06060018 CITY OF CUPERTINO
BUILDING DIVISION PERMITTQ `� � '
BUILDING ADDRESS: JIM LEONARD PERMIT NO-
06060018
22042 HIBISCUS DR
PERMIT ISSUE DATE
OWNER'S NAME: ,
JIM LEONARD06/02/2006
SANITARY NO. CONTROL NO.
qE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION Job Description
V 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
<� in full force andefrecty�z�� WATER HEATER REPLACEMENT
; ? License Lk• HANDYMAN CONNECTION PAID FOR BL 6/2/06
Contractor
ARCHITECTS DECLARATI N
i < I understand my plans shall he used as public records
7yri
a H Licensed Professional
<n e OWNER-BUILDER DECLARATION
3 1 hereby affirm that t am exempt from the Contractor's License Law for the
-a oa 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
Z; prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuati$nl 0 0 0
< that he is licensed pursuant to the provisions or the Contractor's License Law(Chapter 9 Sq
G F (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 3�P6NN0 �3 4er 0 0 Occupancy Type
not more than five hundred dollars($500)
❑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 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.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7144,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
i
Owner Date '
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
L]1 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 Worker's Compensation hisu tree carrier and Policy number are:
Cartier � Policy No.:
'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"rsoa w bccogtc subject to the Workers'Compensation
Law"of Calif'rN}
Applicant'3, . —,
NOTICE TO APPLICANT:It,Aer malft this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you mast
,J 0 forthwith comply with such provisions or this permit shall be deemed revoked.
z 2CONSTRUCTION LENDING AGENCY
F~-r 1z 1 hereby alLrm that there is a construction lending agency for the performance of
fx> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
z Lendces Address
U 0 I certify that I have read this application and state that the above information is
Ll, correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
R. (We)agree to save,indemnify and keep harmless the City of Cupertino against
„Ft Uj liabilities,judgments,costs and expenses which may in any way steric against said City
V z in consequence of the granting of this permit. Date
►■ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Re-roofs
Signature of Applicam/Contractor Dare T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
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 No
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? z�,��
C3 Yes UOLtvo
1 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 thc building
docs not currendy have a ten t that it is my responsibility to notify the occupant of thc
requiremcn hich must et prior to issuance of a CcrtificaM
Signature of Applicant Date
All roof coverings to be Class'B"or better
er or authori-zcd gen Date
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32602034 . 00
DATE ISSUED. . . . . . . : 06/02/2006
RECEIPT # . . . . . . . . . : 34670
REFERENCE ID # . . . : 06060018
SITE ADDRESS . . . . . : 22042 HIBISCUS DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . . JIM LEONARD
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : HANDYMAN CONNECTION
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : JIM LEONARD
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . .
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
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 189 . 02 0 . 00 189 . 02 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CASH 189 . 02
TOTAL RECEIPT 189 . 02
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
CITY OF CUPERTINO of oC 060 16
WATER HEATER
CUPCITYEf�TiNO PERMIT APPLICATION FORM
APN# O� ,r d 3 Date:
32t�
Building Address: ! -CC4 S -
�2 Y�
Owner's Name:( Phone#:
Contractor: Phon . License#:
Contact: Phone: Cupertino Business License#:
Building Permit Info:
BI d ❑ Elect ❑ Plumb Mech ❑
Job Description:
Residential Commercial ❑
Cost of Project:
moo,
Strapped ❑ On Platform ❑ Bonded ❑
New Location Replacement ❑
i
Qty.. f
A 1icaf Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPE FEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING