08040077 CTTY OF CUPERTINO ? �' ?:&' 7'- �
BUILDING mv191ON PERNIIT COIVTRACTUR I1 I��JPIM" T1 11
fu -.,.a4'
BUIL.gING1gD�rPsMPERMIT NO.
ENHART LN NATIONAL CONSTRUCTION 08040077
OWNEIS1 R'lNAME: RENTAtisPERMIT ISSUE DATE
JOHN HAIMES 15319 CHATSWORTH ST 04/10/2008
iE. SANITARY NO. CONTROL NO.
(818) 221-6057
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00
LICENSED CONIRACTOR'SDECLARATION - IbD05CrDescription
1 barohy a1Rm tiro 1 w Ol
unlicensed der provisions of Chapter 9(mmmeneing P
with section 7000)ofDivision 3aide Business and ihofeafa.Code.and my lkenc is TEMP POWER POLE
in full force and sfrea
3 Ll i Licence Clan Lk.0
Date coal.,
2g ARCHITECTS DECLARATION
2 I understand my plan,shell W used as public records
0
y C Lic.d Pmsi
fes .nl .,
OWNER-BUILDER DECLARATION
COO hereby afOw that 1 1. exempt From an de Continuities I,cess Law for the
COO o following tures.a permit
t 7031.5.Business and Preme.da u.Code:Any city m county
3$
which mqulms n peanut m rnnat the alter,improve,demoiW,ri repair nay structure
Pfdermtisianece,alsa rtquirvdespplicanlforwchperWe Um asigncduatpting
< that a .lieemedpn n.mmdepm u.wardeconm ter, ante ,W(chap�9 Sq.FL Floor Area Valuation
g�3
,at
exempt
an th thod,n3 thea lucks api e,Mya.laden of 6375
Nat he k 31.5 b therefrom and Use Eula for de alkged esemptim Any it Penalty of
Section 7031.5 EY any applicant(v a permit abjttu me applies m a civil perry ofNumber Occupancy Type
sat mom mm five hundred dollar(SSW). 37515043 ,
°'f��
❑I,u mwnv a(de pmprny,a my wpl.ycn wire WreW u mehsokempewtion,
will do dewaalt and Use tEunum It not intended or offered fousak(Sec.7044.Business Required Inspections
and Profeam.Code:The Contractors U.Law dos roe nst apply an an owner of q P
proleoy Who builds orimpovea demon.snd whodov suchworkhimaelfattiuou th his
own wployea,provided themes improvemcnu wool intended oro@rntl forale.If.
however,the building or improvement is sold within oro year of completion,the owner.
Wilder will lure the burden or p.A.g that the did ma build or imprerm fear purpose of
axle.).
AZ;rl.as.won of me peopen,am eacluuvoly conuxting with lice.ed mnuasom m
wet the project(See 7(um.Business am Proposal..Code)The Coovacers U.
sees Law does not apply m an owner of property who builds or moreover demon,and,
who contras for such projects wits a convavor(s)licensed puannt in de ContracroM1
Lkev W.
❑tun mpl se ,B&PCferthhmu.n
,..or Dw �-ID•B
WORKMPENSATZON DECLARATION
1 hereby arum under penally,of perjury me of the following deckations:
I ,as aM will maintain S=on
of Case.r Code.fum the
Wartsh Compete
!Wren,r provided rte Ey Sttuon 3]W of the Labor code.rte me performance of de
wart for which lams permit is lased.
0 I have and will maintain Winters Compensation insurance,sa required by Section
3700.(the Liber Code,far Use performance of me weak for which glia permit is issued
My Work .Composed..burs.carrier and Policy number am:
Carrie: Policy No.: _
CERTIFICATE OF EKEM MON FROM WORKERS'
COMPENSATION INSURANCE ,-
mbis section need notbecmpleted if Use permit Is farone hundred dollars($l W)
or Ica)
1 certify dot in the performance of the work for which this pemtil is blamed,I deal not
employ o cues lniry,nr TXT mbjtttmmewarken'empenaadoe
of Glia is /Ae L1 O
A"--nil a
NOTICE TOA rc, r m�i g this Certificate of Exemption.you amid
became,ub)ev lac Worker,Compensation provision of the LAhv Code,you mm
,J0 f.Mwila comply with such proviso.orthism
permit.hall be deeed.1sed.
,z., CONSTRUCTION LENDING AGENCY
`
F' I hemhy aRrrm that dem is a construction lending agency for the Performance or
Gi i the work for which this permit is issued Ism.3097,Civ,C.)
GA Lenders Name
z Landers Md.
U O 1 cen)(y last 1 have mad this Application and sate du she above indamWun is
D. cormc.I came to comply wire til city and county mti].mmces androids Ion mitis,m
O Inoidin,co.wnion,and hereby sod Trice representatives of this city in cover upon the
W ahove-meadamd property fon inspection purposes
p. (We)alms I.ave,indemnify and keoP hmnkss Use City of CtIaMibe &at=
y liabilities,judgmc.s,cosumd npeems which may in any wayacanm alumuud City
UZ incomegne or the swung ofdispermit. C_.
^� APP ICA NDFR57ANDS AND WILL COMPLY WITH ALL NO Issued by: Date
SOU R G NDERS
—��l n 4- 10- 09 Re-roofs
SIg or Applian n mr Data
X DOUS MATERIALS DISCLOSURE Type ofRoof
Will de applicant or futum building ttcupant stem Of hands haa.ous material
as definetl by the Cupertino Municipal Code.Chapter 9.1x,and the Heath and Safety
Code.session 255324)7 All roofs shall be inspected prior to any roofing material being installed.
❑rat �No
WIII do applicant or forum Wilding by has B tic equipment er devices which
If a roof is installed without first obtaining an inspection,.I agree to remove
I Isa.aw mcantwinanu u defined by me Bay Area Air Quality Management all new materials for inspection.
�- DlsuicR
0Yes
I have read the busNas mused.],mquimmcm5 under Chapter 6.95 odic Califon.
ns HcaW&Safe Cattle,sections 25505,25533 ami x5534.I understood this lfhe building
dent em. eve:a lcomL Usat it s my mapouibilily m notily me aceupmt nt lac
myuircmc w e ten mnrmia.anaar.Ce.rlk.m.raaPamcy' Signature of Applicant Date
—T
Owners .rimd stem DoteAll roof coverings to be Class'Wi or better
' '
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37515043 . 00
DATE ISSUED. . . . . . . : 04/10/2008
RECEIPT # . . . . . . . . . : BS000004443
REFERENCE ID # . . . : 08040077
SITE ADDRESS. . . . . : 10361 MENHART LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . .. . . . : JOHN HAIMES
ADDRESS 10361 MENHART LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JOHN R HAINES
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . .: NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 15319 CHATSWORTH ST
CITY/STATE/ZIP . . . : MISSION HILLS, CA 91345
TELEPHONE . . . . . . . . : (818) 221-6057
® FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 375. 00 0.50 0. 00 0 .50 0. 00
IEPERMITFE FLAT RATE 1. 00 40.79 0. 00 40 .79 0 . 00
1ERT<200 UNITS 1. 00 40.79 0. 00 40 .79 . 0 . 00
ITRAVDOC FLAT RATE 1. 00 40 .79 0 . 00 40 .79 - 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 122 .87 0. 00 122 .87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 122 .87 #107
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER
L CITY OF CUPERTINO
TEMP POWER
CUPEkTINO PERMIT APPLICATION FORM
APN # 7 r. — i - O. 3 0 (� O Date: p r
Building Address: 0
I® 3 I
Owner's Name: Phone #:
Contractor: Phone #: �$A9 S Z ,SG7S
WA4 ,,,11 ban �� f Fax #: 0 ICo 1 O
Contact: Phone #:
Po,+
Contractor License #: 0
Cupertino Business License #: '77537
Job Description: II
pow-PC O
Residential �' Commercial ❑
Valuation (cost of project):
� 37 _
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>1K Res. Temp Power>1K E 1REAP14
Amps
IERT<200 Res. Temp Power<200 E
Amps
IERT2001K Res. Temp Power 200-1K E
Amps
IEPERMITFE Electric Permit Issuance E
( IELCPLNCK Electric Plan Check E
1BSEISMICR Seismic Residential B
CITY OF CUPERTINO
a10TEMPPOWER
®CUPEROTiNO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
IECT<200 Commercial.Temp Power E
<200 Amps
IECT>lK Commercial Temp Power E
>1KAm s
1ECT2001K Commercial Temp Power E
100-1K Amps
f ITRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
Community Development
10300 Torre Avenue
F /' Cupertino CA 95014
-` Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPEkTINO
Building Department
JOB ADDRESS: 10361 ftpyjkaLn
PERMIT # 0O 01-f 00 ..7
ME
OWNER'S NA : 7o PHONE # 0 3 - 2(o
GENERAL CONTRACTOR: S2 14 FAX # 408 744- 8991
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical Co +r h �q I s •t2 S 3
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
r/Contractor Signature Date