08040232 CITY OF CUPERTINO x ,�- ". ga9
BUILDING DIVISION pgRMj'r CONTRt1QT6JkA.NNk'®RMATTON
BUILo1VNCrTT"SSHAR LAP DR TBD - TO BE DETERMINED PERMIT08040232
OWNERS NAME: Y PERMIT ISSUE DATE
ARTHUR AND MARIA LECLAIRE 04/30/2008
NE: SANITARY NO. CONTROL NO.
AacxtTECrfFNaNEER: U INFO
TEMP POWER GARDNER BLDG BELECT PER PLUMB MECH
s o p LICENSED CONTRACTOR'S DECLARATION
uCW I ber by afrred Met I mea licensed under provisions of Chapter 9(Commencing —'---^ -- • ^—bob Description
ith S
�
antis 70W)of Division 3 of the Business and Prolcssions Code.and my became is
m in full force aM t.
Lie..3/ 233E
2 Dau Convenor ,Az0*.A.1
.w{ ARCHITECTS DECLARATION
o I undetsuol my plans shall W used as public mcnNs
g G Licensed Professional
''y3 OWNER-BUILDER DECLARATION
i<E 1 herchy alum Nal I am exempt from the Convenors License Law for tie
00 fallowing romn.(!;au.7011.5.Business and Projections Cade:Any city or county
S$V which requima a permit to cmmauaL alert,improve,dcmolim.ear repair any Creature
prior m its issuance.also requires Ne applicant for such permit to fila a signed statement
<
that W a licensed pursuant to de provisions of the Contractor's Liave Law(Chaper9 Sq.Ft. Floor Area Valuation
x�$ (commencing with Section 7000)of Division 3 of Ne Business and Professions Code)Or
that m is exempt therefrom and the basis for the alleged esemption.Any violation of
Section 70313 by any applicatfar•permit subjcces tW applicant m a civil penalty of APN Number
rum Occupancy�y t roam dun law ane hundred dollao(115M). P y •)'Pe
b L as,ower of the Property,or my mmployees with wages a their sour compnnsedon,
will ao the work,and the structure is not intended Or offered fur sale(See.7(aU.Butinass
and profession.Code:The Commune,License Law does not apply to tin owner of Required Inspections
property oro Wildswimprovutherton,and whodoessucb workhimCelforthmugh has
mriceeplayncs,pmviOd Instance improvements an not inWded craffertd(orale If.
bvxesc.the Wilding or improvement uaold within one year of completion,Ne owner-
Wilder will have Ne Wr ice of proving that o did at Wild or improve for purpose of
ale.)
❑1,u corner of dee property,as exclusively contacting with licensed conuacmn to
camwct the projcn(Sec 7016.Business ad Prafesdmu Code:)The Contractors U. .
Cone Law does not apply to an owner of property who Wilds or improves Nemon,end
who contracts for such projees with a eanuanor(s)licensed pursuant u,the Commerce,
License Law.
❑Iunuemptunder See ,BdPCforthismamn
owner • Dau
WORKER'S COMPENSATION DECLARATION
I hereby amens under penally of perjury,ore of the following declantiou¢
1hseand will mainrn•CmuOaunf Consent m rah-insure for Wohefs Comp r.
ado.,as provided for by Section 3700 of the Labor Cade.fw the performance of the
wars for which this prmmit is issued.
❑1 have and will mainaln Wortees Compenntion issuance,a scoolrea by Section
37W of the labor Cade,for Ne performance of the wade for which this Permit Is issued.
My Worke
Cr's Compensation Insurance artier and POlice nu ot :
Ca rnw-5ri➢'T� AIVA110 Policy NoJ areL 7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu mention need nal W conplemd if the permit is foram hundred dollars($I00)
or bail
I Certify that in Me pmrocamen of the work for which Nu Permit is Wood.I Carl an,
employ any Person in any manners as le oame subject to tie W.l¢a'Compewdan
Laws of CsdUO.ia_Dau
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificau of Excerption,you ahauld
become subject ne de Workmt's Campewtion poevisioo of the tater Code,you most
.,O forthwith Comply with mch Pmct vitioor this permit shall Ise dcemed revoked.
z y CONSTRUCTION LENDING AGENCY
[-• IMreby affirm Into Vert is a cosnuucon lending agency for Ne perfwmana of
CYi the wars for which Nis permit is issued(Sec.3097,Civ.C.)
Q Lembert Nam.
z Lender's Adams
V Q 1 cedify that 1 have mad this application and suss that the move information it
LL cotctt I agme to comply with all city and county ordinances and some laws mlating to
Wilding comuuction.and hereby mthmise mpmaenutivea of this city to cnerupno the
ed
W aWvides.j gmcnO,pcst for inspection which may
'gy (We)agree to ave,indcmmily and seep harmlea the City of Cupertino against
(VIZ Iiabili.Wentg,at Me lending mrpeiueeraft, may in any vnyamue against mid City
V'� in conscgtmtea of the yrentini of this parmil.
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z�_')o�y
SOL(gCE REGULATION .
St z .�0%2- Re-roofs �-----
gnsu lApplionUConwcmrAban
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or factum Wilding=uPmL atom or handle hazardous material
ss de0ned by the Culatino Municipal Cade.Chapter 9.13.and the Health and Safely
Calc.section 025532(a)v
y. 4N. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or devices watch If a roof is installed without first obtaining an inspection,I agree to remove
rsuuba=msa air Commemorates as defined by tie Bay Area Air Quality Management all new materials for inspection.
❑Yea IZljfo
1 have mad the haardcua materials mq.i anams under Charter 6.95 ofthe Califory
nla Health d Safety Cade,Savor 25505.15533 and 25536.T uncontested ave if the Wilding
dors not curcnily ha c a Mont,Nal It it;my maponubility,to notify the wuupent of de
nu when mus be tpd�iuuawx of CertificaM of pNyr. Signature of Applicant Date
owmwo enthardrd aSeat— f o, All roof coverings to be Class'%?.!'or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32635042 . 00
DATE ISSUED. . . . . . . : 04/30/2008
RECEIPT # . . . . . . . . . : BS000004635
REFERENCE ID # . . . : 08040232
SITE ADDRESS . . . . . : 10441 PHAR LAP DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ARTHUR AND MARIA LECLAIRE
ADDRESS . . . . . . . . . . : 10441 PHAR LAP DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1118
RECEIVED FROM . . . . : VIRGIE GARDNER
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 500. 00 0 .50 0. 00 0 .50 0. 00
1EPERMITFE 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
1TRAVDOC 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 1111
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --------------------------- ------ ---------------------------
402 TEMPORARY POWER -'
•
CITY OF CUPERTINO
CQr' TEMP POWER
• Y F
CUPEVINO PERMIT APPLICATION FORM
APN # Date:
3� �s 6ya.Building Address:
Address:
IOZ(41 O "
Owner's Name: Phone #:
2 '
Contractor: Phone #:408-6'x-So/o
tlal6k 57 do Fax #:4og -&S- Sr,14e,4
Contact: Phone#:-los-eol s- So i o
�8-
44 sG ?rte
Contractor License #: 0 / z 3 3 z
Cupertino Business License #:
Job Description: IZ�n�oac—L ZES'Qt� t�'+G
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑Q
Residential ® Commercial ❑
Valuation (cost of project): a
Quantity Fee ID Fee Description Fee Group Permit Type
1 ERT>1 K Res. Temp Power>I K E 1REAP14
Amps
1 ERT<200 Res. Temp Power <200 E
I
Amps
1 ERT2001 K Res. Temp Power 200-1 K E
Amps
/ IEPERMITFE Electric Permit Issuance E
IELCPLNCK Electric Plan Check E
IBSEISMICR Seismic Residential B
CITY OF CUPERTINO
TEMP POWER
OF
CUPER,TINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
1 ECT<200 Commercial Temp Power E
<200 Amps
IECT>IK Commercial Temp Power E
>1K Am s
IECT2001K Commercial Temp Power E
100-1K Amps
/ 1TRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
#UPEI�TINO
Building Department
JOB ADDRESS: PERMIT#
O P .4& 02 19e0yo 2 'L
OWNER'S NAME: .&•'/fits Lt, PHONE
GENERAL CONTRACTOR• ,eta&A"-r eo FAX#cO F
I am not using any subcontractors: `,) , , e.1..-.�.
Signature V Date
Please check applicable subcontractors and complete the followmi 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 f5ate