05080121 CITY OF CUPERTINO ,kin•*a
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION .:.
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BUILDING ADDRESS: BAY AREA HAULING & BOBCAT gftVD05080121
OWNER'S NAME: PERMIT ISSUE DATE
NICK CHOSICH 1151 SPENCER AVE _0.SZ151200e;
NE:
SANITARY NO. CONTROL NO.
(408) S92-9755
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ep0 LICENSED CONf1tACTOR'S DECLARATION
I nemby affirm that l am licensed under provision of Chapter 9(commencing Job DescriptioFIN"'
n�
tzw with Section 7")of Division 3 of NC Business and Professiam Code.and my license is ry
m ren rnme and effect. DEMO (E) SWIMMING POOL �Tpa
'q uanaeclna tae.» �, (�
Fat Dale ConDECL h (9
ARCHITECTS DECLARATION
c5 a I understand my plans shall W used au public meads ry
S o 3 Lianmd Pmfcssional a�(��/�[ 2005
OWNER-BUILDER DECLARATION t/
y I hereby affrm that I am exempt from the Com icmrs License Law for the
o O following mason.(Section)1131.5,Business and professions Code:Any city nr cnty
m which requires a permit to conswel,eller,improve,demolish or repair any structs m @J (l .,r 14 A 8 4.0 0 0
_i y that he s tubi nce.cels pursuantto
the the inion odor Corm fmitsa License
(Chapter
S< thalheiocing,wit PSection7Nc provisions of Ne Conlrazmfs LianmlawlC Code)
Sq.Ft.Floor Area �Valua[fo0�
yH� tache is exempt
Section7")and in Divisionr of the Business pt Professionsslation of �7 �1,1
Q�� Nat he is exempt thcmfmm and 0e baso far Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a onshfabIpce.the applicant to a civil penally of r 0 0
not mom than fire hundred delta.($500). Occupancy Type
❑L o thewowner of the property,or my of Unstudied
do with wages u theirSec.sole compensation,
wmaothewmk,and theswmare istors Lkaed ofoffered do rs notage pply.7oaa.owner
or Required Inspections
and Pm who bu Cade:The Contractors dremour nd rhe law docs not apply lf an rough of q P
pmpeny who builds of that such
Ih improvements
and who ares such wart oroffr edlamugh his
Own
ow a her,th ea,provided inori that such ext is mid wit are not intended of
d mpletired formthe Owner-
builder e. f.
b ,Np building or improvement is sold within ane$ser of completion.theosof
will have tie burden of proving that he did amt build or impraas for purpose of
' uleJ.
❑1,as Owner of the pmpcny,am exclusively contracting with licensed contractors to
boomed le pmjca(Sce.70aa.Business and Profcssinns Codc:)Te Contractors Li-
cense Law docs not apply to an owner of property who Wilds or improve daemon.and
who co for such projects with a connacmr(s)licensed pursuant o the Connector's
Li law.
Owncm ePCfor this mason
zc tunWORKER'S COMPENSATION DECLARATION'f)e¢
1 hembY edam under penalty of perjury one of the following declaradon:
I have and will maintain a CertiOcae of Consent to self-insum for Workers Compcn- .. ._
sation,or provided for by Section 370)of du labor Code,for the pefformanen of the - -
work for which this Permit is issued. "
❑1 have and will maintain Worker's Compensation Insurance,as mi,iced by Section
3700 of the labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance ansa and Policy number ase:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section recd not Wcomplcwd time permit is prom,hundred dollars(SIM) '
or less)
I certify that in the Performance of the work for which this Permit is issued.I shill not
amPlaYany Nixon in any manner been ubj Wort" pbnation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Ccniricaii or ffacirptiah.you should
Wer me subject to the Workcfi Compewlion provision of time labor Cade,you must
.J z forthwith comply with such provisions of this Komil shall W deemed revmked. -
z O CONSTRUCTION LENDING AGENCY
I hereby affirm that Vert is a construction lending agency t'or the Performance of
!Y the work fur which Nis permit is issued(Sc,.3097.Civ.C.)
W Q Lender's Name
U:D z Lender's Artemis
fJ Q 1 testify that 1 have mad this application and stale Net Ne above l initiation.r,is
C bonding 1 Agmeonstr to comply with all city and county ordinances and cute laws rclnin t e
QU boove-gconsnuetion,and hambyamaorimreeamt. iws of Nis oily to crier upon the
}W ahovcmcmianed Pmpcny forinpcction Purposes.
,r Q. (We)agree m save,indemnify and keep harmless Be City of Cupcnino aganst
N liabilities,judgments.costs and expenses which may in anyway accrue against said Ci ty
U Z in consequence of the Fmnti ng of this permit. ^
APPLICANT UNDERSTA D WILL C MPLY WITH ALL NON-POINT Issued by: Date b-._ ,r 6 J
SOU REGgLA N .
g-15'-0 Re-roofs
Signau of Applicant onrracmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant serum or handle hanrdous material
as defined by the Cupertino Municipal Code Chapter 9.12.and the Heald,and Safety
Code.Sc❑c yo525532(a)? No All roofs shall be inspected prior to any roofing material being installed.
Will the appaard r ru�uilding occupant use egvipmenl or dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
it hvurdous air conuminants as defined by the Bay Area Air Quality Management all new materials for inspection.
❑Ya No
1 have real the haiarials mquimments under Chapur6.95 of Ne Califor-
niaHalN&Safny Codc,Stttian 255U5.255J1 and 75576.1 understand thmif de Wilding
docs on,earre ol,have a to l Y fnponsi IiIY b notify the n upant or the
mgvimmbn niG,mUlhe at dada avddrora rtihaeor dnpendy. ignature of Applicant Dale
owrera as ri, agem _/Dau All roof coverings to be Class"B" or better
r' l� Community Development
,1 10300 Tone Avenue
Cupertino CA 95014
z ,J Telephone(408)777-3228
CITY OF Fax(408)777-3333
9UPEkTINO
Buildin Ike artment
JOB ADDRESS: PERMIT#C7 S�lp U 2
-7 S (=fE�4 CANE
OWNER'S NAME: Cr I C PHONE # cinq -;?-5 5--2 6 V
GENERAL CONTRACTOR: FAX # S ctit r
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin.-information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation j A✓ A 2FAf A- Qt—IG 653'430
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
,5M DEMO psi
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
z l3 � z � - IS - OS
Building Address:
-7 qs F1 E!3vA- t kiy
Owner's Name: Phone#:
I C4L-- CW--OS 1941 qD - 6
Contractor: G License#: b q,3' / 3
Contact: � 1 Phone#:
Q{ i2/Z GN -7Z3- ®s8
Applicant/Contractor:
Building Permit Info:
Bldg ✓Elect Plumb Mech
Job Description: DF-mo
�
Residential: P00(- VFM oL F/ v`_ Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupancy Group:
Qty. if
A licable Fee ID Fee Descri tion Fee Group
BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
EJBUESLTC EaBusiness License BUILIDNG
3 7sf