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07020141 CITY OF CUPERTINO BUILDING DIVISION PERMIT � TIIt� T '1R � �` �� * PERMIT NO. BUILpI)<I,CtAJ�VEIAENEY CREEK PL A & A P DUMBING 07020141 l�J j`� PERMIT ISSUE DATE OWNER'S NAME: CARLE HYKEMA 924 E F:=ONT AVE 02/27/2007 SANITARY NO. CONTROL NO. NE: (408) 733-8878 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 1,%ZO LICENSED CONTRACTOR'S DECLARATION Job Description W F 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z, with Section 7000)of Division 3 of the Business and Prof terms qqc and my license is REPLACE FURNACE r H in full force and Z�LVJ` z Lie law t-o Date Contntyar � ARCHITECTS DECLARA i a a I understand my plans shall be used as public records )yc� u.h Licensed Professional H; OWNER-BUILDER DECLARATION 1 hereby affirm that l am exempt from the Contractors License Law for the in o following reason.(Section 7031.5,Business and Professions Code:Any city or county e mff which requires a permit to construct,alter,improve,demolish,or repair any structureo"rn prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation _z r Ft.Floor Area < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 S q $3500 2 tx� (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 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 4 2 4 8 0 2 3 . Number Occupancy Type not more than five hundred dollars(5500) 0 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.). 0 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 contnctor(s)licensed pursuant to the Contractors License Law. 0 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 declarations: 0 1 have and will maintain a Certificate of Consent to self-insurc for Workces Compen- sation,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 Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the pormance of the work for which this permit is issued. My Werke C`rtpensau u�}tee cornier and Policy(n bei ZZ74W , Policy No.: S �� IFICA OF EXEMPTION FROM WORKER COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars($100) or less.) 1 certify that in the performance of the work for which this permit is issued,t 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 O forthwith comply with such provisions or this permit shall be deemed revoked. Z V) CONSTRUCTION LENDING AGENCY [�.�-+ I hereby affirm that there is a construction lending agency for the performance of fY. the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name z Lcndees Address I certify that I have read this application and state that the above information is U. correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. W (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequent the granting of this permit. Date 2 APPLIC N STANDS AND WILL COMPLY WITH ALL NON-P INT Issued by: SOU G ONS. i - Re-roof: i fApplicanUContractor DatType of Roof HAZARDOUS MATERIALS DISCLOSURE YP Will the applicant or future building occupant store or handle hazardous material defined by the Cupertino Munici a(Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof;shall be inspected prior to any roofing material being installed. 0 Yes 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 contamina7N. defined by the Bay Arca Air Quality Management all new -naterials for inspection. District? 0 Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafctyCodc,Sections 25505,25533 and 25534.I undcm=d thatif the building docs not cu y have a tenant that it is my responsibility to notify the occupant of the require wh: cast be met prior to issuance of a Certificate of c �x Signatul a of Applicant Date All roof coverings to be Class 'B or better Da IN orized agent CITY OF CUPERTINO 7 ITEMS OF 11 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34248023 . 00 DATE ISSUED. . . . . . . : 02/27/2007 RECEIPT #. . . . . . . . . . BS000000550 REFERENCE ID # . . . : 07020141 SITE ADDRESS . . . . . : 1C399 HENEY CREEK PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER CFRLE HYKEMA ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0829 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : MIKE FOX LIC # 25401 COMPANY . . . . . . . . . . : A & A PLUMBING ADDRESS . . . . . . . . . . : 924 E FREMONT AVE CITY/STATE/ZIP . . . : SLNNYVALE, CA 94087 TELEPHONE . . . . . . . . : (908) 738-8878 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 BREMFURN NO UNIT 1. 00 14 .31 0. 00 14 .31 0. 00 BSEISMICRE VALUATION 3, 500. 00 0.50 0. 00 0 .50 0. 00 BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 . 00 0. 00 EPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38.37 0. 00 MPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38 .37 0. 00 PPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 271.78 0. 00 271.78 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ------ ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL CITY OF CUPERTINO 0102-0 14 I :«,. U N ACEAC CUPEkTINO PERMIT APPLICATION FORM APN # Date: ) 42.-B54-2.- Buil uil indres : � Owner's N e: one ( J �, Ph011e: i 1 ICe1lSe �:� Con - c,zo ��. ��'`C�� `'gj,,� r �� Contact: �' Phone: Cupertino Business License#: 2- 0 1 Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech Job Description: Residential Commercial ❑ For Residential I st llations: Attic 1:1I Sc floor 2nd floor❑ Adhere to min set back requirement❑ For Commercial Installations: _eplacement same weight ❑ Additional weight (structural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: J � Type of Construction: Occupancy group: c� C,C Strapped El 'On Platform LJBonded 11 Sq.Ft. Floor Area: New Location ❑ Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Imergy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER tVC Unit> 10,000 cfin MECHANICAL BREMAIRHAN QVC Units <= 10, 000 cfm MECHANICAL BREMRECEPT Recptl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILIDNG EPERMITFEE J31ec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMTTFEE Plumbing Permit Issue PLUMBING BPERMFEE HPlan 31dg Permit Fees BUILDING BPLANCHK Check Fee BUILDING BPGAS Jas Piping System Fee PLUMBING BUSLIC L .3usiness License BUILDING