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CITY OF CUPFWI'INO
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-CONTRACTOR TNFO$MATION
BIJII.CING DIVISION PERMIT
BUILDING ADDRESS:
R. P. D. ELECTRICAL SERVICE
iffd7ND06090098
7.01.20 N DE ANZA BLVD
OW Nlell'S NAME:
PERMIT ISSUE DATE
ST. JOSEPH CHURCH
3550 CHARTER PARK DRIVE
09/14/20OG
ONE:
SANITARY NO. CONTROL NO.
(408)265-2850
ARCHITECT/ENGINEER:
BUILDING PERMRINFO
BLDG ELECT PLUMB MECH
0
LICENSED CONTRACTOR'S DECLARATION
Job Description
hereby affirm that I am licensed under provisions a(Chopler 9 (commencing
with Scclion 9000) of Division 3 of the Rosiness and Professions Code, and my license is
in full force and pi
TEMP POWER (FOR FESTIVAL) GENERATOR
Liccos Class Lic. X
Dale Cmillowr
ARCHITECTS DECLARATION
I understand my plans Shall he Used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I oto exempt from the Contractors Licens Law for the
following reason. (Section 91131.5, Business and Profession Code: Any city or county
which requires a fount Ill consumer, alut Improve. demolish, or repair any $INCm2
$3000
Orion in its issuance. also Rgmires the applicant for such permit to rile a signed autement
Sq. Ft. Floor Area
Valuation
that he is licensed purs.enun the pmvisi.nao(dle Contranurs License Law (Chapter 9
(commencing with Section 7M(p of Division 3 of the Business and Pmfeasinos Code) or
Nm he us exempt Ncrtfmm and the basis for the alleged eaempllon. Any violadon of
r U U
Occupancy Type
Section 7031.5 by any applicant for a permit ubjects the applicant 10 a CIVII penalty of
not more than five hundred dollars ($500).
0 I, u..on.fine property, fir my employm with wages v their sole comorati ln.,
Required Inspections
will do rbc work, and We he Com is not intended or offereddo fairsalea(See. )614, Business of
and Pathe work Cade The Commissions noti Liaise Law does not apply man owner.(
prapeny who builds or improves thereon, and who does such work himselror through his
awn employees, Provided thea such improvements are not intended or.ff,.d faradic. It,
however, the building or improvement issued within one year of completion, the owner.
builder will have the burden of proving that he did not build or improve for purpos, of
sale.].
/
At I, as owner of Ne prapeny, am exclmively candy ing whh licensed ronoacmrs Int
c nswn the (Sec. and Code:) Thu Conuanom
(O
es not o an wnsinm
ny who but n
cense Law docs not apply je an owner of property who builds fir impluves Cestan, and
who f0! SUCH projects with a CanlraLlar(S) llCtnsed pur9uenl10111C GanlmCtn(S
O /
La
Licenseest Law.
O lam ere ,antler Sec. B&PC for no anon
�'
O.,he me ,^',fes'_'
K COMPENSATION OECLARADDateWOR
hereby affirm under penalty .(,do, ane of the following dedsratioest
I have and will maintain a Cenifica, of Consentto self -Insure furWorkeisCompmciom
u provided for by Section 3700 of rhe Labor Code, far me perlasmancc a( the
eak for which this permit is issued.
IMI
1 have and will maintain Workers Compensation Insu mance, as required by Section
M Of the labor Code, far me performance ofthe work forwhich mos permit is issued.
yy Workers Compensation Insurance carrier and Policy number art:
Carrie,. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
'
(,Tis section need nnl be mmplcicd line permit Is fnraec hundred dollars (SIM)
u Ices.)
I coni fy that in the performance of the work for which mise permit is issued, l shall not
employ any pe.ad in any t. mersnumMeomc sghjecuo me W.rh ri-C.I-T7
f C9ifornia.Omc
;1me�,
ApniceLaws
Applicata �� n,.1'
NOTICE TO APPLICANT: It. after this E o you hl mutt
sothe bar d
Som of the labor Coded you most
Compensation previsions
become subject m the Worker's Comps Nalfon
oravit
fonhwilh comply with Welt Provisions this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a convection lending agency for the performance of
the work for which this permit is issued (Sec. 3077, Civ. C.)
Lender's Name
Lender's Address
I certify that I have read this application and sola that the above information is
correct. I agree to comply with all city and county ordinances and shoe laws relating to
Wilding emnsuvcti.n. and hereby authorise representatives of this city to cmcr upon de
aho,c monitored property bar inspection purr dea s.
(We) agree t. save, indemnify and keep harmless the City o/ Cupertino apiov
liabilities, judgmenta.costs and eapcnss which may in anyway samespent siaid City
in croscquenec of the gmnung of this Fermi,.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:6i Date
SGU EREGULATIQNS. r)
j � �� �o `No
Re -roofs !� �
Type
[
Signamrc ypllCanYC00Ll.r Date
m
HAZARDOUS MATERIALS DISCLOSURE
of Roof
Will Nm applieanl or future Inilding occupant store or handle haulNmus material
u verified by the Cupertino Municipal Code, Chaper 9.13, and the Health and Safely
Code, Semi.. 25532001
All roofs shall be inspected prior to any roofing material being installed.
❑Ycs NNu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant us equipment or devices which
ail hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
oroi,
❑Ycs �No
I have mad the havNnu�si mxmdals m,lo cmona under Chapter 6.95 of the Califon.
1�f
x Healm& Safety Code, soon.023505,$533 and 5534.1 undersand mat ifdc Wilding
nalcuncmy haw
ne nhw hmost metpducluissvancaofaCenlricate too Pulpy..
$ignatureofApplicant Date
l�da,n.�d ` ILI^ tL��
All roof coverings to be Class "B" or better
tna4�
&M 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: B11c: Lot:
APN ........: 11626093.00
DATE ISSUED.......: 09/14/2006
RECEIPT #.........: 36037
REFERENCE ID # ...: 06090098
SITE ADDRESS .....: 10120 N DE ANZA BLVD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: ST. JOSEPH CHURCH
ADDRESS ..........:
CITY/STATE/ZIP .... ,
OPERATOR: amyw
COPY # : 1
is
RECEIVED FROM ....:
LESLIE ERICKSEN
CONTRACTOR .......:
RICHARD P. DEANE LIC # 26006
COMPANY ..........:
R.P.D. ELECTRICAL SERVICE CO.
ADDRESS ..........:
3550 CHARTER PARK DRIVE
CITY/STATE/ZIP ...:
SAN JOSE, CA 95136
TELEPHONE ........:
(408)265-2850
OEE
ID UNIT QUANTITY
AMOUNT PD -TO -DT THIS REC
NEW BAL
----------
BTEMP
-----------------------
FLAT RATE 1.00
----------------------------------------
62.10 0.00 62.10
0.00
PPERMITFEE
FLAT RATE 1.00
38.37 0.00 38.37
0.00
TOTAL
PERMIT
---------- ---------- ---------- ----------
100.47 0.00 100.47
0.00
METIIOD
OF PAYMENT AMOUNT
NUMBER
-----------------
CHECK
------------
100.47
------------------
2393
TOTAL
RECEIPT 100.47
VOICE
ID DESCRIPTION
VOICE ID DESCRIPTION
--------
103
----------------------------
UFER
________ _____----------_____________
304 ROUGH ELECTRICAL
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