04090260 CITY OF CUPERTINO `'
BUILDING DIVISION PER
'Cf)NTRACTRfiTNFOI.tMON ^
BUILDING ADDRESS: PERMITNO
04090260
OWNER'S NAME: PERMIT MEE DATE
JEAN LIVING
NE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEGs
;Oo LICENSED CONTRACTOR'SDECLARATION �1{ y�
iUZ F I hereby affirm that 1 am licensed under provisions of Chapmr 9(commencing tGryt yl'tl`.'�1j•'yI\f
?¢w full
andcfof0ivision3of the Businc and Profrssina Code.and my licenm is
in roll forte and effaL t
License Class Lie.If 8 FENCE
Dam TDECL C� 2005
ARCHITECTS DECLARATION Uri
� I undcrsund my plans shall W used u public records
D
30� Liccnmdpmfcssi.nal B��� 'p art
` 3 OWNER-BUILDER DECLARATION �W4a®tag
<f I M1cmby aTrm Net 1 am cmmpt from the Contractor's License Law for the
0 o following moron.(Section]1131.5,Businessand Professions Cole:Any city Or county
S..
m which mouires a Permit to construct,almr,improve,demol6h,or repair any atmctum :.
prior mita vereamc.also requires the applicant for such permit to file a signed stamment
that he is licensed Putman,to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section]BOB)of Division 3 of the B usiness and Professions Code)or
i that he is emmpt thcmfrom and the basis for de alleged caemplioo.Any violation of
Section 1031.5 by any applicant for a permit subjects the applicant o a civil penalty of 37ifflyAkNub ter90 Occupancy Type
not more tom fire hundred dollars(5500).
❑hazowner of We property.or my employees with wgautMir sole compcnation,
will do the work and the structurt is not intended or offered forsale(Sec.7W,Busireas Required Inspections
and professions ie Cade:TContractors License taw dors not apply m e an owner of q P
pmPaoy who Wilda mimpmens thereon,and who dnesauch work hireseuorthmogh his
oven employees,provided oat such improvements are nmimended or offered fora]..If.
how ver,the Wilding or improvement is mid within one year of completion.the owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
X1.u owner of the yropeny,mo ezclusimly c0nuaming with licensed eontracrers to
co wet the project(Sec.7044,Business and Profeaions Code:)The Con o toi s Li. _
cc se law does not apply to an owner of property who Wilds or impfosv thereon,and.
who contracts for such proji with a ennlraclor(s)licensed pursuant to the Contractor's
Liceme Law.
El xionp,under Sec. .B h P clurch,sm i
ve
DateIV
/ WORKER'S COMPENSATI DECLARATION 7
hereby affum under Noah,of perjury one of Ne following declarations:
1 have and will maintain aCenifrau of Consent to alf-marve for Worker's Comycm
.tion,u provided for by Section 3100 of the Labor Code,for the performance of the
work for which this Permit is Wood.
1 have and will maintain Worker's Compensation Insurance,as required by Section
3100 of the laWr Code.for the performance of the work for which this permit is issued. '
My Worker's Compensation Insurance artier and Policy number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need net he completed If the permit is forone hundred dollar($I00)
or less.)
1 certify that in the performance of the work for which this permit is issued,I shot 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 C.OIGcxm of Exemption,you should
become subject to the Worker a Compensation provisions of Ne labor Code,you must
.JO forthwith comply with such provisions or this pormit shallW deemed revoked.
y00 CONSTRUCTION LENDING AGENCY
[—r Ihcmhy M.that them is a construction lendingagency(Or the perfurmmce of
!Yi the work for which Nis permit is issued(Sce.3091,Civ.C.)
B]Q Lemno's Name
Z)Z Lender's Add= -
U 0 1 certify that I have read this application and more that Ne above information is
IL Pcarted 1 agree to comply with all city and county.Ninan.es and sure laws relating to
C)U building construction.and hereby authorise reprechruidva of this city to enter upon the
Cabove-mentioned properly for inspection purposes.
(We)acme to save.indemnify and keep harmless the City of Cupenino against
HfA liabilities,judgments.costs and expenses which may in try way accrue against mid City
U in conseptimme of the granting of Ibis airmit.
'—' APPLICANT UNDERSTAN AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
OU REGULATIONS i r- ,�
S'7O Re-roofs
X c f ApplilmUCrmr.r ate
HAZARDOUS MATER( IS DISCLOSURE Type of Roof
il .nt
HI
the applinnl Or future building occupant smm or handle ha ardous material
as defined by the Cupertino Municipal Code.Cls p¢r 9.11,and the Health and Safety
Code.Scp` eszss3z(,)y }��/)0 All roofs shall be inspected prior to any roofing material being installed.
Win fire applicant
or f I H building Occupant use equipment or Jevity which If a roof is installed without first obtaining an inspection,I agree to remove
.nit harardnus air contaminants defined by the Bay Area Air Qnsth,Maagcment all new materials for inspection.
District?
0 yes u
1 have mail the hvzNrxsmarerials requirements under Chapter 6.95of the Califor.
in.Health h SafetyCove.Sceume )5.23533 and 255S4.Iundemmnd over if Ne-Wilding
d nal CYrenlI haw a IC nL Nath Is my Rs'n,ijblllty m runty de,..'ant Of W i
il
nu wnmhm 1 atpd.r uTi Cerdfiam.f pane Signature of Applicant Date
37 d All roof coverings to be Class "B"or better
Ow eruf authomcd agent Date
® � I' ED
SEP 2 7 2004
BY:---
WE
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OMED
MACaMNE' IHEtC , 00
fik znd qm fcations OUR
tv an ft 10 at all times and it is udq
iawfat to mft arq changes or, alterations
I" game wemat written permissionfm
!ha WOMB Dep. city of Cupertino.
Tho atmmpft of tM otan and spaeirrcoftM
;;HALL Mt ft M tm permit ot,to Aa Va
rpprivrai 0 ft of any PWMM
a anv t�Tv 0 drnirnt�2Yr lata Uvr.
V,01- F
INC. c% Proposal and Contract�.�����rF�0 4 6 4 3 5
1133 N.10th Street-Sen Jose,CA 95112 (408)995-3397 Sante Clare County
SE(51Q)179 Alameda County
pAamber Bonar RuclrosT Buraeu
Contractors LIC.0606051 (650)369.29110 Silo Mateo County
VISA I MC ACCEPTED BY: FAX(408)9WS296
PROPOSAL UDMDTED TO NOME PHONE -- PVTF�
�O
ADDRESS WORM PIgNE wvo E a
CITY,STA .MN ZIP CODE FAM. REFERENCE
JOBADDRESBDI aT) / CELL PHONE MAP LOOADON
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CITY,STATE.and ZIP CODE PADER0 TENANT PHONE
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Nar6:T41G PROPOBAL a/M/YaE Wl��/p�gA_L�N BT US IF NOTACCEPTED"THIN� MYS. q Er` • � I I Lir
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/O.0✓ DDUARs III �� 1 9 LUI
E' MATDR IAUT IZED SIGNATURE
TEAROUT AND mst Cast � 2 F
RUM mm M
NAULAWAY INCLUDED TR m
POM SET Nl CONCRETE 0A14,'4d g � ❑ O ' ❑ 7 � 7
RADS 6D3MW;r1 "P,:.( 7' ❑ ❑ r ,a•
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RETAINER
Dolm NOT m(W - EtdOYAL., ..j+._�„ '-' :,.I '.. • .
PSO Is 611 ® undsrgroundplpea. IIT, , ,.TC)TAL; .: 1/2 SHARE
; :#"p,r".
�:_ .23 ig.
' W O
PAYD9EPITT1cRTa3:PRymbnt in full i6 dueupon,t omplltlbri:tntirost shilaeru
l Ce Immte 80DWY at a raft of 1%per month
Dndfa'a$�51Bta panalq foo aa.overdue BCcount, INt' IfAgtteet @tTOOitltlft will be submllled to a Collection agency,InaufflCbnt .
fuie�lE¢Ataned;Ctloda fee!e f26.
Seercwer9'��bi� '+�aaWorraltarms.
DATEYb1e TO COMMENCEsW Date
13EODIIAPtETED SDate
Data
® 9/20/04
To the City of Cupertino Building Dept:
I do not object to my neighbors and I building an 8 foot fence do to the fact that some of
our properties are one to two feet higher than another. This will give us all at least the
normal 7�ft fence.
Signed\ c QU-.ERECEIVED
� SEP 2 7 2004
Address: iB—Y J
1 v �
Phone: �'�=� J � S-S - �� �
FEE COR
r
9/20/04
To the City of Cupertino Building Dept:
I do not object to my neighbors and I building an S foot fence do to the fact that some of
our properties are one to two feet higher than another. This will give us all at least the
normal 7 ft fence.
Signed [BY:
CE' I'VED
P 2 7 2004
Address: °/���� �C —(//'�
�— --
Phone: P _QY/
rM
e
9/20/04
To the City of Cupertino Building Dept:
I do not object to my neighbors and I building an 8 foot fence do to the fact that some of
our properties are one to two feet higher than another. This will give us all at least the
normal 7 ft fence. /1�r
Signed
Address:
4 SEP 2 7 2004
cl=
Phone: o?S�2 — 0
•
9/20/04
To the City of Cupertino Building Dept:
I do not object to my neighbors and I building an 8 foot fence do to the fact that some of
our properties are one to two feet higher than another. This will give us all at least the
normal 7 ft fence.
Signed - _n
Address: �b �� �Y S �r
CU2e-rl I, il 07� SEP 2 7 2004
BY:
Phone: _--__
s
am�-,(MoiCITY OF CUPERTIN�
CUP TYOF O PERMIT APPLICATION FORM o
APN # 1 3 0 ( 1 6 Date: /
Building Address: Mailing Address (if differe t from building address):
Owner's Nam Phone #:
(_ D I v / ti Cr- C) �
Contractor: ! i1 .� License #:
Contact: Phone: Cupertino Business License#:
Fax:
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential ❑ � 9�ercial ❑
Sq.Ft. Floor Ar $/Sq.Ft.:
C
Cost of Project: J Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
Pro•ect Size: Standard ❑ Laze ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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