07080213 CITE'OF CUPERTINO
BUILDING DIVISION PERMIT � R
PERMIT NO.
BUILDING ADDRESS:
1132 HUNTERSTON PL MIKE COUNCIL PLUMBING INC 07080213
OWNER'S NAME: PERMIT ISSUE DATE
ZALUSKY ROBERT L AND 1915 O'TOOLE WAY 08Z24/2007
t"r;Tr1TTVT TAT'A SANITARY NO. CONTROL NO.
(408) 272-4900
BUILDING PERMIT INFO
ARCHITECTIENGINEER:
BLDG ELECT PLUMB MECH
0 0 0
p o LICENSED CONTRACTOR'S DECLARATION Job DOSCTIptIOn
m 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 INSTALL TANKLE S S WATER HEATER
<o in full force and effect
v=Ni i License Class Lic•
t- Date Contractor t�Q
RCHITEC•I'S DECLARA I N
a< I understand my plans shall be used as public records
yU
U.�- Licensed Professional
a OWNER-BUILDER DECLARATION
1 a 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
$ which requires a permit to concoct,alter,improve,demolish,or repair any suudure
rm
N prior to its issuance,also requires the applicant for such permit to file a signed statement
z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $1500
? 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 �N Number Occupancy Type
not more than five hundred dollars(5500). 36222027 U
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 oroffered 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 be did not build or improve for purpose of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractor to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cause Law docs not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to die 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:
L]I have and will maintain a Certificate of Consent to self-insure for Workers 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 Workkeeess Compensation Insurance carrier and Policy number are:
Carrier. F,je-A .ns,t/1hnr�. �o� filo.: C
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:U,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked
z CONSTRUCTION LENDING AGENCY
(-+.�. I hereby affirm that there is a construction lending agency for the performance of
fx> the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Name
z Lenders Address
U� I certify that I have read this application and state that the above information is
Lt. a correct.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
U above-mentioned property for inspection purposes.
y a (We)agree to save,indemnify and keep harmless the City of Cupertino against
r•r 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 Z[/
APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued b' l
SOURCE REGULATIONS. / ��y
Re-roofs
Signit#e of Applicant/Contractor 7Date
HAZARDOUS MA ALS DISCLOSURE Type of 1 ZOof
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
Cote,Section 25532(x)? All roof: shall be inspected prior to any roofing material being installed.
0 Yes
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?
0Yes fo
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 d 25534.1 understand that if the building
does not currently have a tenant,that it is in r sponsibility to omify the occupant of the
requirement_%which must be tprior i u co(aCertificate oftxcu Signatur-,of Applicant Date
-- All roof coverings to be Class"B"or better
Own r or authorized agent
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: CathyS
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 36222027 . 00
DATE ISSUED. . . . . . . : 08/24/2007
RECEIPT #. . . . . . . . . . B8000002465
REFERENCE ID # . . . : 07080213
SITE ADDRESS . . . . . : 1132 HUNTERSTON PL
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ZALUSKY ROBERT L AND MICHELINA
ADDRESS . . . . . . . . . . : 1132 HUNTERSTON PLACE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5069
RECEIVED FROM . . . . : RCBERT ZALUSKY
CONTRACTOR . . . . . . . : MIKE COUNCIL LIC # 23033
COMPANY . . . . . . . . . . : MIKE COUNCIL PLUMBING INC
ADDRESS . . . . . . . . . . : 1915 O'TOOLE WAY
CITY/STATE/ZIP . . . : SAN JOSE, CA 95131
TELEPHONE . . . . . . . . : (408) 272-4900
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 40.79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 86.44 0. 00 86 .44 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 86 .44 17794
---------------
TOTAL RECEIPT 86.44
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
CITY OF CUPERTINO
WATER HEATER
CITY OF
CUPERTINO PERMIT APP]-JICATION FORM
APN# � � �� Date:
Z Z� Gc� 11
Building Address:
�dCiq—1
Owner's Name: Phone k
Contractor: Phone: License#:
.� r y
Contact: hone: Cupertino �s* ee#:
ss is ns
et.
!�7 z .
Building Pe t Info:
Bldg ❑ Elect 0� � Plumb Mech
Job Description:
.-// SC
Residential Commercial El
Cost of Project:
Strapped On Platform ❑ Bonded
i New Location Replacement ❑
i
Qty.. f
A 1icaf Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING