05070065 CITY OF CUPERTINO
"BUILDING DIVISION PERMITiCUNTRAC�TOYixRMA'CIrON`�h.
BUILDINGA13DRESS: INTERIOR ENTERPRISE INC PERMITNb5070065
I
10495 SCENIC
OWNER'S NAME: PBRMrr ISSUBOATE
GREG RICHMOND 855 AZURE ST 0'7 /12 /200c;
HE
SANITARY NO. CONTROL NO.
(408) 245-5500
ARCHI'IECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIPLT PLUMB MECH
�Cj LICENSED CONTRACTOR'S DECLARATION
✓y I hereby affirm Net 1 em licensed under provisions or Chapter 9(commencing O
with Section 70M)of Division 3 of the Business and Prefessions Code,and my ticeve is JobRIALED
Tn fn11 from And arc INSTALL TEMP POLE
Z Lkense Clan tie.. nua/V
Z— De¢ Contractor
ARCHITECTS DECLARATION
I.
as n Ian I be used u tib ie rds
3� 1'3�'���' �"�ta��&b� �01005
�tg Licensed Pmfcuionel
Oat I a.eUIL.DEfr DECLARATION U I LI I ISI�
+� I hereby affirm that 1 OWNER-BUILDER
from deRAIO Contractor's License Low for the
Ca O follnwing mesa..(Seed..7001.5,Business and Pro(essinn Code:Any city ar county
Ca
$ which requires a permit to consu a,alar,improve,demolish.at moor any suucure
rte^ prior m its issuance,also mquires tkspplicant for such permit to file a signed suenwot
< that M is licensed pursuant to the provision of du Contractor's license Law(Chapter 9 Sq.Ft.Floor Area Valuation
8 (commencing with Section 70D0)of Division 3 of the Businessand Professions Cede)or
33 Wu lk
t k esrmpl mfrom and the basis for the alleged exemption.My violation of
Section 7031.5 by airy applicant for a permit Aubjecu the applicant to a civil penity of e10 0 Occupancy Type
not mom than firs hundred dollars(S500L
0 1.An owner of the property,or my employees with wages a their sets eomperentlon,
will do the work.and the and.u Rere
Act intended mod for Businesste(Sm.706/.Business
Required Inspections
and Pretensions Cade:The Contractors License reto e
se law dot apply An owner of q P
pmpeny whe builds or impeovex Norton,and wha dnes such wmk himalf or wmugh his
own employcn,provided waimeb Improvemanu as natimmnded noRered forsaln IL
however,the building or Improvement is sold within one year of completion.we owner.
builder will wave the burden of proving that M did tan build or Improve for purpose of
ask.).
0 L as owner of the property.am exclusively conualing with licensed contractors to
comma the project(Sec.70",Business and Profwiam Code:)The Contractors Li.
cease law does not apply to an owner of property who builds or improves thereon,and
who contnc touch projecu with A mnmactm(s)licensed pursuant to tie Commune,
Licence
01 sacro tundra see .B A P C for this mason
Ow r � t� Dow
40 WORKERS COMPENSATION DECLARATION
1 by af"Bm under penalty of perjury one of the fallowing daclan0oas:
Ilia andwillmaimains CeniBauof Co.senttoal6bnumforWmkrsCompen-
as0on, provided for by Section 3700 of the Labor Cade.fur tie performance of we
work r which this permiHs issned.
0 1 vc and will maintain Workers Compensation hour oro,as required by Section
37W of the Labor Code,for the performance of the wed for which this permit is issued.
My WorkM1 Campensedon Insurance carrier and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' '
COMPENSATION INSURANCE
(This section need not be completed if the permit lsforone buMmd dollars($]W)
or Ie0.)
1«nify that In the performance of two work for which win permit a issued.I shall nor
employ any person in any manners.As m become abet to we Workers'Compenamion
Laws of CJifomu.Doe
Applicam
NOTICE TO APPLICANT.IL after making this Certificate of Exemplion,you Mould
become subject to the Worker's Compensation provision of the labor Code,you mum
.J O forthwith comply with such provision or this permit swat]be deemed revoked.
'Z y CONSTRUCTION LENDING AGENCY
(.n Ihamby strum was wart is a construction lending agency for me performance of
lyi tie work for which this Parrott Is issued(Sec.3097.Ci,C.)
GQ Undoes Name
.7 z Lenders Addraw
U0 1 certify that I have red this application end sum was the Above infremad.u
come 1 agree to comply with all city And county dNinanees and sue laws relating to
Wilding construction,And hereby authorize mpm3an4AiM of Nis city to enter upon we
{21 ekve-mentioned property for IPurposes
(We)agree to aonve,Inde if and kap harmlm try of Cupertino against
y liablliti dgmenu,c and which may 1.an yeccmcagtlnnuid City
A c LIC CeUNDe 5TA f t ^cit MP WITH ALL NON-POINT Issued by: Date 7_/2 -f
5 UC U S.
`t Re-roofs ( -
Signa rtafA reanmcan to D
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tie pplicant or forum building occupant mom or handle huardon material
an fined by tie Cupertino Municipal Code.Chapmr 9:17,and the Hcallh and Safety
C e.Seeti..255320)9 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs --)�N.
Will the applicant or future building accupent use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t huardous air commninanu as defined by tie Bay Area Air Quality Management all new materials for inspection.
District?
0 Y f7�fit-t
Ihave th ardnus maurlalarequlrt uundcrChaper6.95ofthe Califor•
ria HeallhA y="5 25505.25373 53.lundernmethuif1Wilding
daenote ti e k1 it is my r n Iety to nou fy tiro occupant of me
.quire n en I to 'fie.earOccu)mnmy. Signature of Applicant Date
o ser ar n Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35706015.00
DATE ISSUED. . . . . . . : 07/12/2005
RECEIPT #. . . . . . . . . : 30327
REFERENCE ID # . . . : 05070065
SITE ADDRESS . . . . . : 10495 SCENIC BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GREG RICHMOND
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JOSEPH
CONTRACTOR . . . . . . . : JOSEPH CAMMARTA LIC # 23611
COMPANY . . . . . . . . . . : INTERIOR ENTERPRISE INC
ADDRESS . . . . . . . . . . : 855 AZURE ST
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087
TELEPHONE . . . . . . . . : (408) 245-5500
QEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
---------- ------------- ---------- ---------- ---------- -`-------- ----------
-TEMP FLAT RATE 1.00 62.10 0.00 62 .10 0.00
BUSLIC FLAT RATE 1.00 102.00 0.00 102.00 0.00
EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 202.47 0.00 202.47 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ --------- --------
OTHER 202.47 AMEX
TOTAL RECEIPT 202.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Cl Fax(408)777-3333
� �UPEI�TINO
Building Department
JOB AD0D 7 S• SL 5 N , l �b PERMTT# -7oo 6S--
OWNER'S
S„-_OWNER'S NAME: ( 0/l)D IPHONE #
GENERAL CONTRACTOR /- 6,i/rW-,PiE I FAX # p
I am not using any subcontractors:
Signature Date
Please check applicable subcontracto#andom Tete the followin information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Adilk Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet RodYZ
Tile
Owner/Contractor Signature Date
�,o�-arxDs
CITY OF CUPERTINO
'URI_ TEMP POWER
•CUPERTiNO PERMIT APPLICATION FORM
APN# / Date:
Building Address:/
Owner's n` 1 Phone #:
K
Co�ctgL Phone: License#:
02 EATZ (�eAtr:
Contact: ,J Phone: _V Cupertino Business License#:
Building Permit Info: '�/
Elect ❑ (--
Job Description:
Residential Commercial ❑
Cost of Project: CIO
•
Qty, if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•