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07110084 CITY OF CUPERTINO ` ' ' BUILDING D1'v'ISION PERMIT _ ��.�t?�. �� ;, <: , ,..;:: .:::::.. :;: ,. . BUILDING ADDRESS: PERMIT NO. 10590 N TANTAU AVE TBD — �'0 BE DETERMINED 07110084 . ...�/NER'S NAME: PERM1T LSSUE Dp`TE MKD CUPERTINO PARTNERS LP � 11/15/2007 PHONE: SANITARY NO. CONTROL NO. ARCHII'ECT/ENGiNEER: BUILDING PERMiI' iNFO HLDG ELECT PLUMB MECH 0 0 0 0 u O p I,ICENSED CON7RACI�OR'S DECLARAT[ON V I hcrcby affirm �hat I am licensed unJcr provisions of Clupur 9(commcncing Job Description � z � wi�h SccUan 7U00) of Diviaion 3 of Ihc Busi�css and ProCcssio odo. �icense is Rivj�j NOl` l— O P 15 GAL WTR HTR & RE P LC W/ SAME NEW . RB ' a in full force and effect_ ��z ucenscC�us ��.�► MAINTEPIAN SERVICES INC . PD BSL 11 / 15 / �7 =^� Datc Conlractor� !' -f � F � A HITECI'S DECLAR N ��°� � [ undcrsunJ my plans shall bc used u puhlic recards iy < e. U L p y Liccnsed Pn�fessional y � OWNER-BUILDER DECIARATION ,� t� I hcrcby afGrm tha� I am excmpt from thc Convactors Liccnsc Law for thc y p O following rcason. (Scction 7031.5, Busincss and Profcssions Codc: Any cily or rnunty K° �i which �cquires a pertnil to conswct, altcr. improvc. dcmolish. or repuir any suucwm y Z� prior w i�s issuancc, alw rcquires U�c applicant for such pertnit to filc a signcd sial�mcnt _< that he is liccnscd pursuant to thc pmvisions of thc Conuactor's liccnsc Law (Chaptcr 9 Sq. Ft. Floor Area � 8 O O Valuation y F- $(commcncing wiU� Section 7000) of Division 3 of fhc Busincss and Profcssions Cadc) or y �.. that he ia eumpt thcretrom and the buis [or �e allegcd exemption. Any violation of Section 7031.5 by a�ry applicant for a pumit subjects ihe appiicant to a civil penalty of �p�j Number Oeeupaney Type not mom than five hundmd dollars (S5o0). 31 F)1 H O:� 5`.'� G ❑ I. u owner o[ tNe property. or my cmployces with wages u the'v sole compensadon, will do the work. and ihe stcucwee is not intended or offeced for sale (Sec. 7044. Businw Re uired Ins ections and Professio�s Code: The Contrxwr's Lianse Law docs not apply tn an awner of Q p property who builds or improvrs �hereon, and who does such worlc Aimaelf or ttuough his own employces, provided that such improvemrn�s ue not intended or ottued Cor sale. l[. however. �he building or impruvement is sold wi�hin one yar o[ completion, the owner- builder wiU have the burden o[ proving Ihat he did not build or improvc [or purpose af sale J. ❑ 1, as awner ot �he property, am uclwively conlracting wiW liansed rnnuacWrs w cons�mct the pcojea (Sec. 7044. Business aad Professions Code:) The Contracwr's Li- cenu Law docs not spply to an owner of property who builds ar improves We�eon, and , who contncta for such projecu with a rnnicutor(s) Iicenxd pursuant w the Controcar's 'cense L.aw. [ am uempt unda See. , B de P C tor this rcaton Owner Date WORKER'S COMPENSAT[ON DECLARA170N 1 hercby �rtn under penalty of perjury nne o[ �he follawing declaruions: ❑ t hsve and will mainuin a Certificate of Consent lo xlf-insure for Workcr's Compen- sation, u provided for by Secdan 3700 of tlu Labor Code, for �he performance of the work for which Wis pertnit is issued. ave and will muntain Workcr's Compenaauon Insunna, as mquired by Scction 700 oC the Labor Codc, fay�he peR'ormance o[ the woric for which �his permit is issued. ' My Worke�s e s ioa Insurancc carticr and Poliry numbor are: rk Cartier: �� Poliry No.: CE 77FICA'1'E OF EXEMP170N FROM WORKERS' COMPENSAT[ON 1NSURANCE • (1'hu scctian need not bc comple�cd if the permit is for anc hundred dotiara (f I00) or Icss.) • I cenify that in thc performancc of Idc woric fw which Ihis pertnit is issced, ! shall not nmploy any person in any manncr so u to bccomc wbject w the Workcrs' Compensation Laws of Cslifomia Dstc Applicant NOTICE TO APPLICAM: If, aflcr making ihis Ccrti�ca�e of F�ccmption, yau should become subject to thc Workcra Compcnsadon provisions o( �he Ls6or Codc, you muu � O farthwiW comply with such provisions or thu pecmi� shall bc dccmcd �cvokcd. z "" CONSTRUCI70NLENDING,4GENCY (- �-�+ 1 hcreby aRrm �hat thcre is a conswctinn Icnding ageM.y 1'or thc performanw uf p; � ihe work fur which this permit is iuued (Scc. 3097, Civ. CJ a A Lendcr's Namc • � z Lende{s Address () � I certifY ihat 1 havc tad this appliea�ion and smtc iAU tl�c a6ovc infom�ation is w►� cortcct 1 a6nx w comply with all city and counry oniinances and sute laws reladng w � U building consuuction, and hcreby suthorin Rpresentadvcs of U�is city w cntc� upon ihc � W ahovc-mcntioned propcny for inspeciion purposes (Wc) agrce to save, indemnify and kecp Iwmiless Ihe Cily of Cupertino against �� IiabiliUea,judgmcnts, costs and expenus which may in any way accruc against said City V z in consequence oC t�c gcanang oC �his permi� Date �"� APPLICANT UNDERSTANDS AND W1LL COMPLY WITH ALL ON-P Kr Issued by SOURCE REGU . �� ,' � � Re-roofs Signu f pplicant/Contractor Da�e HAZARDOUS MATERIA[.S DISCLOSURE Type of R oof �Il lhe appticant w futwc buildieg occupant storc or handlc harardous matcrial dcfincd by Ihe Cupertino Municipal Codc. Chapler 9.12, and the Hcalih and Safcry .:� Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed. ❑ Ycs w��u m� a� r futum building accupant usc equipmcnt or dcviccs which If a roof i� installed without first obtaining an inspection, I agree to remove emi� ha•rardous air conuminan�s as dcfincd hy the Bay Arca Air Quality Managcmcnt all new m aterials for inspection. �5��«� � ❑ Ycs 1 havc rcad ihe hvardous matcrials requimmcnLC unJcr Chap�cr 6.95 of �c Califorv nia Elcalih & Safcry Cadc, Sections 25505.25533 and 25534. I uncicrsund Uut iCthc building dacs not curtcn�y havc a ten 4�at it is my responsi6ility m noufy tlrc occu � of reyuiremcnls whicA ��; �u�� ore c�r� ora� •� Signature of Applicant Date Ow� aumari�c agcnt o„� All roof coverings to be Class ��B" or better CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 31618035.02 DATE ISSUED.......: 11/15/2007 RECEIPT #.........: B5000003247 REFERENCE ID # ...: 07110084 SITE ADDRESS .....: 10590 N TANTAU AVE SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............: MKD CUPERTINO PARTNERS LP ADDRESS ..........: 10590 N TANTAU AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: ROBERT M BURNS CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBD - TO BE DETERMINED ADDRESS ........... CITY/STATE/ZIP ...: , TELEPHONE ......... FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BSEISMICOM VALUATION 800.00 0.63 0.00 0.63 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 PCWHEATR UNITS 1.00 24.48 0.00 24.48 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 TR.AVDOC FLAT RATE 1.00 40.79 0.00 40.79 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 213.69 0.00 213.69 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 213.69 MC TOTAL RECEIPT : 213.69 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 518 WATER HEATER �� CITY OF �CUPERTINO � WATE�t HEATER CUPE�TI�JO PERMIT APPI�ICATION FORM APN # � � � � � � ` ` O � Date: /,� r � !J � � f Building Address: 10�� 1� �A,v�'A,r� Owner's Name: Phone #: �c�� l��tl�T� �f� - �7� s x� � Contractor: Phone #: �� Z � Gj �11 � ��/�b? I v�`�� /�/ l�c�' ,$�/Z Ui �� 5 � Fax #: �3 / �� S� g�l � Cupertino Business License #: Contractor ate License #: ��/ 90 Contact: /��.�.�.,, /� Phone #: � 3 ) 3 � � g .�"� l �� Fax #: Building Permit Info: Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: �� G � �� , �� /oN oP / � GA L GtJ� ��= r2 !9 ��r - r� � � . ' �� Residential ❑ Commercial -� Strapped ❑ On Platform ❑ Bonded C� New Location ❑ Replacement Valuation: ��b Qty. if Applicable Fee ID Fee Description Fee Group Permit T e PCWHEATR Commercial Water B PCWHEATR Heater/V ent BSEISMICOM Seismic Commercial B PRWHEATR Residential Water B pRWHEATR Heater/V ent BSEISMICRE Seismic Residentia B PPERMITFEE Plumbing Permit P TRAVDOC Travel & Documentation B � BUSLIC Business License B