06090238 CITYOFCUPERTINOa � �M. r �^• "' �''" n" -
BUILDINGDIVISION PERMITCd1V.' R. GTQRINIfl'.�ItM'�' I(fN
BUIL DING ADDRESS: PERMITNO.06090238
10592 JOHNSON AVE
OWNER'S NAME: PERMIT ISSUE DATE
GREG SHEPHERD 09/25/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BLDGBUILDING PERMIT INFO
O EO PO MECHO
�op LICENSED CONTRACTORS DECLARATION Job Description I h.reby M.Nn 1 ten licensed under pmvisione of Chapter 9(commmming
with Section 7000)ot'Divkiot 3 of Nc Businessaed Proletarians Code,and my licensee TEMPORARY POWER POLE
in full fare.and effect
s�? License Class Un.0
Dalc Conuactar
7W ARCHITECTS DECLARATION
i I understand my plans shall be used as public recms
J
a(J
au.t; Licensed Professional
.O� OWNER-BUILDER DECLARATION
or
1 thereby from
that 1 1. exempt from Ne Cmmus or'a License Taw for No
-O e which re rtason.(Section 7031.5,Business and Prof&-Wi Code:Any city os me. $100
$fVi which its iresWomen.
o apormit reeiruroaaper.Improv,hermitt fie a sig my edumencem
Tis^ thiormiu iemem aa4u t fin the theApplicant9 for uehpermi'Nkamem Law(Chapter
€< (comencegwith Smuant fin the of Division 3 the Contractor's LkxnselameCodm9 Sq.Ft.Floor Area Valuation
(commencing exempth Section and
inch for
tache BusinessandProfessions Code)or
than be ts exempt Nemlrom and the buus fa Ne a11ae0 assumption.Any Notation of
Section 7031.5 by am/applicant far a permit mb*u the applicant N a civil penalty of NAPer Occupancy Type
Out mom Nan five hu^dmd dollar,(SM
❑1,u vwrxr of Loc pmltary,or my wployen WN roan u Ne'v sok compevrtion,
wiB do thcwork.and thsttuuum 4not Ntsnmdma@red fmuk(Sa.7014,Busi•... Re uired Ins ec S
Nd Pneeeasians Cade The ConttacNls License Law doe rot apply 0 N owner of q p
property who b ildsarimproves themon,andwho doessuchworkhimselfor through his
own employees,provided that such improvements are unilateral aroQemd for We If.
however,thebuildingft hund.Oor provnitsmlheaid did at build of cnmpletion,pulp.O• i
Wilder MB have th harden of proving Nat h did ttm build or improv for purpose of /
1.as O
co 1,u owner oftithe(Sm.
.Business udus rod convening CIN Reacted on^vemoss to /
cam La the project(Se..an an. rod property
who
Cad^:)The ConvSCNfa and.
who law deca not reply N an owner of t raper(who sed p or improv Wonsan.and
who convects pursues projena with a eonuanor(q licensed Durum On Ne Cantranmh
Lceue Law.
❑lam escmpt nmr Sec ,BKPG forth won
130100
ner Data L 06
WO COh ^NSATIONDE TION
I twenty aRTmt under penalty of perjury aro of the fallowing dalatWa�
1hawandwimunuinaCerdr=wofCattsenttoself-InsumforWaak^fCampen-
on,u provided for by Saban 3700 of dee Labor Cade,far Ne perfarmam,of therk for which this pxret,is Issued.
1 have and will maintain Worker's Compensation Insurmte,u requlmd by Section
of the Labor Cade,far th performance ofthe work far which this Permit I.luued Worker's Compensation resonance carrier and Policy number are:
Cartier'. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thus section tied oat becompkvd if the permit is form=hundred dollars($10(l)
or leu)
1«r ify that In Wa perfmmanee of the work for which this permit u Int W,I shall nut
employ any person in my mannoLt9 V�p become object N th Warkeri Compensadou
Lewsof Cali(omiyDa _ 9/ �Vb —
Applicant LL
NOTICE TO APPLICANT:If,after making this Cef incax of Exemption,you should
become subject N the Worku's Compensation provisions of the labor Code,you mum
.JO forthwith comply with such provide.Or due permit SWI k dammed revoked.
y CONSTRUCTION LENDING AGENCY
[.r Ikreby alarm that axon Is a cansunetinn lending agency for the purformana of
!kms the work fm which Nis permit is inced(Sec.3097,Civ.C.)
ALender's Nam.
z Lender's Adder
U O I comfy that I have rod this application and star that the above information is
cornet.l agree to comply with all city and county on Innes and Stam laws misting N
OU building consvumitn,and hereby authorize represenmtiva of this city m enter upon the
r Uabove-mentioned Property for inspection purposes.
6, (We)agree to saw,indemnify and kap harmless W.City of Capcnino against
wF.t
IA liabilides,judgmenu.cuct and espmus which may In my way same against said City
U z in consequence of the granvng of this PermiL
^ APPLICA UNDERSTAN S O WILL MPLY WITH ALL NON-POINT Issued by: Date ��-Z S-!is
SOUR EGULATION� _ //0/` .
Re-roofs
signtart ol'Appipi/Combecour ° Data
HAZARDOUS
MATERIALS DISCLOSURE Type of Roof
Will rix applicant or future building eccupantslom orhandlc hantreous material
u donned by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
cam,secuan us3x(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will Ne applicant or NIUM Wilding acupent ma equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmardom atr mntaceinsnu u denad by Na Bay Amo Air Quality Management all new materials for inspection.
DistricO
�Ycs tQN
I have mad the mearWns materials requirements under Chapter 6.93 of the Califary
nix Health At sarmyC de.Simmons 25507,25333 and x3534.1 understand then ifthc Wilding
does son currently haw a tenant Lou It is my nsnfity m atify Irk acupml of Ne
requlmmon hmuthemel 'a Wat aft amort* o(o Signature of Applicant Date
°1 1r'
owner a ari.ed.g t Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
10592 Ha..r Soly D 6 6 !PO 2'1
OWNER'S NAME: S PHONE # 650 SSS-Y I
GENERAL CONTRACTOR: k FAX #
I am not using any subcontractors: '912-5106
ignature Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS,NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
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
...• o�/ZS/OG
weer ontractor Signature Date
CITY OF CUPERTINO
•m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37528030 . 00
DATE ISSUED. . . . . . . : 09/25/2006
RECEIPT # . . . . . . . . . : 36198 ,
REFERENCE ID # . . . : 06090238
SITE ADDRESS . . . . . : 10592 JOHNSON AVE
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : GREG SHEPHERD
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : GREG SHEPHERD
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
EE 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 VISA
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO
;;CCS TEMP POWER
PEIZT
•CUINO PERMIT APPLICATION FORINT
APN# 3-:75 — 00 -030 Date: I1-25106
Building Address:
16 592Vie .
Owner's Name: Phone#:
rrcrzD (6v)s3s-Z11—
Contractor: Phone: License #:
Contact: Phone: Cupertino Business License#:
S/irvi E 2;� G 3 Z
Building Permit Info:
Elect ;E4
Job Description:
Residential Commercial ❑
Cost of Project: 6
/00, �
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING