08030021 CITY OF CUPERTINO T �"t� "
BUILk1ING DIE ION PERMIT k"11.0 �Q �l � ��0i�
PERMIT NO.
BUU"NGpAD�Es$.__RY AVE BARRY FOSTER ELECTRICAL '08030021
WS NAME; MACON kCTOR- PERMIT LSMUE DA'L'E
CITY OF CUPERTINO 1639, SAN PABLO AVE 03/06/2008
NE: SANITARY NO. CONTROL NO.
(510) 528-7210
ARCHITECDENGINEER: BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
0 0 0 0
op LICENSED CONTRACTOR'S DECLARATION Job D0SCT1pIlOn
UM 1 heaby affirm that 1 am licensed under previsions.f Chapmr 9 kmareackg
Z� with Section 7IXXhmi'Divislon 3 a(dm Business and Professions Code.and my lkemeu TEMPORARY CONSTRUCTION POWER FOR MARY BRIDGE
�y in full tome and&L it) 41 l
y�z Lima.Class Lic.N
DamComrscmr -'
��ACTS DEC A .—,5,rlJi�f
,44
aa i understand my phos dull W umd s pubii,reards CLG�-r ver
U
Licensed Professional
S OW NEB-BUILDER DECLARATION
N I hereby affirm Nm 1 am exempt from the Comrechar's Lien..Law for the '
p O following reason.(Scefiun NO 1.5,Business and Pmfcstom Code:My city or county
%$ which raquhas a permit to construct,alcor,improve,demolish,or.,I,any Im tine
!isy prior w its issuance,also requires the applicant for such permit to file a signed statement
�Q that he is licensed pursuant to the previsions of the Contrmter's Liamc Law(Chapla9 Sq.Ft. Floor Area Valuation
$ (commencing with Section 7000)of Division 3 of the Business and PromainCade)or $6 O 0
m
s ..
that he is exempt therefmre and the bash for the alleged exemption.Any violauen of
Section 7031.5 by any applicant for a permit subjects the applii m a civil penalty ofNumber Occupancy Type
oat more Nan five hundred dollars N5001 32606052A -
01,asownerofthepmperty,ormymploycrawithwagesm Leirmlecompe Oon,
will do the work,and Nesurcture isnot intended oroffered forsale(Sec.7044.Bonuses Required Inspections
Nd Prefeamm,Cede:The CaatrYmYa License Law does cot apply W M Owner of l C
property who builds or im proves thereon,and wha does such work himself or through his
awn emplayet s,provided dot such improvements are notimmundal aroRered forsale.R.
however,the building or Improvement is to within arc year of complatiam,the awner-
builder will have Ne burden of proving that he did cot Wild or improve for ptepom of
sk.).
0 1,4.owner of the pmpeny,am exclusively conuaming with licensed cenrracmrs W
construct the project(Sec.70W,Business and Professions Cade:)Tax Canhacxrora U.
ccnx Law does not apply in an owner of property who Wilds or improves themon,ani,
who contracts for such prejecu with a eanustar(s)licensed pursuant a the ConweroM1
Lkmse,Law.
❑Iamaempsunder Sec ,B&PCfC,dd, umn
Date
WORKERS COMPENSATION DECLARATION
1 hereby alarm under penalty of perjury arc of the fallowing declma0om:
0 1 have and will maintain a Certificate of Consent to self-insum For Woher's Cempem
it..,as provided for by Soman 37M of dre Labor Cade,far the perfomuae of flue
woe for which this permit is issued.
0 I have and will maintain Wmkaes Compensation Insurance,s required by Section
3700 of the Labor Code,for the performance often work fawhich this Permit is issued
My Worke Compensaa Insursae carrier and Polity�n�utm�ber�are:
Grtien:/JWlicy No.: /)AL1_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Drh.Non need not W completed if Ne permit h Forane hundrulmllars(SIM)
or ksa)
1 canify that in the performance of due work for which this Permit is issmd,l shall out
employ any person in my mmrcr an as m became subject code Warkeri Compensation s
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenifiam of Exemption,you should
became subject la the Worker's Compensation provisions of Ne labor Code.you much
.J z forthwith comply with such puvuions or this Permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Thereby affirm that there is a construction lending agency for NC Performance of
the,work for which this permit Is issued(Sec.3097,Civ,C.)
W� Q Lender's Name
z Urok,'s Addms
U Q 1 certify that I have mad this application and state Nat Ne above ink ead.n is
M correct,I agree to comply With all city and county ordinames and state laws relating m
U building construction,and hereby oubmire epMwotaliwS of Nis city m cnmr upon[be
move-mcnrioned pmarty for inspection purposes.
L4 (We)agree in save,mummify and kap harmless Nc City a(Cupcnino against
rq
liabilities,judgments,c.stsumexpens.which may in my way acC..,ptixat saidCity
U in eonsegrcnce of the granting of this Permit.
" APPLICANT UNDEPSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO RCEREGULA / -
rysrcea psn-�-- �o/(l Re-roofs
S' tore of6C
plicamVCemmlor Dole
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or future building acupant store orhendle locations material
as defined by the Cupertino Municipal Code.Chapter 9.13.and the Hexith and Safety
de, C1Yes h.. p7 35532(a)? �/N. All roofs Shall be inspected prior to any roofing material being installed.
�
Will the applicant or future Wilding acupant use equipment or&view which If a roof is installed without first obtaining an inspection,I agree to remove
emit but.. m air contaminants m defined by Ne Bay Arm Air Quality Managcmem all new materials for Inspection.
DimicR
O Yes Y No
1 have read the Iwardaus///smaterials requirements underCamter6.95ofthe Ceifar-
niaHcahh&Sally Cada Suctions ,25533 and]5534.1undcmand alatifthe Wilding
dao not currcndy haw a rcnanL at ie s my rmpamiM1ility m notify Nc oaupmh f Ne
aqui. Iswhkhmostbe ' rmissuanccafaCcnificateof up cy. Signature of Applicant Date
own. r ulhori'rcd m bte All roof coverings to be Class"B"or better
• OSo;ooa �
CITY OF CUPERTINO
TEMP POWER
CUPEkTuvO PERMIT APPLICATION FORM
APN # 32 �O Q 5 Date: _ D�
�P
Building Address: 1C)-755) IKA "E,
(e ve 6 NE-�Eca2 DOVE
Owner's Name: Phone #:
Crv� o F- Cope? `F( ioo
Contractor: J Phone #: 5-JO 'CZb! 7Z) U
5, wvy �L GLC(-��(lll?T�. Fax #: 6-le SZk 3Z
Contact: Phone #:
Contractor License #: 43 )444
Cupertino Business License #: (>7T AC'_J}�lD
Job Description: .
7EM P12 H--f' Ld rUSr7�CIGTIb+CI /�(l(,(i6z
Residential ❑ Commercial
Valuation (cost of project)0 6 ,
OOv 5
Quantity Fee ID Fee Description Fee Group Permit Type
1ERT>1K Res. Temp Power>1K E 1REAP14
Amps
_ 1 ERT<200 Res. Temp Power<200 E
Amps
IERT2001K Res. Temp Power 200-1K E
Amps
/ IEPERMITFE Electric Permit Issuance E
IELCPLNCKElectric Plan Check E
IBSEISMICR Seismic Residential B
'Plat CITY OF CUPERTINO
TEMP POWER
CITY OF
StUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
/ 1BSEISMICO Seismic Commercial B 10EAP14
r IECT<200 Commercial Temp Power E
<200 Amps
IECT>1K Commercial Temp Power E
>1KAm s
1ECT2001K Commercial Temp Power E
100-1K Amps
1TRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRES PERMIT#
Mf�2Y $ N��TEaZ ��(U>��= �ofl z�
OWNER'S NAME: F v' / C3 PHONE #57d. S
GENERAL CONTRACTOR: FAX # Q(6 .
I am not using any subcontractors: lo%
Signature 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
a Q71t-d2- EUgC�"L
Owner/ContractdY Signature Date