06080029 (2) CITY OF CUPERTINO e ''°_� `°�' ''�'"'`�tm� VF N"T a��� `i�_
BUILDING'DIVISION PERMIT - 3ONTRACTO'R-INF,QR1�'I�r�,T70N,
MITNO
BUILDING ADDRESS: CENTER-LINE U044STRUCTION I 06080029
22314 CUPERTINO RD
OWNER'S NAME: PERMIT ISSUE DATE
MR & MRS RAO 918 WASHINGTON ST 08/04/2006
NE: SANITARY NO. CONTROL NO.
(650) 632-1501
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEOCH
�op LICENSED CONIRACIDR'S DECLARATION lob DescrIIt
, p
i I hereby afipm that 1 am licensed under provisions of Chapter 9(commencing p
wish Section 7000(4 ofDirlsioa 7 of the Business and RoleWoov Code.sod my licen¢Is
�? in fail fare daif Contractor { TEMPORARY POWER POLE
Licanwclass ^I' Lk.01 N 9 15 9 ,(u/V
ARCHITECTS
re DECLARATION F
I I undersand my phos shall W red as public ranrds
'0t; Licensed Professional /rte
s OWNER-BUILDER m me Con clo �" /'IJ7�
iON
i I 1 harthy affirm on I .. exempts an tpr Canons Co License taw for dm
O O following reason,(Sauon 710IA,Business and Prokuium Calc:My city or county
92 which requires a permit m construct.alw,improve.demolish,or repair my struetum $400
Zi prior m its issuance.also requires the applieaul far such permit m file a signed atatcmenl
< Nu he is licensed pursuantm dte pmviskm of the Conmcmes littme law(Chapter 9 Sq.Ft.Floor Area a era on
$ (coW mmencing wish uM Pmfc
Section 7000)of 7 ardle Buslnnassionn Code)or
-, Nat is aumpt Usualnessand Use but$for the alleged exemption.My violation of
Sermon 7031.5 by any appliault for a permit subjects Ne applicant to a civil penalty of Occupancy Type
not more Nan five hundred dolman($300).
❑I.uowrter of the pvpmy,ormy employes wish wagesutlm'v wkcampeovatian.
will do the work and the me.is hatimeadadmonered kraak(Sec.7044,Busirw Required Inspections
and Prefessiam Code:The Consensuses License Law does oat apply m an am=of q p
pmpeny who builds lir Impmws dtercon,and who does such wad him in1f lir through his
awn employees,provided that such improtemenu are notim endnd oroBeted forule.It.
however,the building or improvement 4 said within am year of completion.Ne owner.
builder will have the burden of proving that W did rot build lir Improve for purpose of
ukJ.
D 1,as owner or the property am exclusively contacting with licensed comarten to
construct the project(Sec 7044.Business and Pmfespans Cade)The Cont senses U.
cense law does not apply to an owner of property who builds or improves shaman,and
who contracts for such projects with a conoanar(s)Removed pursuant to the Complicates
License U-
0 famessmptunder See. ,Bd:PCfa Nismoon
Owner Data
WORKPR9 COMPENSATION DECLARATION
40 1 bemby affirm under perWty lir perjury am of due following decWelkns:
D[ham and will maintain aCeNficate of Consent to self-insum forWorkees Canapes.
nation,an provided for by Section 77M of Its Labor Code.for the performance of dte
wod far which this permit I.issued.
D 1 have and will maintain Workers Compensation Insunmx,as required by Section
3700 of the labor Cade.for the Performance of the wart for which this permit If lamed.
My Waraces Compensation puurarure carrier and Policy num -
Gnier. 5;fwY a �9— Policy No,: do Z3
CERTIFl�TEOF ZMPTION FROM WORKERS
COMPENSATION INSURANCE
(This secdon med mt W completed if da:permit is(wane hundred dailan 1510M
nr ea)
I cerdfy,that in dee performance of the wars for which this permit is hissed.I shall not
employ any person In any manerso as b become subject m Use Wodms'Cmapersution
Laws of CalifomiL Dam
Appnaam
NOTICE TO APPLICANT:If,after making this Certificate of Eumpuon,you should
become subject m the Workers Compensation provisions of than tabor Coda you muss
D O forthwith comply with such provision or this permit shall be deemed revoked.
„z„51CONSTRUCTION LENDING AGENCY
tr I hereby affirm that there u a construction lending agency for the performance of
[� Ne wad m vi
far which Permit es issC)
leaned(see.3D97,Civ.
OW.Q Lenders Name
z Landers Address
U 0 I certify that 1 have read this application and sate shat the above information t$
ti. F correct.l agree to comply with all city and county ordinances and state laws minting to
O U building conswction.and hereby authorim rcpreunmives of Nis city to cner upon the
14 above-mendmad pnapeny for iovpccuon purposes.
G (Wc)agree to un,indemnify sed kap harmless the City of Cupertino against
r-m r/1 liabilities.Judgments,cases and expenses which may in any mysconteMutant mid City
U rZI.s APPLIICCceneeof the UNDERST ngof DSshes WIParrott, COMPLY WITH ALL'NON-POINT Issued by: Date d
s ECU 1 (S. _V10 L Re-roofs
Signature of ApplicanpComraclor7r Data
HAZARDOUS MATER34DISCLOSURE Type of Roof
Will dte applicant or future building occupant stare or handle hamdous material
as defined by the CuMnina Municipal Cade.Chapter 9.12.and the Health and Safety
cane,Section 23332(.)7 All roofs shall be inspected prior to any roofing material being installed.
Dyes �1a
Will the applicant or comm Wading occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree t0 remove
emit haaNnu air conumimnu as dcOncd by that Bay Amo Air Gaudily Management all new materials for inspection.
DlsWct7
❑Yes )les
I have read the haardtmsmaunais requirements under Chapur6.93 ordhe Califor-
nkHea)theSafetyCade,Satiorts234 .23533and23334.1undcradshatifthc building
does t cu ndy hew a moa shri Itis my sedulity u hasty the occupant of the
mgei whkh m c p rtuis m.f.Cartillsmotdoicupancy. Signature of Applicant Date
O 'y-Db All roof coverings to be Class"B"or better
Owner or authorized 1FnL Dam'
CITY OF CUPERTINO
Sm 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32650040 . 00
DATE ISSUED. . . . . . . : 08/04/2006
RECEIPT # . . . . . . . . . : 35517
REFERENCE ID # . . . : 06080029
SITE ADDRESS . . . . . : 22314 CUPERTINO RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MR & MRS RAO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : NEILL SHIPLEY
CONTRACTOR MICHAEL F SMITH LIC # 28114
COMPANY . . . . . . . . . . : CENTER-LINE CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 918 WASHINGTON ST
CITY/STATE/ZIP . . . : SAN CARLOS, CA 94070
TELEPHONE . . . . . . . . : (650) 632-1501
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BTEMP FLAT RATE 1 . 00 62 . 10 0 . 00 62 . 10 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 100 . 47 0 . 00 100 . 47 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- ---------------- ------------ --------- --------
OTHER 100 .47 MASTERCARD
TOTAL RECEIPT 100 .47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER '304 ROUGH ELECTRICAL
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
alnov Fax(408)777-3333
6UPEkTINO
Building Department
JOB ADDRESS: PERMTT #OLQ
2231ti Ck et •
OWNER'S NAME: w >» sP, go PHONE # 6 50 .632 -I5 a/
GENERAL CONTRACTOR: Ceti lcMv�-L je:) e Ce N s k FAX # g • 3 �•��oz
I am not using any subcontractors: D (�<J2� I ^ y' 0 fo
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
Owner/Contractor Signature Date
Y OF
CUPERTI
CIT EMP POWER NO U08 OV
�UPER�TINO PERMIT APPLICATION FORM
APN# 324-50-040 Date: –
Building Address:
1122 o19? e—,IoJ— , Rd
Owner's Name: Phone #:
fl-a 2 4–M 65e - 6'3z-1Sa )
Contracto : Phone: License#:
e&b/v 5b l7 3 Z C 5 0 ) g 3 S y
Contact: Phone: Cupertino Bu si ess License#:
Ale CG S4 i Ce U Zo'7 g639
Building, Permit Info:
Elect u /ems Pa w e2 F0
Job Description:/0c1
uj k a n, c ., pi>Loaa
Residential Commercial ❑
Cost of Project: o,
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING