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08060164 (2) - BUILDINE DIVISION PERMIT 5CONTRA.C^�T(TR INFO tI�MATOIV BUILDING ApDRUS: PERMIT NO. 1.OAp30 CALVERT DRIVE OTOVO BUILDERS 08060164 OWNER'S NAME: PERMIT ISSUE DATE BILL, SULLIVAN 4262 DAVIS ST 06/24/2008 NE: SANITARY NO. CONTROL NO. (408) 480-0802 ARCHITECTrENGINEER: BUILDING PERMIT INFO BLIX, ELECT PLUMB MECH atilt LICENSED CONTRACTOR'S DECLARATION Job Description F 1 Meby arm That 1 am licamed under provisions of Chapter 9(commencing - `� with Section 7")of Division J of dm Buvnev and Profew ioru Cade, dmyliccnxis TEMP POWER POLE s in full forte and effect n Z Livens CI Lie, A SFO Date �l/4 at�tll�Contractor- / vy R iITERS DECLARATION e U 1 undersand my plans shall W used as public record k iso Liverro Licensed Pfesdonal 5 OWNER-BUILDER DECLARATION �F 1 hereby aRrm Nat I am exempt from the Convectors Lice..Law for the o O following reasn.(Section 7011.5.Business and Proas feadoCode:Any city or county 3 m which requires to permit m cone ruct alter,impmw,demolish,or repair any someone Z< prior to is LRuance,al.W requires the applicants for such Permit to rile a signed statement thathe is licensed lammant W the provisions of the Contncmr's 4ceee Law(chapter 9 Sq.Ft.Floor Area Valuation Elt-m (commencing with Smoan7000)ofDivision Jofthe Business and PmfemioesCode)or $570 r3$ that he is esmpt thetefrem and the basis for the alleged esmpdon.Any violation of Session 7071.5 by any applicant for a Permit subjects the applicant as a civil penalty of N Number Occupancy Type net more than five hundred dollars($500). 375 1 8 0 V 7 ❑Lobe work,and prvputy,ormy intended withmgnsstie'vme.7W.Butursom will Pr the work,and a:Th Co a is tete,License La.do for.1.(See.tooaa,mamircm and property Cade:The Convssrs Leums VW does wt apply s an owns of Required Inspections property Who Wild IXimpmvesthvcon,and wed doessuNwmkhimul(ar Waugh his own em,.she building uithat such improvements art not needed oroaeed forsalm It, budder she Wildingorimprovement4soldwithin one year w impnomforNeowser- builder will One the burdco of poring that he did cot build or improv for puryo¢of mk.). 0 1,as M.of the property,w atlmiwsly Contracting with licensed coutranors s cotsnuct the pmjca(Sec.7049.Business and PreGstlons Cod:)The Contractors Li- ccmue law does not apply to an owner of property who Wilds at improves W reon,and, who contracts for sed projects with aeonuxtor(s)Besnsd pursuant m rhe Canvuaor's License Law. O l oro aempl under Sec ,B&PC for this eswn Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby aRrm under penalty of Pojury ane of the following decluafiaas: 1 haw and will maintain a Carifesa of Consent m aul6i.forWarkors Compere salion,as provid i for by section 1700 of the labor Code,for the performance of the work for which this permit is lasted. 0 1 have and will maintain Workers Compenmdon lesunn¢,as no,notd by Section 1700.1'0.labor Code.for the Fourche .of the wort for which this permit is issued My Worson, C�rypesound Insauranncme�canior and Polley num Cannot. 'J t A"f t lX"'s 1 Polity No.: r � CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu auction need not mccompleted lithe Permit Is formse hundred dollars(SIM) or less) 1 cenify that in the performance or the work for which this Permit u issued.I shall not employ any'person may manners as at become subject to the WIXken'compewtion Laws of Califomia.Dam Applicant NOTICE TO APPLICANT.If,after making this Cenifieste of Esmpfion,you should become subject m the Workers campeesadon previsions of the Labor Code,you muss .J z fafthwimn comply with such provisiar or this Permit shall W deemed rewked. Z M CONSTRUCTION LENDING AGENCY [-a m�-m I hereby aRrm that there iso consuucdnn lending agency for the perfurmsrcc of IY the wort for which Ods permit is issued(Sm.1(197.Civ.C.) MW Q Lenders Name z lenders Address U C) 1 coyly that 1 have mad this at licaden arm sus that the mews Lnfmmaden is M eorteet.I agree to comply with ail city and county ordinances and some laws relating no -0 Wilding construction,and thereby authorise mpesenalives of this city m corer upon the r W aWw-romfiored proper for inspection purpesex t„m LL (We)agree to have,indemnify and kcep to rmkm the City of Cupertino agaims, Vh liabroics,judgmcou,cosos and ea which may in my way acme against said City z in co limes of the gry t is APP IC REGULATIONS. A m-'COMPLY WITH ALL NON-POINT Issued by: Date 2 LT SO R REGUUTIONS: Re- Type / Si ar ApplicanJCan HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII yt ePCapo .Mor uni W11 Ca o.Chapter ore 9.12.handle Heard and Safety - as defined im the Cupnim Manic' al Code.LTmpsr 9.11.and the Health and Safety Cede,Schon 25531(e)7 ❑yes o All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future Wilding occupant use cqulpmal Of devices which If a roof is installed without first obtaining an inspection,I agree to remove 'ha'rdoas air conumirwm/as dimmed by the Bay Area Air Quality Management all new materials for inspection. DWcDyes I/° I hers real Whasardausmamdalsreg3ired2u4.1..&aptedh ifde Caldi.g is Hca S that is Sy responsibility undersand thuiflhe Wilding temtarac Wt it u my mcapamihilimy m twtirY and occupml of the require eta W orsiasuance.facmdfeiteorOc pumry. Signature of Applicant Date ow raraamo cdag m Date 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 375 18 003 DATE ISSUED. . . . . . . : 06/24/2008 RECEIPT # . . . . . . . . . : BS000005196 REFERENCE ID # . . . : 08060164 SITE ADDRESS . . . . . : 10430 CALVERT DRIVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BILL SULLIVAN ADDRESS . . . . . . . . . . : 10430 CALVERT DRIVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ERUMENA 0 OTOVO CONTRACTOR . . . . . . . : ERUMENA OTOVO LIC # 29871 COMPANY . . . . . . . . . . : OTOVO BUILDERS ADDRESS . . . . . . . . . . : 4262 DAVIS ST CITY/STATE/ZIP . . . : SANTA CLARA, CA 95054 TELEPHONE . . . . . . . . : (408) 480-0802 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL --- - ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION _ 570 . 00 0 . 50 0 . 00 0 . 50 0 . 00 IELCPLNCK HOURS 1 . 00 122 . 38 0 . 00 122 .38 0 . 00 1ERT<200 UNITS 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 204 . 46 0 . 00 204 .46 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 204 . 46 #216 --------------- TOTAL RECEIPT 204 . 46 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER • CITY OF CUPERTINO TEMP POWER • CUPEIITINO PERMIT APPLICATION FORM APN # Date: �e7/ � � 03 . J �� t� � E Building Address: I v °0 c-ft✓e22 i p Owner's Name: Phone #: ?' t o SLA I,L Contractor: Phone #: 0117 �v11 L Fax #: Contact: Phone #: Contractor License #: 199 ''s l) Cupertino Business License #: Job Description: Residential Commercial ❑ Valuation (cost of project) Quantity Fee ID Fee Description Fee Group Permit Type 1 ERT>-1K Res. Temp Power>1 K E 1REAP14 Am]2s / IERT<200 Res. Temp Power<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps 1 EPERMITFE Electric Permit Issuance E / 1 ELCPLNCK Electric Plan Check E 1BSEISMICR Seismic Residential B 1TRAVDOC Travel & Documentation B Fee CITY OF CUPERTINO « C TEMP POWER CUPEkTiNO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type 1BSEISMICO Seismic Commercial B 10EAP14 IECT<200 Commercial Temp Power E <200 Amps IECT>IK Commercial Temp Power E >1K Amps IECT2001K Commercial Temp Power E 100-1K Amps 1TRAVDOC Travel & Documentation B Fee 1BUSLIC Business License B e b Community Development r 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408) 777-3333 �UPEkTINO Building De artment JOB DDRESS: PERMIT# P OWNER'S NAME: �, gtjLLj k)Ar-I PHONE v'I_ GENERAL CONTRACTOR- i Ci��UI G j. FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following 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 L r Owner Con actor Signature Date