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08030033 CITY OF CUPERTINO �' .r3 • 1;e815 come %" " ' . BUILDING DIVISION PERMIT CONTRA. TOI2INF.(? , ` ION.w BUILD RESS: PERMIT NO. '��9� PEACH BLOSSOM DR UNITED SITE SERVICES 08030033. OWNER'S NAME: PERMIT ISSUE DATE 18 ANTHONY & MARGARET VIERRA 3408 HILLCAP AVE 03/07/2008 NE: SANITARY NO. CONTROL NO. ARCHIEC(ENGINEER: - BUILDING PERMIT INFO TEMP POLE a1-DG ELECT O O PLUMB MEcx O O reap LICENSED CONTRACTOR'S DECLARATIONIdE IW Description 1 heebY"an dun 1 son licensed under pravidmu of Chapter 9(commenOeSCrIp cing with Section 7")of Dlvidoo Sof the Business aha Profesdo ct Code.W my license is in fall feta and nrren. 3 unman class tea.g E Dau Contractor 'eej��tr ARCH,IECTS DECLARATION 6 U I understand my plans shall W used as public records g CCCCw� Licensed Professional OWNER-BUILDER DECLARATION E I bcmby affirm the I am uempn from the Conuanurl License law for the OC fallowing wan. cd an.(Seon 7DI3,Business and Pmfesdmn Calc:My city or county 1514! with rcquiru a Permit to mnsuuet.alter,improve,demalub,or repair any structure zS prior he its uewnc0.also requires du applicant for such permit m file a signed sutement < that he is licensed pursuant n otheprovisionaloftheConuaur'sLicenseLaw(Chapur9 Sq.Ft.Floor Area Valuation D (commencing with Steven 7")of Division 3 of the B udncu and professions Coat)or 2 that he Is gagmpt therefrom and the basis for du alleged uempdan.Any violation of Section 7031-5 by any,appilcut for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type ore came than ave hundred sal,,(S500S ❑I.ssowmer otrie papctty,car mY wuPloym with sagcauthe,soleearnpenaron, will do the wart and the strucue is rctinunded oroQeted formic(Seg.70/4.Budmss and Professional Code:The Connecters License Law arca Not apply m a ower of _ Required IDSPeCL100S property who buildsmimpmwa Merton,andwha doessuchwmkhimselfar Wough his own employes,provided thetach Improvements are not intended woRered formic.If, however,the building or Improvement is sold within am year orcomPletian,the owner- builder will have the burden of proving that he did act Wild w improve far purpose of tab.). ❑1,u m=or the property,and uGudnly contracting with licensed antrYlea in comuuct the pmjea(Sec.7014.Business acrd PofeWom Cus e)The Conuscte's U. . oma law des nom apply to a ower of prapen,wno builds or improves Nacre,and. who cantata for such projects with aeonuactm(s)licensed paramount to rte ConuumYs Lbeme ❑lam a pt under .a&P m rquon / 6IMOOI Date WORKERS ENSAITON DECLARAT70 I hereby a01tm under ray of perjury ane of rte fellaring declarations:IhaveandwillmdW nna emOcauofCamenuo.1f-imumtw Wod sCmnpeo- saran,as Provided for by Section 3700 of the Labour Code.for the performance of the wad for which this permit is issued. ❑1 have sod will maintain Warners Compemaron W ursnce,u required by Section 3700 of tiro Labor Code,far the pnformance of the wd for which this permit he Wood. Compensation Worker,Compensation I m come artier aha Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thi maim aced an,x completed If the permit is fame hundred dollars(SIM) or leas) I carry that in the performance of the work fm which this Perm,is issued.l shall not employ any person inmymaurcrsossm came an o to Wohen'Compenadon lawaar Califs Da Appaam NOTICE TO LICANP If.aller mg this Certificate of Exemption.you should assume subject Ib the Wartrrs Comps don provisions of the labor Cede,you must 0 O forthwith comply with such Provifiou r Nis permit shall x doomed remised. z tiCONSTRUCTION LENDING AGENCY [—m Ihechy M.rut the.u•amuucrnm lending agemy for the pmforen.of Ce> dm sod far which this permit,issued(Sec.3097,Civ.C.) W Lenders Name z tessera Address U 0 1 modify that I have mad Nis application and sou that the above infmmatiun is carred.I&I=to comply with all city and county eminences and sum laws elarng as O SV: building construction,and hembymihodce representatives ofthis city.tour upon the above-n mmormi property for inspection purposes y (We)agree m un,indemnify and keep bamdaaa the City of Cupertino against rn liabilides,judgmenu,costs and expenses which may In my way statute agdmiWall City U Z in consequct ce of the gn m ng of his pemmlt. ^ APPLICANT UNDER NDS AND WILL C PLY WITH ALL ON-P INT Issued by: Date SOU EGU ,/ v 6a Re-roofs Sig erg ofMplianUConuae HAZAR US MATERIALS DISCLOSURE Type of Roof Will the appllcatmf building msupantstere orhadle hauchms material U defined by Oe Cupemna Municipal Code.Chapter 9.12.and till Health and Safety Code.Section 25532(e)t ❑Yca No All roofs shall be inspected prior to any roofing material being installed. Will the applicut or rulum building occupant use equipmat w devices which If a roof is installed without first obtaining an inspection,.I agree to remove emit hourdous air contaminants u delimd by the Bay Area Air Qua1Ry Management all new materials for inspection. District? ❑Yn _ I have esti the husmaama trials requirements underChap e,6.95ofthe Califm- nix Hal"SsrmyCode.Saaiumu25505,25533 and 25534.1uMaaaM thdifths 'Iding t car.nry ha a mem,da It,.y ndmrty m airy nate t car the I mentswma aummet a of.Certificate Of Signature of Applicant Date weer or amhorixd neem Dow' All roof coverings to be Class'W'or better • CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36611148 . 00 DATE ISSUED. . . . . . . : 03/07/2008 RECEIPT # . . . . . . . . . : BS000004103 REFERENCE ID # . . . : 08030033 SITE ADDRESS . . . . . : 7677 PEACH BLOSSOM DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ANTHONY & MARGARET VIERRA ADDRESS . . . . . . . . . . : 7677 PEACH BLOSSOM DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5248 RECEIVED FROM . . . . : ANTHONY VIERRA CONTRACTOR . . . . . . . : KEVIN MELLIFONT LIC # 742 . COMPANY . . . . . . . . . . : UNITED SITE SERVICES ADDRESS . . . . . . . . . . : 3408 HILLCAP AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95136 • TELEPHONE . . . . . . . . : (408) 295-2263 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 40.79 0. 00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 102 . 89 0. 00 102 .89 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- - ----------- CHECK 102 .89 262 --------------- TOTAL RECEIPT 102 . 89 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL • - 402 TEMPORARY POWER CITY OF CUPERTINO C � TEMP POWER OCUP`EkTINO. PERMIT APPLICATION FORM ,5 CO3 APN 0 toI ry t,QV Date: Building Address: Owner's N e - Phone#: N-) NZ Z(& 22s-z-Wf0 Contractor: s s License#: Contact: /� /v N � L Cupertino Business igense #: Building Permit Info: L; Elect ❑ i-Te-1v1vVA Job Description: Edefn Commercial ❑ ect: • Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING • .r, Community Development 10300 Torre Avenue YJ Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 OUPERTINO Building Department JOB ADDRESS- PERMIT # ? W? PeCA '0(6-4/' a, 0 ©eD �a6 � OWNER'S NAME: eJ PHONE # apF 2YZ- �b GENERAL CONTRACTOR: faoft2k (VV P FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 60 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 niractor Signature Date