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C�NTRAGTOR INFORMATION
BUILDING DIVISION PERMIT
BUILDINGADDRESS:
/,164 DUMAS DR
WILLOW GLEN ELECTRIC INC
PERMIT NO.
08080139
OWNER'S NAME:
PERMIT ISSUE DATE
hi':i:' MAR:CON V
1085 WARREN AVE
08/19/2008
E:
SANITARY NO. CONTROL NO.
ARCHITECIrENGINEM:
200 AMP PANEL UPGRADE
BUILDING PERMIT INFO
eLDOO PLO MECH
O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
der provisions of Chapter 9 (comcming
by affirm 1 am Iicensod unm
1 lerem N
wife Section 70= of Division 3 of the Business ander fns 'ory o .aMmy�ertcu
in fun forte and cit
License s..v--�.�w-- Lk. g
se -
Daw�/ %ori U Conoxsar a i'L6
ARCHITECTS DECLARATION
Public nards
1 undcrsmns nJ my plans shall In used an x
'
Licensed Pulasdoml
OWNER -BUILDER DECLARATION
1 Mmhy affirm that I am exempt from the Contractor's License Law for Ne
following reason. (Section 7031.3. Business and Professions Code: My city or county
which mquims a Permit on cmeumct, ales, Improve. demnlim. or repair any emotion
prior to its issuance. alio reculret NC appllCLn for such permit to rile a signed naNmem
Nal he is licensed to fee Ne contractor's tic.. Law(Chap¢r 9
Sq. Ft. Floor Area
Valuation
pumuant pmvisictuuf
(commencing with Section 7000) of Division 3 of ft Box. and Professions Code) or
feat In, is exempt therefrom and the that for thus alleged eumption. Any violation of
APN Number
Occupancy
P Y Type
Section 7031.5 by any applicant for a permit subjects fee applicant to a civil penalty of
not more Nan five hundred dollars (M),
❑ 1. u owner of Ne property, or my mrplayw wife wage u Jens role eompensstim,
will do the work and Neawcture is not intended oralfemd forsale (Sec. 7044, Business
Required Inspections
and Pafe mans Code: The Comraeme. Lissive Law duct not apply w an owner of
property who buildsorimpnsves Nermn,and who dausuch workiespen or through his
own cmp.inces, provided Na such improvements are not intended oroffences torsade If.
however, the building or Improvement is sold within one year of completion. the owner.
builder will have the human of proving dol he did rot build or improve for purpose of
uic.).
0 I. as owner of the property, am exclusively contracting with licensed common to
covupct the project (See 7061. Business and Professions Cade:) The Commences lis-
.
ccae law dors not apply on m owner of Property who Wilds or improves thereon, and
who contracts for such projects with a eonvactor(s) Roomed purnwnt en de Comractmea
License law.
0 1 sus exempt utWm See B k P C for thus ressan
Owner Dam
WORKER'S COMPENSATION DECLARATION
I Money affum under pealty of perjury one of de following declarations:
I hs.e and will maintain •CevOcaw ofC...t us self-iaum for Worker's COmpcn-
sWm, a provided for by Section 3700 of de Labor Code, for the pefeemtc of the
work for which this Permit is issued.
❑ T have and will maintain Worker's Compensation I., as mquimd by Section
3700 of the labor Code, for she perfonnaree offee work fa which this Permit is Issued.
'
My Workcls Com/penamon ldsurance carrier and Policy number sm:
C.nier.4�C!// y4M CO- Policy hhx� O0�191
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fThu ancient need rot W completed If fee permit is forme bonded dollen (3100)
or less)
1 certify that in We perfarmenro of the wart for which this permit is issued. l shall ml
employ any Kneen In my mMocrso as an become subject to the Workers' Compertsardm
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making that Certifica¢ of Exemption, you should
become subject an the Worker's Compensation provisions of thrs labor Codc, you most
forthwith comply with such Provisions or Nu Permit shall be decmed revoked.
CONSTRUCTION LENDING AGENCY
IWmby afOrm than Nem uaconmuction leodingagmey for use perform cur
fee wart for which Nis permit a issued (sec. 3097, Civ. C.)
Under'+ Namc
Lcmalcea Address
1 astify that 1 have mad this application and sate that the above information is
CO=L I agree an Comply with all city and emery ordinances and sum laws minding to
Wilding eam umion. and herebyamhotien represenuuesof Nu city to enterupmn the
above-mentiomd propeny for inspection purpn¢s
(We) erg. to uw. indemnify and keep hormleu the City of CupoWm against
linbiliuea,judgmenu,e..0 and stpeaes which by in any way segue against said City
in eaaegmnce of the Swung of this penis,
APPLICANDEll{t ND ND WILL COMPLY WITH ALL NON -POINT
Issued by: Date a
sovacEFgq�fL�jlp� .
Re -roofs
Sismsome''////I/ if44 Date
AZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will Use applicant or rumors building accupml swan m handle haamous maerial
as deBnnd by 0e Cupertim Municipal Code. Chapter 9.11, and the Heralds and Safety
Code. Section 25532(•)7
❑ens Wiles
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant uta eyuipmani or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
mit W7,ammus air contsminmv a Jcfimd by the Bay Area Air coolly Management
all new materials for inspection.
P
O mien
❑Yns �No
I hers rend the haardmsmncriau eeQuiremenu undtf Ouspmr6.95ofthe Califon
nu Heaithde Safuy Cade, Smioru 25505.15533 am125534. 1 unbnnmd thuifte Wilding
does ml currently have • u nares, WI it u my mommoihilitY as unify the ottvpen of ue
noulremcnu which must W mel Our w iaaance of Cerdrems of aCupmcy.
Signature of Applicant Date
, All roof coverings to be Class 'W' or better
Owner orauthoritmagent Dae
CITY OF CUPERTINO
• 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: pdtg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35926013.00
DATE ISSUED.......: 08/19/2008
RECEIPT #.........: BS000005823
REFERENCE ID # ...: 08080139
SITE ADDRESS .....: 7464 DUMAS DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ....... -
OWNER ..... I........ LEE MARION V
ADDRESS ..........: 7464 DUMAS DR
CITY/STATE/ZIP ...: CUPERTINO CA,
95014-4311
0
RECEIVED FROM ....:
WILLOW GLEN ELECTRI
CONTRACTOR .......:
LONDRE, MARK T LIC # 15897
COMPANY ..........:
WILLOW GLEN ELECTRIC INC
ADDRESS ..........:
1085 WARREN AVE
CITY/STATE/ZIP ...:
SAN JOSE, CA 95125
TELEPHONE ........:
(408)289-9725
•
FEE ID
---------
UNIT QUANTITY
--------
AMOUNT PD -TO -DT THIS
REC
NEW BAL
113SEISMICR
---------
VALUATION 2,000.00
------------------------
0.50 0.00
0.50
----------
0.00
IEPERMITFE
FLAT RATE 1.00
40.79 0.00
40.79
0.00
1TRAVDOC
FLAT RATE 1.00
-40.79 0.00
40.79
0.00
TOTAL PERMIT
82.08. 0.00 .82
08
0.00
METHOD OF
----------
PAYMENT AMOUNT
REFERENCE NUMBER
CHECK
---------------
164.16
--------------------
#12564
TOTAL RECEIPT
---------------
164.16
0
CITY OF
. CUPEkTINO
•
/
020 013q
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
APN #
5 &()/ oo
Date:
Building Address:
-7 q& y ED L -e 7ta-- -L)v-; c/ e,LD
Mailing Address (if different from building address):
Owner's Name:
Phone #:
Irl Lees
252' 1:00
Contractor:
Phone: 408-289-97 25
WILLOW GLEN ELECTRIC, INC.
Fax: 408-289-1410
Contractor License #: 591918-C10
Cupertino Business License #: 15897
Contact: Mark Londre Phone: 408-640-1840
Fax: 408-289-1410
Residential ❑x Commercial ❑
Job Description:
Building Permit Info:
Bldg ❑ Elect ® Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/VI B, IV -HT, V -B
; rt (L IVa " -, I (-j
Valuation: z,pob_ Square Footage:
Project Size: Express [l`� Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditercen ore
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Revised 7/01/08
CITY OF
6UPEkTINO
0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin information:
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
YU/ 4�.
5 Fl 'IF- C
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
Date