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07080005 CITY OF CUPERTINO BUILDING DIVISION PERMIT PERMIT No. BUILD Dpp ESS: �y� REGNART RD VIA BUILDERS . 07080005 PERMIT ISSUE DATE OWNER'S NAME: - - MIKE. & KATHY YATES 4600 EL -CAMINO REAL 7 SANITARY NO. CONTROL NO. SE: (650) 998-1077 BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH °L Z LICENSED CONTRACTOR'S DECLARATION Job Description 0 W P I hereby affirm that I am licensed under provisions of Chapter 9(commencing ZW withScction7000)ofDivision3oCtheBusincssandProfessions Codc,and mylicense is. TEMP POWER NEEDED FOR-DEMO/CONSTRUCTION. a a. in full force and effect. Z License ClassLic.M p Date 9l— 1�'1Co. PI'Sl�•�_ F. ARCHITECTS DECLARATION i a< I understand my plans shall be used as public records yU U.ti Licensed Professional - t a OWNER-BUILDER DECLARATION the1 hereby affirm that 1 am exempt from the Contractors License Law for 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county : _9 which requires a permit to construct,alter,improve,demolish,or repair any structure 1—y prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor AValuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq Area $500 H (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 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(5500). 366470-.5 . 0 I,as owner of the property,or my employees with wages as their soic 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.Contraemis 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 Contrsetars License Law. 0 I am exempt under Sea B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 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 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. 0 I 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 My Worker's Compensation Insurance carrier and Policy number are: Carver. PSA JP J:6 Policy No.: (A�71-`757 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workcrs'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the workers Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name aLender's Address U Q 1 certify that 1 have read this application and state that the above information is (i. H correct.1 agree to comply with all city and county ordinances and state laws relating to O U building construction,and hereby authorize representatives of this city to enter upon the W ahove-mentioned property for inspection purposes. P4 (We)agree to save,indemnify and keep harmless the City of Cupertino against tai CA liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date ►+ APPLICANT UNDERSTAAIDS AND WILL COMPLY WITH LL NON-POINT Issued by: SOURCE REGULATIONS p-yl at Re-roof:; Signature of Applicant/ n ctor Die Type of Roof H DOUS MATERIALS DISCLOSURE yP Will the applican future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. C Yes I$No Will the applicant or future building occupant use equipment or devices which If a room is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? 0 Yes ACNu 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 docs not currently have a tenant,that it is my res nsibility m notify the occupant of the requirements ich must be met prior�uan of a Ccr ircate of Occupancy. Signatu:•e of Applicant Date G"1-D All roof coverings to be Class"B or better Owner aur orized agent Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36547015.00 DATE ISSUED. . . . . . . : 08/01/2007 RECEIPT #. . . . . . . . . BS000002221 REFERENCE ID # . . . : 07080005 SITE ADDRESS 22292 REGNART RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MIKE & KATHY YATES ADDRESS . . . . . . . . . . CITY/STATE/ZIP BATTLE GROUND WA, 98604 RECEIVED FROM . . . . : JCNATHAN FALES CONTRACTOR VIA BUILDERS LIC # 22525 COMPANY VIA BUILDERS ADDRESS 4E00 EL CAMINO REAL CITY/STATE/ZIP . . . : LCS ALTOS, CA 94022 TELEPHONE (E50) 948-1077 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ------- BTEMP FLAT RATE 1. 00 62 .10 0 . 00 62 .10 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 - --------- ---------- ---------- ---------- TOTAL PERMIT 207 .47 0 . 00 207.47 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 207 .47 MC --------------- TOTAL RECEIPT 207 .47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- ------ ----------- 103 UFER 304 ROUGH ELECTRICAL --�, CITY OF CUPERTINO TEMP POWER CUPEI�TINO PERMIT APPLICATION FORM CPN# Date: --7 � _ 0/,S! Building Address: zgu Owner's Name: Phone#: Contractor: Phone: License #: q s e e v-s 1A c 6 sb 9 qOZ ~ 0`77 - Contact: Phone: Cupertino Business License #: 6 TO - 0-7151 ? a� BuildingPermit Info: Elect 9J. Job Description: Residential Commercial ❑ Cost of Project: C4DG Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 . Telephone(408)777-3228 CITY Of Fax(408)777-3333 ''UPEkTINO Building Department JOB ADDRESS: PERMIT # q 6?0 F49401- OWNER'S N d a �' PHONE # GENERAL CONTRACTOR: ; FAX # &50--Y I am not using any subcontractors: 7�?�� '9.. " r 07 Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing 77::]�Floor�ing-. 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 r 07 Date Owner/Co tractor Signature