06060110 CITY OF CUPERTINOab t{� zE . w
BU16DINo DIVISION PERMIT ".�C:O1vr1'12.AGTC'1R`INl'`�R�ItI „�V
'
BUILDING ADDRESS: , D & D CONSTRUCTION PERMIT No.06060110
0690 MERRIMAN RD
.R'S NAME: PERMIT L%UE DATE
LILY MIRO _ 1447 HAMPTON DR 6
PHONE: SANITARY NO. CONTROL NO.
(408) 666-5298
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO PLUMB MECH O
uoo LICENSED CONTRACTOR'S DECLARATION IOW Description
Inanity arbor Nal 1 am licensed under provisions of Cheper 9(commencing
wim Section 70001 of DiOxion 3 ardor Botrnets and Proressiun Cade.and my[me.is
in full force and effect.
Liz
Lima=Class Ix.g INSTALL TEMPO POWER POLE
Dam Oomacwr r
ARCHnECr3 DECLARATION
tii O I understand my plana shall W used as public mcorda
,a� LkcnsodPndcssional RECEIVED
pN OWNER-BUILDER DECLARATIONS i I I hcmhy afRrm that I am exempt from the Contractor's License Law for dm
is O o fallowing mason.(Scetiam n 7031.5.Business and Professions Cade:Any city or county Jul
$ which requires a permit construct,a1mr,hmo not
ad,dcnlish. air any swop.
prior an its issuance,alar acquires the Applicant for each permit w fico a signed summit
-�< that he is licensed pursuant to me provision,of do Contractor'shapm Limme:Law 9 Sq.Ft.F GOT Area Valuatio 100
(cat be
exempt
heNrom and ft Waionlafthe Burneeandon,Anyn.,Code)or -
.. met io ts exempt therefrom and the buts for tine allagnd exemption,to Any riFlatrn of pp
Section than l by airy applicant for a permit subjects the appOcanuo a dull pkulty of 3 4 2 OT . 00
Occupancy Type
not mart man fico hundred dollen($300).
❑I.u awns of die pmperty.u my employ=wW nags a lash sok compensadon,
will do the week.and thetauetum it notmmnded oroQetad ranale(Sec.7044.1husiaaa Required Inspections
and Pmrefsian Cada:The Communes Lica m Law does WI apply w an awncs a q P
property who Wlldsorimpanw thorn.,end who duessuchwork himsslfo WouN his
awn employee,provided dw such impmwme ss am art imevded aro@sed for rale R.
hawewr,the building or improvement is sold within arc year of completion.the owner.
builder will now me Works or pmvin8 dust he did rot build or immune far purpose of
"k.).
pry 1.as aw sr of the ProRmY,are eachosiwlY comm-{wim licensed mnmcon an
continues the project(Sec.7014•Business and Profession Cade:)The Contractor's Li.
cases law does not apply to an owner of property who Wilds or impmw theism.and,
who concocts for such projects with a conuactor(s)licensed pursuant to the ContraetoM1
License Law.
❑1 ore nempt and .B A PSC ffaar�miar mum..
r Dam 6/is/o6
WORKER'S COMPENSATION DECLARATION
1 hereby afNm under penny,of perjury nn of the fallowing decimation:
❑IhawandwillmalnoinaCeNBcatenf Caase.imelf-ImsumforWorlmesCaopen-
sWon.as Provided raw by Section 3700 of the Labor Code,far me par(...of dm
work for which this permit is issued.
❑I law and will maintain Workeh Compensation Innuince,as acquired by Section
3700 of the LAWr Code,for the performance cruse wok fawhich this permit is loved.
My Workers Compemadn lnsumnce carrier and Policy mumbo am:
cmme, P.1ky No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This smd.nced nttzmar plemd if the permit is faon hundmEdoBan(5100
or less.)
1 anify Wt in the performance of the work for which this Permit is issued.1"1 nt
employ any person in any manmerse u Or become subject w the Workess'Compensation
LAWS of CHffomlA Dam
Applicant
NOTICE TO APPLICANT:If.arm,making this CeNRcam of Emosption,you should
become subject an the Warkers Compensation provisions of the labor Cade,you most
�Q foMwith comply with each provision or this permit Mall be decmN mmked.
�y CONSTRUCTION LENDING AGENCY
F+ (hereby afRrm mat mea 4 a construed.lending agency for de performaom of
a the work for which sok permit k issued(Sec.3097.Civ.C.)
WM Q Lender's Name
a z fender's Addacss
U O 1=try that I haw mad this application and cam mat the aft.laknormn k
{P. comet 1 a5ma to comply with 411 city and county oNinanevs and rum laws relating In
�U building conswctinn,and hereby authorin repmscomives of this city to Omer upon de
GTI show-mcntiuned property for inspection purposes.
d (Wa)agree loss n,indemnify and keep hArmless me City of Cupertino against
rA liabilitie.jndgments,casts and expense which may In any way same against aid City
in consequence of the{noting of this remark.
APPLI DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date C
SOU REOU
1111/-Vmf Re-roofs
Signature of ApplienUComuacwr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futum Wilding aaupmutore an handle hazardous material
Reed by One Cupertino Municipal Code.Chapter 9.12.and me Health and Safety
c,Section 25532(-)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes �`No
If a roof is installed without first obtaining an inspection,I agree to remove
Will me applicant or future building occupant use equipment a devices which
emit h4vardnu,air conuminanu as deRncd by the Bay Art,All Quality Management all new materials for inspection.
Dhubct7
❑Yea 'X'Nr
I hew mad the harardmts materials sequimmeno under Cbepmd.95ofine Cdifor-
niaHcah"SafclYCode.Sec0ats25505,25533 and25534.i understand ttuifine Wilding
does nr curmndy ham a tenant,ren It k my respanlbility,in notify dm sampan mf dm
acyuimmm�u which owsfi met priorwissuancc oIs Ccrtifinem of Occupancy. Signature of Applicant Date
Ir/"jr/.4 All roof coverings to be Class'B"or better
Owner orm nos agent Dam
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34216012 . 00
DATE ISSUED. . . . . . . : 06/13/2006
RECEIPT # . . . . . . . . . : 34840
REFERENCE ID # . . . : 06060110
SITE ADDRESS . . . . . : 10690 MERRIMAN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER • LILY MIRO
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : LILY MIRO
CONTRACTOR . . . . . . . : ENDE WU LIC # 23939
COMPANY . . . . . . . . . . : D & D CONSTRUCTION
ADDRESS . . . . . . . . . . : 1447 HAMPTON DR.
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087
• TELEPHONE . . . . . . . . : (408) 666-5298
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 3117
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
______________--------------
103 UFER 304 ROUGH ELECTRICAL
•
Community Development
10300 Torre Avenue
-%' Cupertino CA 95014
Telephone(408) 777-3228
�U PCITY OF EI �N� Fax(408)777-3333
fL 1 Building De artment
JOB ADDRESS: IA�Q� Aft ;P ;/x444 �W PERMIT#
r i k0
OWNER'S NAME: t4,Y PHONE # 46d- 6SV--.C2 e
GENERAL CONTRACTOR: AV FAX #
I am not using any subcontracto
Signature Date
Please check applicable subcontractors and complete the followinginformation
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
TEMP POWER
•CUPERTINO PERMIT APPLICATION FORM
APN # 34 — I l,�_ 0
I2— Date: 6
Building Address: L L lU
l06 pa 9yleis..r,� �d C� eAiiM� (.P� 3sa1cy
Owner's Name: Phone#:
Contractor: �q D Ct kr74 Phone: License #:
6/ 7 6
lJ ,bq
Contact: Phone: Cupertino Business License#:
-Fva-L W ��-( - 6 )J)
Building Permit Info: Ili r Pa'
� 1—
Elect
Job Description:
Residential Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL,
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING