Loading...
04090229 (2) CITY OF CUPERTINO ' ,'�'�' �` BUILDING DIVISION PERMIT PCONTRAM— OR INFORMATION BUILDING ADDRESS: PERMIT NO04090229 04090229 OWNER'S NAME: PERMR ISSUE OATS ST. JOSEPH ONE: SANITARY 90. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH III uo0 LICENSED CONTRACIOR'SDECLARATION Job Description y C w 1 M¢by affirm that 1 am licensed itder Powsiom^f Chapter 9(commencing $ml! il ]u(%q of Division3of NC Bus'gC�aa dPro uinne Codc,and my'cents is 2m,,, mmB doff«,. TEMP. POWER j 2 Li f"11c Iasi Lic.p CONTRACTOR: R. P .D. ELECTRICAL SERVICE x� sD ry e I undcrvan my pia shall umJ as no lie memds Oyu ;�G Licensed Professional 3 OWNER-BUILDER DECLARATION yR 1 hereby affirm met 1 am exempt from the Contractor's License Law for me i o o following moon.Section 70 21.5,Business and Professions Cedc:Any city Or county K m which requir a permit Ip construct,alter,impmw,demolish.Or repair any s,rectu¢ - Ito-mi prior in its issuance,also requires me applicant for such permit to file a signed stammen, < ma,hes,T,eenudpamuv,ttohepmvisines^rthe connecon•sueenaeLaw(Chapter 9 Sq.Ft. Floor Area Valuatio$ 00 .50 (commencing with Section 7000)of Division 3 of the Business and Pmressioas Colk)or y Nat he is exempt Osterman and the basis for Ne alleged exemption.Any violation of Seedon l031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type no,more than five hundred dollars(550). 01,as owner Of the pmpmy.in my employees with wages w their sole compensation, 31626093 . 00 will do the work end the awc rte is no,intended or offered for sok(Sec.1044.Business and Professions Code:The Conmmor'e Luxe Law does on,apply to an owner of Required Inspections Own property who bodies mvi&d that schimpr andwho=not intended work croffa m through his ownver.the Ding or i prsuchnt is improvements artnot ear of cmOffemd forthe ow.r.. however,the building or improvement is old within one Weld or improve for the owner builder will have me burden or proving mat he did no,build or improve for purpose of salt.). l 1,as awmf of the property,em exclusively convu,ing with licensed convectors to �L comLa the Pmjen(Sec.]1144,weer of and ProfessionswhWill Codei The Contractor's Li \` come,o c law dors not apply a an with a of property who drills or improves thereon.and whoLaw.for such pmjecu with acontnaogs)limned pursuant to the ConvxmYs 0 License am law. �I am exempt ndcr Sec. .B&P C for this moon Dees WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury Om of the following declanduv: I haw and will meimain aCenificau of Covent to self-imum for Winker-COmpen- sstivn,as provided for by Saban 37M of the labor Code,for the perionuince of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3100 of nor Code,for the performance Or the work for whichthispermits issued. Cy We ctaCif C xFl Insurance PrION FROMW Mr RS' ll.• COMPENSATION INSU (This section need no,Wcumplcmd if she permit is fmrune hundred dollars($100) or less.) 1 eenify that in the performance of the work for which this permit is issued.I shall not employ any pension in any manner an u to become subject to the Workers Contractual Laws Of Califomia.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker-Compensation provisions or me labor Cook.you must .J O furthwim comply with such provisions or this permit shall Inc deemed revoked. Z"i CONSTRUCTION LENDING AGENCY [-. Ihereby affirm that lhert is a eoxtmnlnn lending agenry,for the perfmmenac of C4 the work for which this permit is Wood(Sec.309'/.Civ.C.) (4]Q Lende's Name D. lender's Address U O 1 cenify mat 1 have mad his application and area,that the above information is tL P correct.I agree to comply with all city and county ordinances and sues laws relating to 0 building construction,and hereby authom,mordenutives of this city to cna,rupnn me ,ra above-mentioned propeny for ixpcction purpmcs. , (We)agree in saw,indemnify and keep harmless d¢City of Cupcntno against F fA liabilidu,judW�Q is; apcnsea which may in any way acmue against said City U z APPLIeq TtAN Sin,qf IAIND rmn COMPLY WITH LL NON-POI Issued by: Date /`S. Re-roofs coign re of Applicant/4 onhO HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof Will the applicant Or future building occ tparrt store or handle havardous material s defined by me Cupertino Municipal Code.Chapter 9.12.and do,Health and Safety rude.Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building Occupant use equipment or devices which faink If a roof is installed without firs[obtaining an inspection,I agree to remove haurdous air contaminants as defined by me Bay Area Air Quality Management all new materials for inspection. District' ❑Yes V nu materials rtquimments under Chapesrb.95ofthcCalifnr- niaHyC .Seed x235(15.25533 and 25534.1 undcrsund this ifthe Wilding does w a ten 4 that n v ms onsibility to nodtymeOccupantOrthe mqui ate �ri . xis, ¢4�mcemrr:,L o aper. Signature of Applicant Date ter ratmnmcdagent Dam All roof coverings to be Class "B"or better -�, Community Development r ' 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 �UPEI�TINO Building Department JOB ADDRESS: PERMIT # O lc A2.c> �-I, II� a�lo.C�ti ,exl Q,OI� 02 OWNER'S NAME: Sr, pAe-tS PHONE # GENERAL CONTRACTOR: 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 eet Rock /Ire /Contractor Signature ate CITY OF CUPERTINO �2wt�. �p� o � o Z z7 CUPEkTINO PERMIT APPLICATION FORM APN# 3 / LG Date: B ildi dress: U Owne Name: Phone#: Contt9r: 'G .� rC� License C t: Phone Applicant/Contractor: Building Permit Info: Bldg Elect - Plumb Mech Job Description: Residential: Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: tion: Type of Construction: Occupancy Group: • QtY. . A c e Fee ID Fee Description Fee Group / BPERMFEE Bldg Permit Fees BUILIDNG i BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK Plan Check Fee BUILIDNG 7 � W1 I � �L I� ln ' BUSLIC Business License BUII,IDNG z7 1 � 3 �t- ?,� . v7