06090251 CITY OF CUPFRTINO
BUILDING DIVISION PERMIT 'hC�i'["1< Tk� ^'RYA
1`d� �ZO`A`
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BUILDING ADDRESS: AC & SONS SANITATION IN PERMITNG.06090251
7554 NORMANDY WY
OW NER's NAME: _ PERMIT ISSUE DATE
ink CHENE MON-REN 3408 HILLCP_P AVE 09/27/2006
NE: SANITARY NO. CONTROL NO.
(408) 379-5811
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG I
l= ELECTO PLUMB
0 MO
pop LICENSED CONTRACT'OR'S DECLARATION Job Description
i F I hereby affirm that 1 am licensed under provisions of Chapur 9(commencing
with Section 70M)of Dlvtsian 3 million Business and Profession Code,AM my lkeom is
In mu fame and effee TEMPORARY POWER SERVICE
Lke lw Lee 1135
Data Contncmr
ARCHITECTS DECLARATION
I understand my plans Mall he used As public records
)yU
O y�
Licensed PNfCa510NI
<l Oat I am aUILDER DECLARATION
I hcrehy.sect that 11. eumpl from he Canuamor,Code:my c Law for the
O O following uson.(Section 7031.5.Business and are.thalmu de,oAny city or aunty _ $200
fwhich mqulua•panni to uimft alter.Improv,h r4miii car repair cd nmmcnt
-Zi dumselum
ormiuiensedp)uanttotheNovisio of the,
Law(Chapter
Valuation
F NmheislkgwithSmile.
nuammdmpmvivionafdmConunless;(Lmn¢law(CMpta9 Sq.Ft. Floor Area
��$ (eat he is exempt
Sectio rn and de bash f r of the alleged
Runless;and prafesdane CMe)m
a�..
that o u exempt therefrom and the per far the alleged eastpnt to Any violation of
Section in. by yeuryreddontfsapemtitsbjttuNeappikstso•civilpenaltyof Occupancy Type
not moo Nm five hundred dollars($300].
❑I,as owner afthe property,or my amplaycn with wages as theft solcampesadon,
will do thework AM the mother,is stimmnded mattered formic(S.C.70M,Business Required Inspections
and Profession Cade:The CommitteesLiasue Law does rot apply m An awma of q p
property who builds or i m prows themes.and who dao such work himael f m though his
ownemployees,proNdedthalmhimpmnm uamatinwndedaroRemdforale.E.
however.fee Wilding or Improvement Is sold within ons year afse pktion,the awes-
wilder MB have the burden of proving Nat M did net Wild or improve fm purpose of
Asks.).
❑1,As M.of the property,not exclusively cmnusaN{with liaised ammuanan An
aansuum the project(See.7044.Busiass and Paftesion Cade:)The Contractors U• - -
ans law don oat apply to An macer of properly,who Wilds or hnprows themon,rod,
who conuacu for such prejems with a contractor(,)Ilcaad purswnt As Ne Contractors
License Law.
0 1 am exempt under Sec ,B&P C for Nu won
Owner Dau
WORKER'S COMMNSA71ON DECLARATION
/I hereby afRres under peaty of perjury oxo of the fallowing declarations:
M, ham and will maintain A Certificate of Conant to wlGinuro for Workers Compere
Asian,an provided for by Section 37M of the Labor Code,for the performance of not
work for which this permit is sued.
averkhaw and will maintain Worker,Carepemulan Insurance,u myuired by Entire .
3700 of the Labor Code,for the perfarmarale of the work for which this permk is Issued.
My Wo lace C ensadan 1.; art. and Policy number am:
Cam • & II,No.: ;
CERTIFICATE OFEXEM ON FROM WORKERS'
COMPENSATION INSURANCE
Chiu section mod not becornpkmd If the permit is form hundud dollars(SIM)
or less)
1 certify that in the performance of the work for which 01.Permit is issued.I"I ret
employ any person in any mannerso An in become subject to the,Worsen'Compensation
Lawn of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Ccrdficato of Exemption,you Mould
become subject to the Worker's Compensation provision,of dos label Code,you most
.7. z forthwithComply with such provisions m this parmitshall Is,deemed uwscd.
„ztO CONSTRUCTION LENDING AGENCY
f'a I Wmby alarm that Neu Is a construction lending agency far the performance of
Qi > tle work for which this permit Is Waste(Sce.3097,Civ.C.)
Qlandar',Name
0.0 z Lenders Address
U Q I cenify that I have read this Application AM sum Nat the above information is
{1.E., eorrecL l agree to Comply with all city and county aNlnmes and stem laws slating to
and
aby
U Wilding
We)aation,n..indemnify nd keep
of this of urachi upon the
u7 above-mentioned propery,for inspection purposes.
(We)ague to taw,indemnify And seep Isay in m t City of Cupcnst s id City
1F—tst
fa/1 liabilities.jud{menu.cosu sdexpenva which may in my wyaecme•{sins said City
U to consequence of Ne grslin{of this panic n
APPLICA UNDERSTAN W L COMPLY WITH ALL NON-POINT Issued by: Date
SOU.RcEv�GUL/ OfjIS G
oofs (7
s mm�o An^Pplicil�tlCon I 9'p�-0 Re- of Roof
HAZAR US MATERIALS DISCLOSURE Type
WIII the applicant or futum building occupsutom or handle haaardous material
as degud by the Copenino Municipal Cade,Chapter 9.11.and the Health and Safety
Code,Section 15531()7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs
WIII the applicant or Wilding oaupant Am Ctlalpmcat or dCvl.which If a roof is installed without first obtaining an inspection,I agree to remove
emit hnvardnns air canuminsu as declined by due Bay Area Air Quality Management all new mate 'als for inspection.
District?
❑Yn
Q.6 At
ve
I have rand the husnfau materials
nuquue ,underChapter695title DOW-
ga
JNHraIm&SafetyCSalm25505,15533u,pom25l5h3ll4ia.YIum dnmtsfy dNNc ocifcupcsholding
oifdithnge
7/49
arot My . it
recilm uwhc ranaoraCcstlkamafocSign ur ofAppicant Date� All roof coverings to be Class"B"or better
Owner Aauthorizedagent Dau
Community Development
10300 Torre Avenue
alyor
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT## Or
,05
155 -N�YrandW1 Wog
OWNER'S NAME: I PHONE # 1 -
GENERAL CONTRACTOR: "j FAX# 9-;5
Y1jI am not using any subcontractors: Cl -0 -cb
gnature X 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
•
Owner/Contractor Signature Date
CITY' OF CUPERTINO
eem 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36617065 . 00
DATE ISSUED. . . . . . . : 09/27/2006
RECEIPT # . . . . . . . . . : 36219
REFERENCE ID # . . . : 06090251
SITE ADDRESS . . . . . : 7554 NORMANDY WY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHENE MON-REN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : RONALD GALVIN
CONTRACTOR . . . . . . . : YOUNGBLOOD, FRANK LIC # 742
COMPANY . . . . . . . . . . : ACME '& SONS SANITATION INC
ADDRESS . . . . . . . . . . : .3408 HILLCAP AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95136
TELEPHONE . . . . . . . . : (408) 379-5811
*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
--- -------------- ------------ ------------------
OTHER 100 . 47 VISA
TOTAL RECEIPT 100 .47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO cp(gp.,Z
� - TEMP POWER
•CUPEkTINO PERMIT APPLICATION FORM
APN# 2 Law_ I—I— C/ „5 Date:
Building Address: ALJ
75 rwt,4Nd r>
Owner's Name: 1 Phone#:
IJ - F-r3 - I eaNC
Contractor: �� Phone: License#:
ri G , e n X108- 3� L - 377 -r?�38Co
Contact: ACi � Sn0tvW"one: Cupertino Business License#:
Building
Permit Info:
Elect Lid'/
Job Description:
PC) Vic
Residential Commercial ❑
Cost of Project:
oC7. 0�
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•