06060118 CITY OF CIJPERTINO : �'
BUILDING DIVISION PERMIT ..,CONTRtS.CTORrM'.Ed�TI0&
`�.x�na.Y3,�,
BUILDING ADDRESS: LENTZ CONSTRUCTION INC, J PFA"" O.06060118
10605 FARALLONE DR
' R'S NAME: PERbITI ISSUE DATE -
SCOTT & SABRINA ELLIS 5087 MAITLAND DR 06/14/2006
PHONE: SANITARY NO. CONTROL NO.
(408) 264-0555
ARCH"ECTNENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
O ij LICENSED CONTRACTOR'S DECLARATION J e n
I hereby affirm Wt 1 am licensed under provision of Chapter 9 wournmneing
with Section 7000)oft ivision 3 ofthe Business ad Profession Code.a ad my license is
n iafufmfE— deft. i 3 KITCHEN SKYL t N CEILING SOFLET
Llcenry C;ua Lk.g
ConLIGHTING
Da¢ avao
ee A HITECI'She DECLAR 7101
tl T unda
ersnd my plans shall used as public fmarN
JUL 4 E- 2006
ltL XXXa� Licensed Profcaul oll
OWNER-BUILDER DECLARATION �'�A I� I��;''111 tf�� ''�rrrttl �]
cc
hcrthy.(Semthat I 1. attempt firman h<Cssions o :Myciecas Taw!arft
my �tt IFI
p O following reason. emit 7031.5,Business mid P.fmsinu Code:Any Aly or county B I,I�J/til'{tjI�71WI
a$ which mqulres a e,also m c lnauucl,alar,impmw,do Permit
t fie asig ed statemenuctivet c
priorice its Issuance,also regmirea Neft isionsof forsuch Comecnnit mucence ate ssammenr Valu i II6500
< On wholy licemedpuewutmay)aDivam.3dKCanuactossllanolkela(Chapterode). Sq.Ft.Floor Area
x�9 (commenc amps Section,703y)ad
Divkion]of theegeineuaWPfuAWnu Code)of
Net io u u1.5 b therefrom and Ne buss for be cts ntl eumpda o Any violation of
Section 7031.3 five
airy red doll ran permit subjects Ne applkut m a civil penalty of 3 ApN N�>�Lbe. 0 0 Occupancy Type
not mom Nan fiw hundred dation(5500). X93 9 7
i,ulawnes of thn pmperty,mmy wPloyro with wagnssdek sokeampeuadon.
will do the work and Obstruction,is notinkded oroRered Imsak(SM.7011,Business Required Inspections
and Pmfessiam Code:TM Colonnades License Law does not apply m an owner of q P
Property who builchorimprovm therms,and who dcessmhwahhimself orllwugh his
owoempkyem,pmvlded d m such impmvnmmu an,mtinledd waRemd fwsVa If.
however,dw building or Nmpmvmmt u mid Whin ane ymc of compkdon.Na ownes-
builder will have de burden of proving On he did set build or Improve for purpose of -
uk,).
❑1.as owner of the property.am esGu ovely emulating MN Removed centrunon to
ceuwct the project(Sec.7044.Burin and Profession,Code:)The Couascmfs V-
mrae law does he,apply to u owner of property who builds ar Implores themon,and,
who contfals for such pmjecu with a conuaaor(s)licensed pusuanl u Ne Cons amofs
License Law.
❑I ammemplundmsec. .BAPCfoelhisrtasou
er Dao
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Ne following dexImWaeu
❑Thaw and will mainuina CersiOcme ofUmcmmulf-iuurt for Workers Compem
sation,as provided for by Section 3700 of the Labor Code,far Ne performance of Ne
work for which this permit is island.
❑I Nve and will mainuin Wortbra Compensation Insurance,as required by sermon
370C.1'ft Lab d wlbt performance ofde wort forwhkh utis permit u loved.
M Worhels al ones m ad Poli num f art:
Cam Polity No.:
CERTIFICA OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not be completed IN the permit is forane hundred doOan($100)
at less.)
I certify Nat in the paformaae of the ware for which this permit u bound.I shall not
employ any person in any muuwrso as at become subject to do Warters'Compensation
Laws of Califomia.Daae
Applicent
NOTICE TO APPLICANT:IL after making this Ccmlcaw of Eampdon,you should
become rvbject M de Workers Camperaati m provad.0 of Ne labor Code,yam muss
.J 0 forthwith comply with such provisions or this permit"I be deemed revoked.
'Z'► CONSTRUCTION LENDING AGENCY
[-n Iherebyaffne,Na Nert lea commissions lending agency for the performance of
pi> the work for which dust permit u Tuned(Sec.3097,Civ.C.)
Q lendc e
Nam
7 Z Lenders Address
C)Q 1 terrify that I have read this applicamn all sou aur the.bow inflammation a
t" macer 1 agree to wreply with all Aly and seamy ardinuces ad saw laws miring m
Qbuilding construction,and hereby anhonte mpmsenmiw of Nis city to enter upon Ne
�^U above-memi.ncd properly for inspection purpu
os.
(We)agree 1a un,indemnify and keep harmless the City of Cupertino saiul
nFi cn liabiiides,judgmenu,casu and eapcnvs wh maymany wayaameapimtuid Cuy
in orthe
U rZ+ APPLnIC eUNDENMtingofNi IL COMPLY WITH All.NON-POINT Issued by: Date
SOUR EGU NS. _
G Re-roofs
ig mm afA s outrecm Dow
HAP.ARDO ATFRIALS DISCLOSURE Type of Roof
Will appllcut orfutuf9 building mcupmtsmw or handle husrdous maw"
tle0nd by the Cupertino Municipal C .Chapter 9.13,and the Health mad Safety
Seetion 3553x()7 All roofs shall be inspected prior to any roofing material being installed.
❑Yee a
Will the appli ant or future building oceu tase eyuI twin or devices which If a roof is installed without first obtaining an inspection,I agree to remove
. emit boardnms air canumlranu u do the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yet No
I have and the mantels mmeriakrequiromena umkr Chapter6.95 afthc Cables-
nia"with&SafelyCo ,S.d.25505,35533ad25534.1undemud Nmifde Wilding
does not, myhoe•teen y Nli,ymom",de.muput or de
require which moa I rut arse CeniOcsteoroecepaey' Signature of Applicant Date
Gwne lanutha a em Dace All roof coverings to be Class"B"or better
06/16/2006 06:26 4062647940 JERRY LENTZ PAGE 01
06/19/20.06 10:,48 FM1X 400 777 3333 CITY CUPERTINO 4 UUI/VUi
C =uairy Development
10300'Corm Av
OCOF Cuperth,o CA 95014
Telephoeo(4)8)777-3228
Felt(4)8)777-3333
• CUPEQN0
puilding De artmei it
JOB ADDRI✓SS: r, PERMIT#
ID FUtC ,�110K' � I Oq 3l0011b
OWNWS NAME: �1 j j PHONE# A
GENERAL CONTRACTOR
XI am not using any subcontractors:.
gi Date
Please check applicable subcontract nrs d co lete the following ' ormati >n:
SUBCONTRACTOR BUSINESS NAME BUSMESS LIC•FNSE #
Cabinets&Millwork
Cement Famishing
Electrical _
Excavation i
Fencing
Flooring:iCmpeting
Linoleum/ Wood -
Glass / Gazing
Beating
Inaulalion
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
paving
Plastering _
Flumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile _
• n gn, k>xe Da-e