050801610 C
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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
COMT AXit, DRiINFORMATION"s
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BUILDING ADDRESS:
RPD ELECTRICAL SERVICE CO
PERMITN0ID 5080161
OWNER'S NAME:
PERMIT LSSUE DATE
ST. JOSEPH CHURCH
242 HILLSDA
08/19/2005
DNE:
SANITARY NO. CONTROL N0.
(408)867-0658
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 E 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Descri [Ion
1 h neby affirm that l am licensed under pmvisions of Chapter 9 (commencing
p
with Section 7ty(ID) of Division 3 of the Business and Professions Code, and my license is
in full furan and effect
TEMP POWER (FOR FESTIVAL)
License Class Lie.0
DateCunuacmr
DECLARATION
ARCHITECTS DECLARATION
T� P�
1 underuanJ my plans shall be used upublic
res)yC•V''1, S
FB'1' NA,rhD
Licen¢d Pmfeasional
OWNER -BUILDER DECLARATION
I hereby of im Not I am exempt fmm dM Conuactor's I-mense, law for the
following mu mn. (Section 7031.5, Business and Professions Code: Any city or county
t7 20M
which requires a Permit to construct, alter, ImpTve, dranorish. or repair any sWCW2
100
pilon ul its issuance, also lequima TIM applicant for such permit in rite a signed inurement
hal he is licensed pursuant in he previsions of the Contmetar's License law (Chaper 9
Sq. Ft. Floor Area
l
rJ
�b r Valuation
(commencingwith Section 7") of Division 3ofthe Businessand ProfessionsCode u
Aa
� R
) 1'
Nal he u exempt therefrom and the basis for the alleged exemption. Any violation of
Y
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u 1 ) (i l eman
IAffix
`Oceupan`cy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of
.or name than five hundred dollars (1650%et'
I, as owner of the property, or my employees with wages as their role compensation,
Required Inspections
will do Ne work, and the swcmrt is not intended or offered for ask (Sec. 7044, Business
and Profession. Code: The Cmnuacm/s License law does Mt apply m an owner of
property who builds or improves dome. and who does such work himself or through his
own employees, provided Nat such improvements are not inlelMrA interfered forsale. If,
however, the building or improvement is sold within one year of completion. Ne owner -
builder will have the burden of proving that he did not build or improve for puryom of
ofleI
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Coda:) Thc Conummuns Li-
mose law docs not apply to an owner of property who builds or imp vmas theremn, and
who contracts for such projects with a eonuactor(s) licensed pursuant o de Conumort's
- .-
Li ase law.
I am exempt under Sec. B h P C for this reason_
--
Owner - Date
-' - -"
WORKER'S COMPENSATION DECLARATION-
1 hereby anon under Pemlty of perjury one of the following declarations:
I have and will maintain a Cenificate of Consent to self -insure for Workei s C'ompen-
gmion, as provided for by Section 37W of Ne labor Code, for the performance of the
:.._ ... -
workforwhichNisPermitisissued.
❑ 1 have and will maintain Worker's Compensation Insu mm, as required by Section
37011 of the labor Codc. for the performance of the work for which this pemlit is issued.
My WokV CnmPensatim Insurance carrier and Policy number am:
Carrier: f_✓ ' -a--' Policy No.:
CE F�RIICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
,
This se h. need not uncompleted Hthe Permit is forms. hundred dollars ($10(1)
Ili less.)
I ecroN that in the performarm of Ne work for which this permit u issued, 1 shall or
employ any Nixon in any manner in az to bccWn. subjec)Ipthe Washers Compensation
a''�N+-'d. 99a 0..7
Laws mf CalicoJn'a.Daw
-
NOTICE TO APPLICANT: IL after making this Cenifcale of Exemption, you should
beceme subject to the Worker's Compensation pmvisions of the Taut Cook, you must
forthwith comply with such provisions or this Petmit shall be deemed rovoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that There is a eommu,don lending agency for the Performance of
the work for which his peonit is issued (Sec. 3(197, Ci, C.)
Lender's Name
Under's Address
1 certify that 1 have read this application and sale Nat the above information is
correct. I agree to comply with all city and county ordinances and rule laws relating to
building construction, and hereby authorim representatives of this city to enter upon he
alcove -mentioned property for impection purposes
(We) agree m save, indemnify and keep harmless W City of Cupertino against
limilitiu,judgmens, casts and expenses which may in any way acerin, against said City
in c of the r
APPLICANT UNDER
STANDS AND ND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
5 EREG�UL�T'PIN�
L• ml(_
Re -roofs
Type of Roof
Signa um of Applicanl/Cmnuacmr Date'
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous maarial
az defined by the Cupenino Municipal Code, Chapter 9.12, and the Health and Safety
Codc. OYoonn 25532(a)?
All roofs shall be inspected to any roofing material being installed.
�No
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Wru the applicant or future building occupant use equipment ordevicm which
it harardnas air contaminants as &flood by Bac Bay Arta Air Quality Management
all new materials for inspection.
Istria?
O Yea XNu
1 have mad the mi abnus ma crialsrequircmcns under Chi pter6.95 of the Califor-
nia Health S SafetyCode. Secuum 255()5.25533 and 15534.1 undersand thmifdte building
docs not cuocnlly have d larrom. that it u my responsibility m notify the ne.imenl or lac
ri entswhich mug W mprim tuissuance ofaCcrdOexleofQcuPany.
Signature of Applicant Date
eh �4 A5 �9'tS
All roof coverings to be Class "B" or better
Owner
.da e.('
or aulhomcd age.( Dale
ItCITY OF
UPEkTINO
0
[.1
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
2,0'a 0. —0& -
PERMIT #
OWNER'S
OWNER'S NAME: Vne&(m
PHONE # 14Q,
GENERAL CONTRACTOR: Le-�cz 4�n-
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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Owner/Contractor Signature U Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement 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
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Owner/Contractor Signature U Date
al-
CITY01
UPEkTINO
CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
0 S --O jv 61 q
APN #
Temporary Power
ELECTRICAL
Date:
Building Address:
J
C to er
o
Owner's Name:
Phone #:
Contractor:
E
I Phone:
��
-2-bS-igsa
License #:
Contact:
L lc
Phone:
144 (
C(`
Cupertino Business License #:
2 600
Building Permit Info:
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Job Description:
Residential ❑
Commercial
Cost of Project: 0�,
I i D O O b
Qty. if
ADollcable Fee ID
Fee Description
Fee Groun
BTEMP
Temporary Power
ELECTRICAL
EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
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