06010034 CITY OF CUPERTINO
BUILDING DIVISION PERMIT rtl4S^,yam' n m„.ryz�;�4f4MC }+y�{l,y4l TION
BUILDING ADDRESS: PERMIT ND.0 6 010 0 3 4
OWNER'S NAME: PERMIT ISSUE DATE
SILVERSTONE PROPERTIES 01/06/2006
ONE: SANITARY NO. CONTROL NO.
RCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EO PLO MECH
O
3Oo LICENSED CONTRACTOR'S DECLARATION lobDeacri tion
u 1 ncreby affirm That 1 am licensed under provision,of Chapter 9(commencing p
with Suction]0111))of Divin
doI optic Budness uM Profeuians Cotle.aM my license h
^�
in full ea erten. �j ADD 2O0AMP TEMP PANEL
2 Lice, tau Lk.N O Y
-I-.- Dam Contrsewr CONTRACTOR: HELIX ELECTRIC INC.
0 ARCHITECTS DECLARATION
1 understand my plans shall he used as public record,
kw� Lkented Prof..i...I
OWNER-BUILDER DECLARATION
i<E 1 hereby aM m Nm 1 am exempt from the Contractors License law for the
p o following recon.(Section 7031.5,Business and Profesaions Cade:Any city or county
$Pi which requires a permit to construct,slut.Improve,demolish.An repair any structure
poor m its Issuance,also requires theapplicant forsuch permit to file a sipnMaulement
< that he A licensed pursuant m the provisions ofthe Commentrs Liam Law(Chapter 9 Sq. Ft.Floor Area Valuatio 300
$ (commencing with Section7000)of Division 3nf the Busioeuand Proposal...CMA)or
Nat he is exempt therefrom and the hur m
la foe alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjecu the applicant to a civil penalty of APN Number Occupancy
not men Eve lowered dollars(ML 36940002 . 00 TyPe
oa N
0 1,a owner of the property,or my uoployees with wages u their sole compensation,
willdo thework and the sructute Is not Intended or.frosl rental.(Sm.71144,11udnrss ns Required Inspections
and rofetsmns Code:The Conuenora License law dost not apply in in owner of q p
propertywhohullos i improvech Improvements
andwho am sarchwalehWsetfedtiuough his
ovenemployeuiproveed thatovenlmprowmenuarere year
f mplabrM fertilethe ow.
if,
however,tic have
the
or improvementissale a did one year of completion,the owned
builder vela have the buNan or proving Nn he did not build or improve far purpme of
.In.). JJJ
❑st u ower of the property..B exclusivelynd contracting with:)The Cconwm's U.
construct the project(See.toad,BYlnro and Prowho Wilds
Cade:)The Connectors and /
come law does not apply a an owner of property who builds rs improve Nemo..and
who contracts far such projects with sconuacmr(q licensed pursuant on use Canvseurs, L]
License law. /+
❑1 em exempt under gee. .B d:P C fu Nla wan Co
Owner Date
WORKER'S COMPENSATION DECLARATION
7 hereby alO, under pemity or perjury one of the fallowing dalantla n
Thaw andwlll mdnuina Cu OataofConuntmselLinsumfar Work a Compere
'an,As povlded for by Salon 370(1 or the labor Cade,for tha Performance of the
work for which this,permit is Wised.
0 1 new and will maintain Worker's Compensation Imuran,,As required by Section
3700of Ne Labor Code,fw the performance of the wmb forwhich Nu permit Is Want.
My Workce,CampQ1e�,wa Insurance artist and Policy�mo�n//be�r am: �(�� � 'J
CmimlW ILIA Polity Na.:lp(y3(.1�U)11J 3
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section wed notbecompleed bine permit le foram hundred dollars(SIM)
or leu)
I certify Net in the performance of the work for which this pump is land.I shall not
employ any person in my manner an u An become mbjat to one Workeri Compensation
Laws of Celifomia.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
became subject to the Warkes Compensation pamiaio..of Inc,tat or Code,you most ,
,J Q forthwith comply with such provisions or this pctmil shall be dmmcd revoke.
'Z� CONSTRUCTION LENDING AGENCY
[r (hereby Affirm that Neu is a comtmcdon lending agency for the performance of
ai> the work for which this permit is ismal(Sec.3097,Civ.CJ
�W Q Lendce,Name
O z Lender,Addoeesa
U O I certify that I haw mad Nis application AM,tau that the,bow Inromtadco is
ly F coma 1 agree to comply with all city And county ordinances aM sake taws miming to
OU building conuuction,and hereby authorize repremnmives oftbiscity,or enter upon be
{77 ahove-menton d property for Inspection puqusea
(We)agta to saw,indemnify and keep harmless the City or Cupertino against
W Iiabilldn,jaegmane,costs and expenses which may In my Way aaNe against said City
U In consequence of the gaming of this pa reit.
AP ICA UNDERSTANDS D WILL COMPLY WITH A N N-POINT Issued by: Date D
CE GULATION .
Re-roofs
gnsturfo Appll HAZARDOUS MATERIALS DISCLOSURE rtuoCarmiscuorate Type of Roof
Will Use applicant or future building occupant atom At handle matedd
As de0md by Ne Cupertino Municipal Code,Chapter 9.12,and Ne Health and Safety
Ma,Sectiona 35532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yen 'jfjNo
Will the applicant or future building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazudnw air conuminmH u defined by the Bay Area Air Quality Management all new materials for inspection.
Infa
tricR
O Yes �No
I haveread the herandms malefiatarequiremenak under Chapterh.95ofthe Califao
HnlNe:SafetyCade,Satio..7SNh5,25333 and253N.l unJerwnd If Ne Willing
I oily hew•tenant u my mspo..ihility m notify occ t of Ne
i men wmm�mambRm pd m umcanceninnteor i pan Signature of Applicant Date
OM. rauthorisedegenl ate All roof coverings to be Class"B”or better
Community Development
ac, 0114
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
10320 e w2 8(vt 6v el L a C-4 66 / 3
OWNER'S NAME: s Uprie ro . PHONE # 7Z5- (n 77'05
GENERAL CONTRACTOR:606 4, , FAX # g Z 5 - (v 7 7-O Z
I am not using any subcontractors: � IAII o
Signature bate
Please check applicable subcontractors and complete the following information:
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 f
/ L (o cg
Owner/Contractor Signature I lbate
Jan . 6 , 2006 9 :4 2 A M No , 3461 P , I/9
CITY OF CUPERTINO
ia, TEMP POWER d
IUPER_TINO PERMIT APPLICATION FORM
APN# 3 (, cl q0 a o 2 Date: I
$uildingAddress: 320 (be euz* $Jo
Owner's Name: I Phone#:
St 'U-6,r.5 NC RoP2r1,
Contractor:/ 7 fr Phone}: n License#:
'" fK QC IN
C C (?5^ 'r.'7-7 s�p ,.
Contact: Phone: Cupertino Business License#:
„, (ZCL,) C6) f25 - Z7 - OS6 (
Building Permit Info:
Elect D
Job Description:
N —w 206 AMS ><pna P 4A)e
Residential Commercial
Cost of Project:
Qty. if
Applicable Fee ID, Fee Description Fee Grow
BTEMP Temporary Power ELECTRICAL,
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
3 276`
z os-. 7