following declarations: PERMIT NO. ALL VALLEY PLUMBING 07020087 PERMIT ISSUE DATE I have and will maintain a Certificate of Consent to self -insure for Worker's Compen- ation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 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. Ay Worker's Compensation Insurance carrier and Policy number ale: Carrier lei MM '7 Policy No.:��0��01 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is formic 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 Workcrs 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.) Lenders Name Lender's Address 1 certify that I have read this application and state that the above information is correct. 1 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 liabilities,judgmens, toss and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOUR REGULATIONS. s Signatu& of ApplicanUC nttactor 'Date — HAZARDOUS MATERIALS DISCLOSURE 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)? t�� /// ❑ Yes p5 No Will the applicant or future building occupant use equipment or devices which :mit hazardous air contamin7N. defined by the Bay Area Air Quality Management District? [] Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califon 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 tht requirements which must be m"rior to issuance of a Certificate of Occupancy. of authorircd 3345 SEL (510)376 -4816 REPLACE WATER HEATER iq. Ft. Floor Area �p Number 32615104:. (7U Issued by: Re -roofs Type of 1,00f SANITARY NO. Job Description $375 Required Inspections CONTROL NO. BUILDING PERMIT INFO ELECT PLUMB uatlon Occupancy Type Date 2 �%5l L, All roofs shall be inspected prior to any roofing material being installed. If a roof s installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF `'UPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax (408) 777 -3333 Building Department JOB ADDRESS: r� PERMIT # 1 a r3 a? OWNER'S NAME: �-e L V CZ PHONE # - - 5 GENERAL CONTRACTOR: All VOW FAX # 6--f I am not using any subcontractor ?rs _� V Signature Date PIPacP rhprk ar»»lirablP siubcontra d comoj ete the followine information: 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 Owner/ Contractor Signature Date 4 ITEMS OF 7 CITY OF CUPERTINO PERMIT' RECEIPT Sec: Twp: Rng: Sub: B11:: Lot: APN 32615104.00 DATE ISSUED.......: 02,'16/2007 RECEIPT #.........: BS0)00000476 REFERENCE ID # ...: 07020087 SITE ADDRESS .....: 10:_26 ALPINE DR SUBDIVISION ...... CITY CU- 3ERTINO IMPACT AREA ...... OWNER SU:�", CRAFTS ADDRESS .......... CITY /STATE /ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY /STATE /ZIP TELEPHONE .... OPERATOR: amyw COPY # : 1 RECEIPT INTERFACE MAZY SANDBRINK LIC # 23015 AL:i VALLEY PLUMBING 33.15 SELDON CT FR:EMONT, CA 94539 (5L0)376 -4816 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC - - - - -- NEW BAL ---- - - - - -- ---- - - - - -- BENERGY ------- - - - - -- PERMIT FEE ---- - - - - -- 1.00 ---- - - - - -- 34.86 ---- - - - - -- 0.00 ---- 34.86 0.00 BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 ---- - - - - -- 0.00 ---- - - - - -- TOTAL PERMIT ---- - - - - -- 191.02 ---- - - - - -- 0.00 191.02 0.00 METHOD OF PAYMENT --------------- -- CHECK TOTAL RECEIPT : AMOUNT --------------- 275.04 --------------- 275.04 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING REFERENCE NUMBER --------------- - - - -- 7719 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 506 GAS TEST CITY OF CUPERTINO WATER HEATER PERMIT APPI -4ICATION FORM APN # JG r� _--�� ++ nn I —� �ll1 Date: BUILDING PLUMBING BUILDING BUILDING Building Address: 1 � . 01 Owner's Name: 51 Phon # _- _ -- - . P nt / -- Co7/—� r: License #: Contact: one P&Lrj Cupertino Busines License #: Building Permit Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: Residential (]. -' Commercial ❑ Cost of Project: �.�5 Strapped On Platform Bonded. New Location ❑ Replacement Qty. if Vm "-crrintinn Fee Grow A licable Pee W BPWHEATER pp Uvff rFEE BENERGY BUSLIC i - ._-_ Water Heater / Vent P1 ing Permit Issuance Energy Business License BUILDING PLUMBING BUILDING BUILDING