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07100140 CIT�' OF CUPERTINO ` �^ ` y � ` ' ` BUILD[NG DIViS10N PERMIT ��"��`��* ,..:. .._ :... _.: ,:: PERMIT NO. BUIL g�� c � o � ES � : AKCREST CT A& A PI�UMBING 07100140 . PERMIT LSSUE DATE dER'S NAME: SHABEL JACK AND JENNIE 924 E FI:EMONT AVE 10/18/2007 SANITARY NO. CONTROL NO. PHONE: (408)73f3-8878 BUIC,DtNG PERMITINFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH c� o 0 0 i p p LICENSED CON7RACTOR'S DECLARATION JOb D6SCTiptlOT1 � V� I hcrcby af[itm that I am licensed undcr provisions aC Chaptcr 9(commcncing : Z� wi�h Sccdon 7000) of Divi�ion 3 o(ihc Busincsa and Profcssiuns Codc and my liccnsc is FURNAC E RE PLAC EMENT �� y in full Corec and effecy , j v� Z Licensc Class Lic. k �/ j Z � Datc Contrannr � .�,... ,..s : � � ARCHR'ECI'S DECLARATION ;� .a U I undcrswnd my plans shall bc uud as public rccords ,a ' u. F' Liccnud Profcssional � y � OWNER-BUILDER DECLARATION [ hcrcAy �lTirm th�i I am excmpi Crom �hc Contractor's Liccnsc Law for tt�c � p O [ollowing rcason. (Scction 7031.5, Business and Profacsions Calc: Any city or couniy �°, � which rcquires a pcmiit to conswct, altcr. improvc, dcmolish, or repair any swcmrc ° Z y prior w i�s issuance, also requircs ihe applicant for such permit w file a signed statement Valuation � z o that hc is liccnxd pursuant to thc provisions o[ thc Conuactur's Liccnsc Law (Chaptcr 9 Sq. Ft. Floor Area $ 3 5 0 0 Y t- (cammencing wi�h Section 7000) of Division 3 of �he Business and Professions Codc) or i�� ihat he is exempt thcrcfrom and ihe basis Cor the allcgcd exemption. Any violation ot Section 703I.5 by arty applicant for a pecmit subjects ihe applicant to a civil penalty of 3 4 2 4 8 0 0;? .� Number Oeeupaney Type not more than fivc hundred dollars (5500)• ❑ I, at owncr of ttie property. or my employces witt� wages az their wlc compensadon, will do �he wodc, and ihe suuaur is not intendcd or aftered for sale (Sec.7044, Business Required Inspeetions and Professions Cadc: The Contrdcwr's License Law does not aQply to an owner of propeny wha 6uilds or improves thercon, and who does sucA work himulf or thcough his own employccs, providcd that such improvemenls are not intended ar otrereA for sale. If, however, the building or improvemen� is sold within one year oC compleGon, Ihe owner- builder will have the burden of proving �hat hc did not build ar improvc (or purpose of sa1cJ. ❑ I, as owner of �he property, am ezclusively conuacting wiW Iimnsed convactors a construct �he project (Sec. 7044. Business and Profcssions Code:)'Rie Contnctors Li• cense Caw dacs not apply to an owncr of propeny wha builds or improves thneon, and . who conuacu for such projects with a contncwr(s) licensed pursuan[ to the Convactor's License Law. ❑ I am ezempt under Sec. . B& P C for this rcason ier Date _ . _ WORKER'S COMPENSATiON DECLARA170N I hcrcby �rm under penalry of perjury onc o( the foltowing declaradons: � 1 hsve and will mainuin a CeniGcate of Conscm to sclf-insure for Workcr's Compen- sation, u provided for by Secuon 3700 of the Labor Code. (or �he performance ot the woric [or which ihis pertnit is issued. - ' �.I havc and will maintain Worker's Compensation Insunnce, as rcyuircd by Scction JO of thc Labar Codc, Cor thc perfortnance af the work for which this pem�ic is issued. ..�y Worker's Compensation Insurancc carricr and Policy number a�c: Carrier. � k�+� Poi�eywo.:,I�"'t SOL g 8y CERTIF[CATE OF EXEMPIiON FROM WORKERS COMPENSATIONINSURANCE ([his secUon nced not bc complcted if the pccmit is foranc hundred dollars (5100) or Icss.} I cenify thxt in thc perfortnancc af thc work for which �his pertnit is issucd, I shall not employ any person in any manncr so az to bccomc subject io ihe Workcrs' CompcnsaGon Laws of Cali(omia. Datc Applicant NOTICE TO APPLICAM: It, af�cr makin� �his Ccrti�cate of Exemption, you should become subject to the Worker's Compensation provisions of the La6or Cc�de, you must � O farthwith comply with such provisions or this permi� shall bc dcemcd awokcd. z ""' CONSfRUCf10N LENDING AGENCY (.�-i �-�. I hcrehy a(tirtn Wat thcre is a conswctinn Icnding agcncy Cor the perfurmancc uf _ p�,. � ihc wurk fur which this permit is issucd (Scc. 3097, Civ. CJ W� A L.endcr's Namc � L.cnder's Address V � � ceni(Y �ha� 1 havc rcad this application and staic that Uic above infortnatiun is w � cortect. 1 agree to comply with all city and county ordinances and state laws relating w O U building conswction, and heteby authori�e reprcsentatives of Nis city to enter u�n �he � w abovc-mcntioncd property (oc inspccuon purposes. a (Wc) agme to save, indcmni(y and kecp harmless Uie City af Cupertino against „�', � liabilitia, judgmcnts, costs and expcnscs which may in any way acccuc against said City V z in consequcncc ot Ihc gnnting o( Ihis pertniL Date �� ►�+ APPLICANT UND ND WILL COMPLY WITH ALL NON-POINT Issued by . /J /��'� SOURCE R ONS. � E �� 7 Re-roofs /'.�� Signatum of A ontractor �a� T of R oof HAZARDOUS MATERIALS DISCLOSURE }�� ill ihe applicant or futurc b�ilding occupant storc or handlc harardous ma�crial defincd by the Cupenino Municipal Codc. Chap�c 9.12. �nd thc Heal�h and Safety ��. Scction 25532(a)? All roofs shall be inspeeted prior to any roofing material being installed. p vcs �6to _ �11 thc applicant or Cuture building occupant usc cyuipmcnt or dcvices which If a roof is installed without first obtaining an inspection, I agree to remove cmit harardous air conwminants as dcfincd by the Bay Arca Air Quality Managcmcnt all new rr aterials for inspecxion. �s�«� DYcs �Nu 1 havc rcad the ha�ardcws maicrials requiremcn�t umicr Chap�cr6.95 a(�hc Califor- i HcaIU� & Safcty Cadc, Sccuons 25505. 25533 and 25534. ( undcrsund U�at it Nc building .�ocs not cwrently havc a tcnant,,_�hat-itis "m' y resp�e sibility to notify thc occupant of thc rcyuiccmcn�swhich �-be"metpriort ' [ e.�,;rka�ara��r. g�gnature ofApplicant Date '�%� �� All roof coverings to be Class "B" or better Ow�cr or authorizcd agcnt �� a , . CITY OF C'UPERTINO � � �� , ,'` ��JJ�.I��`�/�.� `UPE�,TINO PERMIT APPL�[CATION FORM APN # Date: �yay- g-�,�ahov ��./� �� uilding Address: Z� �22 C�G- �%� ��-� c� Owner's Name: Phone #: � Jw�� /� -- G so S�3"- zyy y �;ontractor: � Phone: I.icense �: , � 7 � .� B�3 � � 36/� �i 3Z Cont t: � Phone: Cupertino Business License #: , " , %�' 3�3 —�"�� ca?��- ( Building Permit Info: Bldg ❑ Elect �—�"r� F'lumb �� Mech � Job Description: �, � �la.c G /GG"'�''r"�� Residential � Commercial ❑ For Residential Installations: Attic � 1 St floor � 2 flOOI' � Adhere to min set back requirement❑ or Commercial Installations: Replacement same weight ❑ Additional weight (st-uctural calcs) � Structural Calculations required for new installation �� New installation Planning Approval Required ❑ 'ost of Project: Type of Construction: Occu c oup: .� �� -- � � Strapped ❑ On Platform � Bonded ❑ Sq.Ft. Floor Area: New Location � Replacement � Qty. if Ap licable Fee ID Fee Description Fee Group � BENERGY E�iergy BUILDING BREMFURN Furnace MECHANICAL BREMACOVER A'C Unit > 10,000 cfin MECHANICAL g�Mp,�� A'C Units <= 10, 000 cfin MECHANICAL BREMRECEPT R�cptl, Switch & Outlets ELECTRICAL BSEISMICRE S�;ismic Fee Res BUILDING BSEISMICOM S�;ismic Commercial BUILIDNG / EPERMITFEE E ec Permit Issuarice ELECTRICAL � MPERMITFEE M ech Permit Issuance MECHANICAL PPERMTTFEE Plumbing Permit Issue PLUMBING BPERMFEE B dg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING CITY OF CUPERTINO 6 ITEMS OF 6 PERMI�.' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B11:: Lot: APN ......... 34:?48002.00 DATE ISSUED.......: 10,'18/2007 RECEIPT #.........: BS�)00003027 REFERENCE ID # ...: 07:_00140 SITE ADDRESS .....: 22�i22 OAKCREST CT SUBDIVISION ....... CITY .............. CU:?ERTINO IMPACT AREA ....... OWNER ............: SH;�BEL JACK AND JENNIE ADDRESS .......... 22�i22 OAKCREST CT CITY/STATE/ZIP ...: CU:?ERTINO CA, CA 95014-0830 RECEIVED FROM ....: A<t A PLUMBING CONTRACTOR .......: MI]�E FOX LIC # 25401 COMPANY ........... A �t A PLUMBING ADDRESS ..........: 92�� E FREMONT AVE CITY/STATE/ZIP ...: SIT]JNYVALE, CA 94087 � TELEPHONE ........: (4�)8)738-8878 FEE ID UNIT QUANTITY .�MOUNT 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 EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 172.04 0.00 172.04 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 172.04 #5433 --------------- TOTAL RECEIPT : 172.04 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL