06040147 CITY OF CUPERTINO "-• "*•�' '
AUILDINCISIVISION PERMIT iCdl t.� ll •JNFt ,xMAT ON,'-<
BUILDING ADDRESS: - pONSTRUCTION PERMITNO.O6040147
7630 KIRWIN LA
OWNER'S NAME: PERMIT ISSUE DALE
ANIL SUPUR 360 W 8TH ST 04/25/2006
ONE: SANITARY NO. CONTROL NO.
(408) 893-7693
ARCHITECf/ENOINEER: BUfLDINO PERMIT INFO
9LDGO ELECT O PLO 0
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joo
LICENSED CONTRACTORS
e'UmesDECLARATION of
IOb DOSCrIpUOn
Out
I hereby aRirm that I son 14xnacd under psovidoex of CWper Y(cmnmencln{
! with Section 7h10)arDivikm 3 ofhe Budrcss and Prorcnkex Ccuimand my lkenm is
jgDI It TEMPORAkfand off INSTALLATION OF
� LisoanLim{
�pnw_
ARCHffECPSD Cmr TON •L S■/"'17�\w/
1 d a 1 undersunl my plass Wll be used as public records A PR
Licensed Professional �- 2006
y OWNER-BUILDER DECLARATION
'7d I hereby aRrn that I sm attempt from hO Contramoh Uccnm Law for the
O O following reason.(Section 711313.Business and Prefeta on Cade:My city or county $700
5.3 which rtquims a pmnit m emmuaet.alcor.improve.demm140.0¢Pair any suumum
prior m its instance,atm requires he applicant for such Termism Rle aiigncdtWL•mant Ft. Floor Area 1 n
< dm he blicemcd putsuantwte provisitueftheCom en's license law(Chapmr9 �Q•
,e, m (commencing with Session 7000)of Division 3 of the Business and Professional Code)or
3.. that he In exempt therefrom and the basis for he alleged csemPdm.My violation of13 9 r Occupancy Type
Section 7031.3 by arty applicant fora permit wbjeeu ton applicant k•civil penalty of APM
an,mom dun five hundred dollen WWI.
❑I,towner of the WODonY.a my wplaym with va{ea u theh colo compennaon,
willdothewwLmdmeauunutebmtinkndedorortemdforW (Sm.7041,Busircn Required Inspections
and Pla(eiNem de:COThe Corucmra LICGtY LA.does met apply m m awns,of 9 P
property who Wiles or impresses discrete.and Mho dm mesh work blmmi f of Ihneith his
own employees,provided that such impmvemmta art not Intended oOBered fossle If,
howcvm,the building or impmvammt is sold within one year o(mmpletme.the Owner-
builder will haw the WNen of proving that be did an,Mid or improve for purpose of
uleJ.
❑1,as Owner of the property am exclusively emtramiog with licensed contractors to
construct the pmKct(See.7044.Business and Profeshms Code:)71e Cm ns on t Li-
curse law does not apply m m owner of property who Wilde or improves Worm,and,
who commem,for such projects wish ammmtm(s)licensed purawnt to the Conhaetor's
Lmeue Law.
❑1 sm exempt under See. .B&P C for this won
OwnerDam
WORKER'S COMPENSATION—DECLARATION
1 hereby am.under penalty of perjury monads:fallowing decla,ulmr
❑I have and will maintain a Cenifrcateaf Coment to half-IuumforWorkeYsCamper.
nation,u provided for by Section 3700 of the labor Cote,for she perfomsance of the
work for which this permit is issued.
❑I haw and will maintain Workees Compensation Insurance,at required by Section
37M of the labor Code,for me performance of the work For which this Permit is Issued.
My Worker's Compensation Insurance moicr and Policy number arm ^ C�
Cartier. ?':r� �'2W PolicyNo.: 06 Tp Y' /
CERTIFICATE OF EXEMPTION FROM WORKERS*
COMPENSATION INSURANCE
Irish;scolon coed not W completed if the permit Is fortune hundreddollan(1100) v
nrleaa.)
I merrily that In the perfomenca of the work for which this Permit is blued,I shall not
employ a lypenon in my manrerm at to become-subject In the Worker`Compensation
Laws of Caltfomia.Data
Applicant
NOTICE TO APPLICANT.If,allot making this CeniBeste of Exemp0on,you shot
become subject to the worker's Compensation provisions of the labor Code,you most
vsO forthwith comply with such provisions or this permit shell W deemed revoked.
�f�v CONSTRUCTION LENDING AGENCY
(•:; for
hich lids
courecti097.Cin{agency fm the performmm u(
GE vat„
the work fur which hit permit b issued(Sec.N19f,Civ.C.) '
Lrm.es Name: Landers Address -
r T
G L9 I«tme con I Wve tad Wary and county
dna sum hon the above laws
totaling b
1 i r certecL 1 sgme m comply hem all city and county oMmancef and stale laws r upon t e
G C) buildingW.- conswnlonendhemby auhorinremues. ions of his City to enter upon the
><la7 atrovcmentiuncd to..for inspectionainceses
I Tyr (We)ogre m cove•ami cut en and keep hay in an the City of alalmoa id CRY -
I f7 incomentuWgmenh,eoIDandexpenaef mil. may In mYw'+Y acarC aPIN1 mid CITY
L)T A APPLICANT
of he granting of hispermit. s p`de/
's APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date � (tea
SOUR EGULATIO
kip yt�2r�c- Re-roofs
Signmun atApplIMUCOOMoseloor J Dam
HAZARDOUS MATERIALS DISCLOSUREType of Roof
Will the applicants or e building onulnumm re orhandk b... 0.roam"
az aeRned by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
41 Code.Semite 35532(a)7 All roofs shall be inspected prior to any roofing material being installed.
QYex
Will hcapplicmto future building occupamus,equipment ardeviaa which If a roof is installed without first obtaining an inspection,I agree to remove
emit I andoes air cannminmuU de red by the Bay tea Air Quality M,n.amem all new materials for inspection. -
Uis rin7
❑Yq No
I haw mad the ha»Nws materials requh neons umkrommor6.95ofte Califor•
nu HmIh&SsfetyCedm Somata 25505,25573 std 25S34.l ordemard hetifde Wilding
dos tot currents Mw a mean hn it b my main fly to redly the occupant of de
¢npdrementa 'chmuslW-i imiciosmceanecrd(mamarpcetp�. L Signature of Applicant Date
YL 7 v
Ox nor or whorbed agent DamAll roof coverings to be Class"B"or better
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35922015 . 00
DATE ISSUED. . . . . . . : 04/25/2006
RECEIPT # • • . . . . . . . : 34119
REFERENCE ID # . . . : 06040147
SITE ADDRESS . . . . . : 7630 KIRWIN LA
SUBDIVISION . . . . . . :
,CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ANIL SUPUR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4357
RECEIVED FROM . . . . : RALPH CHARVEZ
CONTRACTOR . . . . . . . : RALPH CHARVEZ LIC # 23615
COMPANY . . . . . . . . . . : CHARVEZ CONSTRUCTION
ADDRESS . . . . . . . . . . : 360 W 8TH ST
CITY/STATE/ZIP . . . : GILROY, CA 95020
TELEPHONE . . . . . . . . : (408) 893-7693
•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
----------------- ------------ ------------------
CHECK 100 .47 494
TOTAL RECEIPT 100 .47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
•
Community Development
10300 Torre Avenue
' s Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
OUPERTINO
Building Department
JOB ADDRESS: PERMIT #
G 3o /,'14 ,�, G�� o a
OWNER'S NAME: A-", c.- PT40NE # Yo k-y f 3- 1t.5
GENERAL CONTRACTOR: CL,,a.,: e,7- FAX #
I am not using any subcontractors:
Signa 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
• V- 2$=b
Owner/Contractor SigKature Date
CITY OF CUPERTINO D b�--014-
TEYiP POWER
*CUPS OF
PERMIT APPLICATION FORINT
APN # 3 — 7i — Date:
Building Address: Y
Owner's Name: Phone#:
-6 41o#r- -f'f3441-3
Contractor: CMs� Phone:
y. Yq —d 5�( License o Z 3 f 4
Contact: Phone: Cupertino Business License#:
�� Ll��1�� y�� ' fer3- Gs3 23015
Building Permit Info:
Elect ❑ /RlS�/d [cf( t, ak o� '/4ayJ pbrJ�fZ
Job Description:
ADDfTifii
Residential [6--' Commercial ❑
Cost of Project: � da
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•