06070045 CITY OF CUPERTINO -RAN
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BUILDING DOISION PERMIT CSNI'RACT,Q� R IA}kORMATTION
BUILDING ADDRESS: MANA GENERAL CONTRACTOR P°IMITND06070045
1114 HUNTERSTON PL
OWNER'S NAME: PERMIT ISSUE DATE
DAMLE 1839 TAMPA WAY 2006
NE: SANITARY NO. CONTROL NO.
(408) 375-4288 '
t BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0 0
lob LICENSED CONTRACTOR'S DECLARATION IOb Description V I hereby affirm uses 1 am Wns licensed under Pmvoof Chapter 9(commencing
with Section 7")of Division 3 of the Businty and PrOICsskm Code.and MY Ike=is
? „
in full Z O INSTALL TEMPORARY POWER POLE
?M4 Liangt L'e.g
stq Date Canlraster
7W ARCHaECTSDEcLARAT ON
tae i I understand my plans shall be used As public records
)yU
eQ Licnnud Professional
b N OWNER-exempt fr DECLARATION
i f I hereby.Harm that 1 1. acmn1(runs Uro lessons o e:enseAny
Lew for the
p O following renwa permit
a 7(D br Busher, and Pwferaiom Cade Any city or county
which required a permit re uiruvuc4 dor,improve,demolish.,ri rtpoig soy tmcmure $450
thatPriorhe its lensed Pummel
the applicant for suchCon Mnni'W isle r Law(ummcm
that he is licensed purwantwthe provisions;of Ude Contractor's Lkensc law/Chapmr9 Sq.FC.Floor Area Valuation
e�g (commencing with Section 70D0)of Division 3 of the Business And Professions Code)or
that he is exempt thmefrae and the basis for the alleged eaemptiaa My violation Of
Section 7031.5 by AM rpplicwt for A Permit mbjeets the aPPnant w a civil prmltY of —3fAW4Me_rU U Occupancy Type
oat mom titan R.beedred dollars IS50U).
❑I,u owner of W property.a my wploym wW ergo u tim'u sok compensation,
wnl Prdmam"'cra The
coruscate,
orsWmnGAa9Remle fs set Apply W-a,Buaircv Required Inspections
and property
wh obu Cade:M Conuwlors and
whoLicense Law dos ret apply f et roughawase is q P
awn
who builds mimprowath Improvements
and who Am neahwoh hWutl(mthrr sons ick
own employees,provided that well Impwsemwu are Imt ear o ed 9 planed tarsale.If,
build. the Wilding or Imp of
tshat within am year or completion,the purpose
balder will have the burden Of proving that he did not Wild or Impww(ar purpow of jf'��
sal
❑1.as owner of the proper(,.B sines And conessi n,Cod licensed anuwlprs w
NALED
Construct La Ude awned apply
7044.Business rad rty who
Code:)The Contrsowr. nd
ansae law does not reply je an owner of proper(who bailee or Improved thereon,sod.
License U tsfor such pajeN LlNaconvacmr(s)licensed pvrewm wNe Contraewrs /t1(re Q
License law.
D lam exempt unGS Sec .BkPCfor this reason �'�a asyy �yjp�la(��Jf,/Q�p��'
trwner Date �{UILM11 Wq
WORKER'S COMPENSATION DECLARATION [j�a`f� N V
1 hereby dram under penally 9f perjury aro¢(the fallowing declensions:
I h.vo mm will maintain a Cen imeas ofConsem w self-Insum far WorkersCompen-
sath.,a provided for by Section 3700 of the labor Code,for the Performance of the
wort for which this permit is Island.
D 1 have sod will maintain Workers Compensation Insurmuct,As respired by Section
3700 of the labor Code,for the perfarmwee of the wank for which this permit u issued.
My Workers Compensation Ins mnce carrier sod Policy
yr291P
ca AM: p
Gdrimr q I.lb Polley No.Hts O 1f�.�
6'Z
CERTIFICATE OF EXEMPDON FROM WORKERS
COMPENSATION INSURANCE
i nnkaectiad need amixcanplemd If Ile permit ufaane hum beddooan(2100)
nr beta)
I canary that in me performance of Um work for which this permit Is Issued.I shell not
employ any person in my mannerw As W become subject to the Worker'Compensation
Laws of California.Dam
ApPllam
NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should
become subject W the Worker's Compensation provisions of the lahar Code,you most
vJ O forthwith comply with such provisions or this permit shall he domed revoked.
ti tiCONSTRUCTION LENDING AGENCY
[r 1 bewby niftier that there ie a construction lending agtacy for tie perfonnance of
gYr> the work for which dust permit is issuW(Sec.3097.Ch.C.)
QLenders Name
D z lenders Address
U O 1 cemly That I haw read this application W atsm that the above informaum is
w F comm.I agree to comply with elf city and county ordlmomes sod MM,laws relating W
OU building construction,and hereby authOtiM wpwsenudisv ofthis city to Cron upon the
0. above-memioned PMPCny for inspccdon Purposes.
(We)agree to mw,indemnify and keep harmless the City of CV,Mbro against
f'+cm IlablllUa,jud c osis aM expwa whichmay In Any way accmeagaimn midCity
04 in consegoan eat lin this permit.
ri APPLICA UN STA AND WILL COMPLY W A L NON-POINT Issued by: Date
SOURCER GUL NS.
Re-roofs
Signuure ofA UCARDOr Data
AZARDOUS MATERIALS DISCLOSURE Type Of ROOF
WII1 the e C lamer fuu ni building e.Chaptnorc and
th hamaons mamrial
As deRnN by the Cupeniaa Municipal Code.Chapmr 9.11,and the Health And Safety
Crack,Section 25531(¢)7 All roofs shall be inspected prior to any roofing material being installed.
41 Dyes ANO
Will the applicant or future building Occupant taw equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havaNaa air contaminants a darned by the Bay Amo Air Quality Mwagnmenl all new materials for inspection.
Dlslrict7
❑Yea PNO
hew mN the hMaNtsu materialswquiwmeats under Chapmr6.95of the Califor-
ni "Safety Coe.Saetiom25505.15533VW25531.1undcruWthnifil building
n erre w a mna.L Nat It is d9)sresponsibility W notify tie occupwt of the
qui tax most be mat prior Wulnitccofacemricamofcup tr. Signature of Applicant Date
i]lY'1 l OG All roof coverings to be Class"B"or better
mead agent Dam. .
CITY OF CUPERTINO
TEMP POWER
OPUPEkTWO PERMIT APPLICATION FORM
APN# Date:
3(dZ--: -—o3� /0 )&
Building Address:
I rJTEP—� 0 PL-
Owner's Name: Phone #:
4-0 - 4 q • 13 o
Contractor: Phone: License #:
Q a �� i, c0 a- g� toq
Co tact: Phone: Cupertino Business License#:
os 315 i;a-e8 Z-1
Building Permit Info:
Elect ❑
Job Description:
A 1.1. v- �wE �bL2
Residential Commercial
Cost of Project: o
�Q
•
Qty. if
Applicable Fee ID Fee Description Fee Grog
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36222030 . 00
DATE ISSUED. . . . . . . : 07/11/2006
RECEIPT # . . . . . . . . . : 35184
REFERENCE ID # . . . : 06070045
SITE ADDRESS . . . . . : 1114 HUNTERSTON PL
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DAMLE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CARLOS ORELLANA
CONTRACTOR . . . . . . . : CARLOS ORELLANA LIC # 27468
COMPANY . . . . . . . . . . : MANA GENERAL CONTRACTOR
ADDRESS . . . . . . . . . . : 1839 TAMPA WAY
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (408) 375-4288
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------- ------ ---------- ---------- ---------- ---------- ----------
BTEMP FLAT RATE 1 . 00 62 . 10 0 . 00 62 . 10 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 100 .47 0 . 00 100 . 47 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 100 .47 MASTERCARD
TOTAL RECEIPT 100 .47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
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103 UFER 304 ROUGH ELECTRICAL