06060008 I
CITY OF CUPERTINO ��,�T �a=a;r�pa. M E's'ry` "^
BLRLDING DIVISION PERMIT t, O7rRAG'Y'Ox
�:i,� ...�.r<.,��e•�,.t tuna i�.�,tir. �s� o- L �«r.
BUILDING ADDRESS: ' JUAN MADUENO PERMITNO.06060008
18631 CYNTHIA AVE
OWNER'S NAME: PERMIT ISSUE DATE
A
Milk
JUAN MADUENO 2006
E: _ SAN fARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
O
o0 LICENSED CONTRACT'OR'S DECLARATION Job Description
hereby aRirm that I am licensed under provision,of chapter 9(commencing
with Section 70rAR of Division 3 of Jia Busmcanamd Profusion,Code.and my license is ��1
in full tome elWeffecl. TEMPORARY POWI
Z Lmen,e Class Lic.N /
QFg p
Date ARCHI'IECrS DECLARATION
i E V 1 understand my Plans shall be used as public record,
oLicensed Professional JUN ZZ 1006
,s,5 OWNER-BUILDER DECLARATION
<2 1 hereby a1Brm Na,I am escmpl from the Conuenors License Law for the
0 o following mason.(Section 7031.5.Business and Profusion,Code:Any city or mumty
319 which empoms,permit to conennc4 shut.Improve,demolish.or mpair any geumu s $100
prier to its issuance.also requires the applicam forsuch permitlo Bic&signed smumus,
Cthat he is licensedpurmentmce
teprovisionsoftheCommuneslinselaw(Clupter9 Sq.Ft. Floor Area Valuation
i (commencing with Section 7000)of Division 3 of the Business and Pmfessiau Code)or
8 that he Is exempt dnerefrmn and tie basis for the alleged exemption.Any violation of
Section 7031.5 by ury applicant for a permit abjew the Applicant to a civil penalty of r Occupancy Type
mat more than Rw hundred dolhn(5500).
❑1,u owner of the property,a my employees with wagon as fair gets campensader.
will do the work.and the,uumum Isnot invaded or offered far me(Sec.7044,Business Required Inspections
and Profealons Code:Tho Contractors License Law does rot apply m e an owner of q P
property who builds or im proves themon,and who does such workhemac r er through his
own employees,provided dhae such improvements tae notintanded aroRered Image.It.
however,Na building or Imp novamat is gold within one year ofcumplelon,the owmr-
bullder wIR have the burden of proving that he did m,bald or Improve for purpose of -
ale.).
.a owner of the property,am eaclusively cnnuaNng with licensed conuaeon to
mwct the projeel(Sec.7044,Business and professions Cade:)The Coouaemr,U.
sense law does no,apply m an owner of property who build,or improms Merron,and.
who contracts for such projects,with a mnuanort,)licensed pureuen,as Me Connors '
License law.
❑lam exempt merseaB&P/C,{or 44is maso/9,^
Owner Due v I c `�
RKER' OMPENSATION DECLARATION
40 I thereby affirm under penalty of perjury on,of Js,fallowing declarWmc
I basis and will Maintain•CaNRamafCo�ntto set(-Ware fm Workers ComPen-
radon•u provided for by Section 3700 of the laher Cade.for The performance of the
work for which this permit is issued.
❑1 have and will maintain Worker,Compen,aion Insurance,as required by Section
3700 of Re labor Code.for the performance of the were for which Nu permit 1,Issued.
My Workers Compen,ed.In,unna carrier and Policy number tic:
Cartier. Polley No.:
CERTIFICATE OF EXEMFnON FROM WORKERS'
COMPENSATION INSURANCE
C7hu seed.need solos competed Rthe permit is fmonehuMred dollars($100)
or leu)
I certify that In the performance of the work fm which this permit is tsmnd,I shall m,
employ any person J.any summer"se lar pest to Me Warkus'CaapensW.
Law,of Callf.N Due G C�
ADPlicanl
NOTICECANT:1, n ss nnRcsm of Exemption•you sh.ld
Oeeame u m dm Worker,Compensation provialon,of the Labor Cade,you most
.JO forthwith comply with such provisions or this Permit NW be domed mclud.
ti► CONSTRUCTION LENDING AGENCY
1herehyaffi.
(•" Jut Nem is a contuuctions landing agency for tie Performance of
a> the week for which this permit is issued(Sec.3097,Cm.e.)
W�Ca Landers Name
z Lenders Address
U 1 certify that I ban mad this Implication and sum the the above information is
LL F coned 1 agree to comply with all city and county ordinances and sum laws relating to
O U building construction,and hemby authoim representatives of Nis city m enter upon the
�a &hove-mentioned propcny formspecucm pugnaser.
p� (We)agree In ave,indemnify and keep harmlm the City of Cupertino against
Fa Vl Ihbilidesjudgmenu.eoms and eapeae,which may in anyway Aceonegalml Wd City
U,'Z in consequence of the trending of this Permit.
r APPLICA UNDERSTAND$AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU ONE,
� L r O L Re-roofs
siN pp laMcesuan. Dam
r
HAZARDOUS MATERIALS DISCLOSURE Type of Roof.
MR de applicant or future building oceupammune or handle baardou materiel
as delhed by the Cupertino MuMejpdrogue.Chapter 9.12.and Js,Health and Safety
o
Code.sden 25532(s)?
❑Yu All roofs shall be inspected prior to any roofing material being installed.
40 Na
Will the applicant m Iron,be IM meupam use equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove
.mit haardnns alt cen=I...ss d by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yee No
I have mad the haaardnur materials requiremenss underChapur6.95 of tie Califer•
nialmalthk alely Code,Schon,25505.25533.425534.I undera"Matifthe building
Jam rot cu mly bow a tartan,.that h is my nesposoMility m muly the eceupantp(the
mquimm, which mum be melpriormIssuance of,Certykamor cmp.4. Signature of Applicant Date
/1— (//JJ.. 1(!-0 FVC
Ow onuthonard agent Dam - All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPEf�TINO
Building Department
JOB ADDRESSIg /7 I � ;� LY,C tT(014 PERM
�6o6?
OWNER'S NAME:// (' V et H p PHONE #
GENERAL CONTRACTOR: u, FAX # OS-�' 4(
I am not using any subcontractors: C_� —a G
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cab' &Millwork
ement Finishing
Electrical
Excavation
Fencing
Flooring: 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
l_o
rContractor Signature Date
CITY OF CUPERTINO
Om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37523002 . 00
DATE ISSUED. . . . . . . : 06/01/2006
RECEIPT # . . . . . . . . . : 34649
REFERENCE ID # . . . : 06060008
SITE ADDRESS . . . . . : 18631 CYNTHIA AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JUAN MADUENO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JUAN MADUENO
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : JUAN MADUENO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BTEMP FLAT RATE 1 . 00 . .62 . 10 0 . 00 62 . 10 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
-
-- ------- ---------- ---------- ----------
TOTAL PERMIT 100 .47 0 . 00 100 .47 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 100 .47 NOVUS
TOTAL RECEIPT 100 .47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
•
CITE' OF CUPERTINO O( &OV
f.'EIVIP POWER
CITY OF
OUPEkT►NO PERMIT APPLICATION FORM
APN# 2,
3` �n Date: 1
Building Address: L q l
g .�I � W �rG t/•e• f .hd �.
Owner's Name: Phone#:
Contractor: Phone: License#:
Contact: /i Phone: l r Cupertino Business License#:
Building Permit Info:
Elect
Job Description:
Tew", Y 4Vk-- vne,':r\
Residential Commercial ❑
Cost of Project: I too. D6
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Is$uance ELECTRICAL
BUSLIC Business License BUILDING