05090226 CITY OF CUPERTINO ct ..agw,5u't
BUILDING DIVISION PENT CUNTRACTORaI.�NF, ORMAT
BUILDING ADDRESS: PERMIT NO.0 5090226
10224 PENINSULA BLVD
OWNER'S NAME: PERMIT ISSUE DATE
Alk MICHAEL VITALE 09/30/2005
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: �a n BUILDING� MM INFO
MIN
ELEC'f (L..r UFtB O
tau'I11
30o LICENSED COMRACTOR'S DECLARATION Job Descri hon 1�
1 hemby affirm Wt 1 Am licenw•d under pmv ms of CMpwr 9(mmmencin{ P
wish Saban 7")of Division Sof the Busineatand Professions Code,and my ik.is
n, bmBmreeandA'ellve^3! 3 062 REPLACE SEWER DRAIN, LINE OCT z5 2005
Dam °a l C a�"aemr V. CONTRACTOR: ALERT PLUMBING
Aacx CrSDECI.ARATIO � ;a F���}]� y .��p
1 un0ersund my plansshall W used u public records �J+(�- et�l t7
X c] Lkertud Prefcsaional
OWNER-BUILDER DECLARATION
j�I I hereby 4f m Nil I am exempt from the Conuamoor's Licens,Law for the
O O following reason.(Section EB 1.5,Business and Professions Corte:Any city or county
s$ which requires a Permit to construct,altar,improve,demolish.or repair any umetum
prior In its issuance,also requires the applicant for each permit to Ole a signed sumncol
< that Imislicensedpunuentlolheproviatons ofineCmnusecmr''sLm
icee aw(Chapter 9 Sq.Ft. Floor Area Valuati
x O (c.mencingwiLh Setion7000)of Diyision3ofsite Businm and Nor=ionCode)or
$ Nn he is exempl therefrom W ma bub for the alleged caemptim.My violation of
Section 7031.5 by any applicant fora permit subjects the Applcanl to a civil puulty,ofppPNN NNttmber Occupancy Type
not mare Than five handred doll.(M). 3 2 6 2 2 8 2 0 . 0 0
❑1,as Owner of the property,or my employees with wages As their sok compensation,
will do the work and Ne ewcwre bo at intended Or offend mrsam(Sm.7044,Business Required Inspections
and Professions Code:The Contractor's License taw does not apply m e in owner of q P
progeny who builds or i mprows thacan.and who does sach wank himself ser through his
own employers,provided that such improvements are not inmWed moRered for ale.IL
however.the building ar improvement ie sold within oro year of completIon,the ower
builder will have the burden of proving Wt he did ret build or improve fan purpose of
us.).
❑1.as owner of the property,am exclusively contracting with licensed convector to
construct the project(Sec.7000,Business and Professions Cade)The Conlraelo's Li-
cense law does not apply to an owner of property,who Milds or improves thereon,and
who contacts for such projects with a contractor(s)licensed pursuant u the COAMO r'1
License law.
❑I am exempt under Sec. .B as P C for this won
Owner Das
WORKERS COMPENSATION DECLARATION
I hereby Alam under penalty of perjury one of the following declarations:
1 have and will maintain•CeNficate of Consent to self-Inium for workees Compere
Amon,ex provided to,by Section 37M of the ISWr Code,for the performamc of the
work for which this permit is iuued.
1 have and will maintain Workees Coope ecu mon Insurance,as required by Section
3700 of the tabor Code,for dta performance arms work for which this permit s iumd.
My Worker's Compensation Insorance carrier and Policy number Art:
Carrier: Policy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section Deed not ac<ompleudi lithe permit lsfmme hundreddolaa($I00)
or leas)
I emify that in the performance of the work for which this permit is Issued,I shell or
employ any person in any manoer An as in become subject in the Workart Compensation
Laws of Califmmla,Data
APPOcamI
NOTICE TO APPLICANT:If.after making this Cenincam of Exemption,you should
become subject to the Worker's Compcmation provisions of the Labor Code,you mutt
.,O forthwith comply with such provisions or this permil shall M domed ne okcd.
r CONSTRUCTION LENDING AGENCY
[—i 1 hereby alRrmdut them is a mrmuctinn tending agency for the peffonnence of
Ci 7 the work for which this permit Is iasacd(Sec.3097,Civ.C.) '
W� Q lender's Name
O Lender's Add.
V O i certify that 1 have read this application and suer ser tM above Information Is
ly!'. correct.I agree to comply with ail city and county ordinances and stem laws relating to
O rV' Wilding construction,and hereby authorice representatives of this city m cner upon the
W ahove-mentioned property for inspection purposes
0. (We)agree in sew,indemnify and kap harmteas the City Of Capcnlno against
,.y y
liabilities,Judgments,cosd expeuea which may In my way acme against a id City
V In ce c{nn of Nu permit. �^a
A ICA U R WILL COMPLY WITH ALL NON-POINT Issued by: Date —r—,4- 0
SO C EGU 5.
Re-roofs
Signa of A p I I w-0 Conuactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant am or handle harndou material
AALu delmd by the Cupenina Municipal Code,Chapter 9.13.and the Health and safety
we,Seetion 25533fa)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yee o
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haurdou aircmuminanu delned by the Bay Amo Air Quality Management all new materials for inspection.
/ DistricR
❑Yca u
I haw mad the hedtwsmatadas mquimmcos under Chapter 6.95 Of the Califon
cab N&Sat yCode, 355115.35533 and 35534.1 understand that ifeae Wilding
not tiro 1 hn c ret,t t is my n mmandholly m notify the occupant of dta
muwk rat met IssuarecofofsninAmotOccapancy. Signature of Applicant Date
Owautnonree agent Data All roof coverings to be Class"B"or better
x Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
I=Lk A&r2rfLy) s"-D -� Cd 2 Z G
OWNER'S NAME: ICke&,j j\kfkgE PHONE #I{pb
GENERAL CONTRACTOR CK'C - V wn b FAX #
I am not using any subcontractors:
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 IUMI yV
Roofing
Septic Tank
Sheet Metal
Sheet Rock
ile
Contractor Signature Date
I
CITY OF CUPERTINO 2'6
' REPIPE/SEWERS/MAIN SERVICE D Sv a 2
•CUPERTINO PERMIT APPLICATION FORM
APN # 3 .Z Z2 n Z d Date: z�
Building Address:
Owner's Name: r /r Phone#:
MI �f
Contractor: Phone: License#:
ALBkT :l1v-664 11* 7.-7 L q Zo 6
Conta • Phone: Cupertino Business License#:
FUOCN &CobA
Building Permit Info: 9311"Bld El Elect El Plumb 93
Job Description: _
4404Ct 67'e54w Sew G ✓+�I i L �'�a
Residential Commercial ❑
Cost of Proje :
Off'
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Repipe of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING