08030135 CITY OF CUPERTINO r & '• - x „�, € �' * °"' s., r"'
BUILDING DIVISION PERMIT CC�NTRAC'rORLZMA, O1C :
BUILDING DDRESS:
PERMIT NO.
1081 SCENIC BLVD C & D FREITAS CONSTRUCTION 08030135
R'S NAME: PERMIT ISSUE DATE
TIM & EMILY MASLYN 23610 MORREL CUT—OFF RD 03/24/2008
PHONE: SANITARY NO. CONTROL NO.
(408) 353-1228
ARCHrIECT9ENGINEPR: BUILDING PERMR INFO
BLDrO ELECrO PLUMB O
3m
0o
LICENSED CONfRACnOR'SDECIaRfChap Job Description
'� 1 hmcby affirm Nu 1 nm r ft Bu under previsions of cM , Y(commencing
mitt Secred Malt,
DlHuon3ofdc Bainess aes Profuoiom Cess,and mylittnses TEMP POWER
mm.roresAntleE 2w$GSl'1
Data Cl Lrso
Data cor7rS DEC
ed ARCHr1ECse D public s
t U I uMeratand my Ptsm Nail be tined u public rtCoNs
Licensed Profeanonml
5 OWNER-BUILDER DECLARATION
5 I hcmby affirm that I Am uemp,from the Conmmors License Law for the
is O 0 fallnwinp mown.(Section 70 M.Business and Professions Code:Any city or county
$ which mqulrm•Pa,mit u cmtuucl Alun hmpmve.demol W,nr mini,AsstructureYstructureiy Mar to its ismama.Alan requires the applicant far such Permit to fin a signed suumcm
IMl he u licensed pursuant W that Provisions or the Caraccou'l{Jeanne law(Chspw 9 Sq.Ft. Floor Area Valuation
6 (commencing with Section700MorDivision 3ofdive Business and PrefessionsCode)or $500
�.-
thou he is sumpt datmfwm and the bads for the aisges..-...pdmt My violation of
Section 7031.5 by Amy appliaua far a Permit subjects the applicant to•civil penally of
non mart than firs hundred dollars(SM 35704035 _V((f Number Occupancy Type
❑I,uowm of Nape Manci mmywploysv or
rOaagpunneb role ,Bacences
will dothe wort,and thehe ComtsooI,I.I a raw cafornr(Sec.7014,".a,a
And PoIlenYwh obu cam:The wsthom ,Lures law uch nal apply lf An ower i Required Inspections
Own,un lana bunmarimproveschmeon,wawM Me nsmn wart coopuse,jm ago ala
owoemploym,pogorI that raahimPrommmit in mlintendesmaedon.the
r.
huwevv,aor lhaved es mden of
wngthat wlthuamueu of mpoe,for the owner- -
Milau w10 have W burden of Prating that Ire did not bull or improv for pudpose of
ssrJ. .
❑1,As ower of Chat property am exclusively cm arr ,sing wad Iiceued Contneton nc
comtNm the Project(Sec 7044,Baines and Professions Cotler)The Commence,U.
acme Law dais mol apply 0 u owner of property who Wild,m improve,theman,aha,
who Contracts for such Projects with m mnwcsrtU licensed P.m to tie Contractors
License Law.
t]l Am a sap,undo See .B d P C fm this mssom
IV
WORKERS Dau
COMPENSATION DECLARATION
I barony affirm under penalty of Perjury and of the fallawing CACWkro,
❑1 haw and will maintain•Cowifcaudd Consent to nelf-iAsum forWofte,Compan-
.dm u provides fm by Secdan 3700 of tic ha Code,fm ths perfonnamo of the
work for which this Permit 4 issues.
❑1 hove And will maintain Workma CampuuNan Imurnntt,An required by Sees.
3700 of the Labor Code,fm the Perform Anto of Ne wart for which this permit u lssml
Mr workers cartim Cmnpenud snit¢ and Policy numberm
a :
r:
Curle -`S�Policy No, I2S9 JG
ERI7FlGTE OF E%EM MON FROM WORKERS'
COMPENSATION INSURANCE
or Iual('fists Unction need Out ancompleud If the permit is In,one hanades mllus($100)
I certify that In tan PmfomanCo of Chat wart fm which this Permit 4 Wood.I shin amt
employ lay Person in any mance rat u A)become subject to the Worker,Campena0m
Lawsof California Due
Applicant
NOTICE TO APPLICANT'If,after making this CcniHnte of Exemption,you should
become subject An the Workm's Compensation Pmviuom of she Mbm Code•you muss
0 O fonnwith complY with tach provluou m this Permit Nail be demand mwkcsL
'Z
y CONSTRUCTION LENDING AGENCY
1 hemwy aRnm that dam is mcd finding Agency rat the Perfmrce
meof
0.' the work fm which thin permit 4 mncd aa(So(Sec.300 97,Civ,CI
GQ Lenders Nunn
7 Z LanmrAAdam••
U O 1 ttniry that I Mw read this application and Main de,do above infomNaa I. -
{T. ;•-� carmtt I aide u comply with All city and county oNimnas and sun taw,mining an
v E buildingcon{Wction,and hereby auNariw re,.suw of this city on enter upon Ne
y shove-mejudgm property far uspemim Purpowhich may
L„a (We)agree nc ase,indemnify sed keep harmkm the City of Cupertino,guru,
C.i r/I incoiuumance,Of the
expemuash. may In My acrue qunuaid CSry
U z in camegmme of the gruun{of this permit
ti APP ANT U NOS AND WILL COMPLY WM ALL ON-POI Issued by:qjtQ� Date
E ON
3 Ly O Re-roofs
thlinklume of AppiimnUCon r I Dan(
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will uat applicant or forurt building oreupw,rmm o handle huallom mmmiai
defend by the Cupenim Munici Code.Chapter 9.12.and the Hallh and Safety
, ❑Yat Section 255324)?p)7 All roofs shall be inspected prior to any roofing material being installed.
No
Will them Applicant or future building actor nt 1 If a roof is installed without first obtaining an inspection,I agree to remove
PP g e equipment w devices lament g P
�Disl�caisrtlnm sir cmuminau u deDY the Bay AmA Air Quality Management all new materials for inspection.
t]Yes No -
I haw mad the haadanu materials mquimmenu uncerchapter 6.95 fthe Glifor.
n4 Hanith sty Cade,Seemm ZIM5,25533 wW 25534.1 understand this if the building
data n an IIW it 4 my malamu ility to notify the 4SaPwt a
omen ark ssanttar.cn0tttearOc Signature of Applicant Date
m mmm�dantla enI Dye All roof coverings to be Class'W'or better
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35704035 .00
DATE ISSUED. . . . . . . : 03/24/2008
RECEIPT # . . . . . . . . . : BS000004246
REFERENCE ID # . . . : 08030135
SITE ADDRESS . . . . . : 10481 SCENIC BLVD
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER TIM & EMILY MASLYN
ADDRESS 10481 SCENIC BLVD
CITY/STATE/ZIP . . . : CUPERTINO- CA, CA 95014-2764
RECEIVED FROM . . . . : C & D FREITAS CONST
CONTRACTOR . . . . . . . : CLARENCE FREITAS LIC # 21616
COMPANY . . . . . . . . . . : C & D FREITAS CONSTRUCTION
ADDRESS . . . . . . . . . . : 23610 MORREL CUT-OFF RD
CITY/STATE/ZIP . . . : LOS GATOS, CA 95033
TELEPHONE . . . . . . . . : (408) 353-1228
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 #4647
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER
003 0/35
CITY OF CUPERTINO
C .- TEMP POWER
CITY OF
• CUPERTINO PERMIT APPLICATION FORM
APN # Date:
3 z y / 0v
Building Address:
10471 Sc'e c eJR,=(rtA0 -CA Q�
Owner's Name: Phone #:
c NJ
ON--2)
Phone #: `� og3S(o S'7 i 0
ON--) / :TCOCTM&l Fax #: 407 35 — S-7'91--
Contact: Phone #:
� o ►� C �Lf S �j2€ �T,�.S' �'DB 31 .6 -/ i 3 F
Contractor License #:
Cupertino Business License #: CZPN ( to kvc)
Job Description:
-4bD RE.a1 n C)F- DEA,,iiA
Residential Commercial ❑
Valuation (cost of project):
S'D0 cam'
Quantity Fee ID Fee Description Fee Group Permit Type
1ERT>1K Res. Temp Power>1K E 1REAP14
Amps
IERT<200 Res. Temp Power <200 E
Amps
IERT2001K Res. Temp Power 200-1K E
Amps
IEPERMITFE Electric Permit Issuance E
IELCPLNCK Electric Plan Check E
/ IBSEISMICR Seismic Residential B
gailm
CITY OF CUPERTINO
aTEMP POWER
•CUOF
PEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMIC0 Seismic Commercial' B 10EAP14
IECT<200 Commercial Temp Power E
<200 Amps
1ECT>1K Commercial Temp Power E
>lK Amps
1ECT2001K Commercial Temp Power E
100-1K Am s
1TRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
Eli
� Community Development
i 10300 Torre Avenue
�' �� Cupertino CA 95014
Telephone(408)777-3228
OCUPEfITINO Fax(408)777-3333
Building Department
JOB ADDRESS: 41
PERMTT #
I c��-SS I �c rc ►2 �� -$
OWNER'S NAME: I I H S PHONE #
GENERAL CONTRACTOR P i , FAX # p L
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin 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