06070096 CITY OF CUPERTINO d!hw. w+)ti"x�aa�xbfs«3`�'" '"`• '` > '"
BUILDING DIVis1ON PERMIT lCm1' RACTtjR IIYFURMATIQ `
I's.E vxa.rEYa'"h t ren
BUILDING ADDRESS: ELCO ELECTRIC INC - FE111,1ITN0.06070096
10585 JOHANSEN DR
ER'S NAME: PERMIT!ISSUE DATE
DENIS COLIC 10585 JOHANSEN DR 07/17/2006
NE: SANITARY NO. CONTROL NO.
(408) 393-1484
ARCHI CV¢NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
lmoo LICENSED CONTRACTOR'S DECLARATION Job Description
6 FF 1 hereby affirm Nal 1 em limned under provisions of Chapter 9(mmmcocin`
with Section 70(10)of Division 3ofthe Business and Pro(esskn Code,and my liMAWI.
+� mfuefameandeffeeL TEMPORARY POWER POLE
�gz Elmore env uc.m _
q Dau Can
3 W ARCHITECTS DECLWAT10N
7 1 undersand my plans Nall M used as public records
eyV
u Licensed Professional
s7a3 OWNER-BUILDER DECLARATION
2 0 f 1 hereby alarm onn 1 am exempt from the Canuanafs Lieenm Law for ON
p o following tires a permit
t 71131.3.Buaiau and Proere.d e oil Cade:My city m county
:00
$ which requina•Pwmit re conaau4 aloe impmsu h permit t fie a sig any Wucmn $300
PdarmtuIssuance.
ensedprsu require tWaisionsn for Contractor's
Law(ned auumem
�o
(that commencing of Division hacoBaantesaumeedatw(ehapm9 Sq.Ft. Floor Area Valuation
$ (commencing with Senior 71100)of DivbionJof the Business and Profession Codes)or
That he is eaeps therefrom and IN bub for the ailegus excmptioe My violation of
Section 7031.5 by any applicant for a permit subjects the applicant u a civil penally of
Occupancy Type
Nat man Ilan five hundred dollars($500}
❑L u owner of Ilio property,nr mitamplayem with wages.deer sok mmpaeWon,
wlBdo thewoh.and thelwctumts.tkunduswaRcnd farmk(Sec.70N,Btsainev Required Inspections
ad Profession Cade:The Conueaar'a Lima Law does rot apply m wr
an aus of 9 P
pmNnywhobuilds mimprow thereon,and who doessuch work himselforRuough his
awn anployeoo,proNdeA that Inch impmwmenu are not intended waamed(arsala If.
however,0m Wilding or impm oma,is mid within ON year of emnpktioe,the owmef-
builder will have the burden of proving that In did NO Wife or improve for purpose of
ate.).
❑1.as Owner of the Property sm exclusively commaing with limned mnuaams to
construct the pmjea(Sec.76x.Business aid Profess a s Cade:)The C.aauYs U. -
cam law dao not apply An an owner of property who Wifes m improve thereon,and a CA G �[A� g,
w�Lacufar such projects wiNaeonuacmr(a)Ikenxd punwntmthe Conuaemh yA— �Tt3 Rs ®
Lk taw, pfgJ9,'s— Ugp�NDsQSs "ry
am P, see ./ .B k P C for dust reason
ED
Dau� I✓I/�
a WORKER'S M AT70N DECLARATION )�
I hereby affirm under penally at paday No of ON fallowing decla r ate
I ham and will maintain a Cenifimk of Conant to sel(AM-re tar Wmmes Compton' sw qq II���ryk fy �y'
wlion,r provided for ra Section 7700 of the labor Cade.for de peRomenm of de p p � , N's
work far which this or by Se tion 3 p���{fy 4t�f�J �JWfI,f ,Flt�`f1{
❑1 have and will maintain Woftes Corepenatlon Ifuunnm,u tequind by Senior
3700 of the Labor Code,for Ne performance of the work fw which this permit b issued.
My Warkn` a patntionfe iw and Policy number an:
Grde Policy No.:
CERnFl ATEOFEXEMPfI0N Fl20M WORKER5
COMPENSATION INSURANCE
Clhb seas.nous rot becompleted Btie pemil is froom hundred deRara,31001
Or las.)
1 mNfy that in the performance of the work for which this Permit b issued.l shall not
employ any person in my mmnerm As m bocomembject to the War 'CMPenadan
LAM of CalifoMa.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Ce tificau of Facmprion.you amid ,
become subject as than Wormes Campenadan prevision of du Lahr Code,you nun
., foMwith comply with such provision or this permit Nall IN red ro
deceoked.
z r~N. CONSTRUCTION LENDING AGENCY
[.r I hereby alRm that then is a construction lending agency for tic performance of
lYi the work for which this permit is issued(Sec.3097,Civ,C.)
WQ I<mdels Next
::) Lmdcla Address
U 0 1 certify that I haw food this application and suss put the above information is
IL H correct I agree to comply with all city ad county aNlnMes and San laws misting of
OU building mounruaion,and hereby authorise representative of this city to enter upon to
W above-mcmioned Property for inspection purposes.
W (We)ASrte to ave.indcmmfy and keep hamlets Inc City of Cupertino again,
fn habilides,jusgments,costs ad expenses which may in my way Ace=against said City
U Z in corvequace of the granting of this permit.
APPLICANT UNDERSTANDS AND WI L COMPLY WITH ALL NON-POINT Issued by: Date
SOU GULATIONS,
Re-roofs
Signatemo Appli -UCC96UWI Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant w future Wilding occupant Mon orhandle Insom ous maudai
As dcBnd by the Cupertino Municipal Code.Chapter 9.12.and the Health ad Safety
Scellon 25532(an All roofs shall be inspected prior to any roofing material being installed.
❑Yoo Na
Will the applicant or mtum building Neutral we equipment or Nvima which If a roof is installed without first obtaining an inspection,I agree to remove
It hrrardom air comuminau u dcnbmLyOn Bay Arta Air Quality Maagemat all new materials for inspection.
Diana?
❑Yes ❑N
I haw rad the baaa loss materials require==under Chapa6.95 ofthe Caiifw-
nb Hcatthb.Sefely Cade,SwdMZ53W,25533ad2553a.Nmdcrvardthmifde building /
docs.t cummly hew a unarm,Nat It b my nspomibilily m notify tW oecupal of the
mqut which mot be "arwiuuamafacc 111 up(Occup�y. SignatureOfApplicant Date
Ow Neronulhommdagenl Dale All roof coverings to be Class oB��or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37537052 . 00
DATE ISSUED. . . . . . . : 07/17/2006
RECEIPT # . . . . . . . . . : 35276
REFERENCE ID # . . . : 06070096
SITE ADDRESS . . . . . : 10585 JOHANSEN DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DENIS COLIC
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : DENIS COLIC
CONTRACTOR . . . . . . . : DENIS COLIC LIC # 27233
COMPANY . . . . . . . . . . : ELCO ELECTRIC INC
ADDRESS . . . . . . . . . . : 10585 JOHANSEN DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 393-1484
AtE
E 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
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
CITY OF CUPERTINO 0(p0-100�ya
gVj, TEMP POWER
UPERTINO PERMIT APPLICATION FORM
APN# O Dale 7`
Building Address:
:7o#,fAjS cAJip
Owner's Name ,, Phone#:
E-Aj C. co L t C, Cf08-3<-j E3�/
Contractor: Phone: License #:
F4CCD E7LEC7'r- rc, 4,os -335 - 489 92-C 975
Contact: Phone: Cupertino Business License#:
EAJ GoC iG 39 -/
Building.Permit Info:
Elect tl�
Job Description: � �Q� �
Residential Commercial ❑
Cost ofProjec • y
O�
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING