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06070045 (2) CITY OF CUPERTINO -RAN f' BUILDING DOISION PERMIT CSNI'RACT,Q� R IA}kORMATTION BUILDING ADDRESS: MANA GENERAL CONTRACTOR P°IMITND06070045 1114 HUNTERSTON PL OWNER'S NAME: PERMIT ISSUE DATE DAMLE 1839 TAMPA WAY 2006 NE: SANITARY NO. CONTROL NO. (408) 375-4288 ' t BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 lob LICENSED CONTRACTOR'S DECLARATION IOb Description V I hereby affirm uses 1 am Wns licensed under Pmvoof Chapter 9(commencing with Section 7")of Division 3 of the Businty and PrOICsskm Code.and MY Ike=is ? „ in full Z O INSTALL TEMPORARY POWER POLE ?M4 Liangt L'e.g stq Date Canlraster 7W ARCHaECTSDEcLARAT ON tae i I understand my plans shall be used As public records )yU eQ Licnnud Professional b N OWNER-exempt fr DECLARATION i f I hereby.Harm that 1 1. acmn1(runs Uro lessons o e:enseAny Lew for the p O following renwa permit a 7(D br Busher, and Pwferaiom Cade Any city or county which required a permit re uiruvuc4 dor,improve,demolish.,ri rtpoig soy tmcmure $450 thatPriorhe its lensed Pummel the applicant for suchCon Mnni'W isle r Law(ummcm that he is licensed purwantwthe provisions;of Ude Contractor's Lkensc law/Chapmr9 Sq.FC.Floor Area Valuation e�g (commencing with Section 70D0)of Division 3 of the Business And Professions Code)or that he is exempt thmefrae and the basis for the alleged eaemptiaa My violation Of Section 7031.5 by AM rpplicwt for A Permit mbjeets the aPPnant w a civil prmltY of —3fAW4Me_rU U Occupancy Type oat mom titan R.beedred dollars IS50U). ❑I,u owner of W property.a my wploym wW ergo u tim'u sok compensation, wnl Prdmam"'cra The coruscate, orsWmnGAa9Remle fs set Apply W-a,Buaircv Required Inspections and property wh obu Cade:M Conuwlors and whoLicense Law dos ret apply f et roughawase is q P awn who builds mimprowath Improvements and who Am neahwoh hWutl(mthrr sons ick own employees,provided that well Impwsemwu are Imt ear o ed 9 planed tarsale.If, build. the Wilding or Imp of tshat within am year or completion,the purpose balder will have the burden Of proving that he did not Wild or Impww(ar purpow of jf'�� sal ❑1.as owner of the proper(,.B sines And conessi n,Cod licensed anuwlprs w NALED Construct La Ude awned apply 7044.Business rad rty who Code:)The Contrsowr. nd ansae law does not reply je an owner of proper(who bailee or Improved thereon,sod. License U tsfor such pajeN LlNaconvacmr(s)licensed pvrewm wNe Contraewrs /t1(re Q License law. D lam exempt unGS Sec .BkPCfor this reason �'�a asyy �yjp�la(��Jf,/Q�p��' trwner Date �{UILM11 Wq WORKER'S COMPENSATION DECLARATION [j�a`f� N V 1 hereby dram under penally 9f perjury aro¢(the fallowing declensions: I h.vo mm will maintain a Cen imeas ofConsem w self-Insum far WorkersCompen- sath.,a provided for by Section 3700 of the labor Code,for the Performance of the wort for which this permit is Island. D 1 have sod will maintain Workers Compensation Insurmuct,As respired by Section 3700 of the labor Code,for the perfarmwee of the wank for which this permit u issued. My Workers Compensation Ins mnce carrier sod Policy yr291P ca AM: p Gdrimr q I.lb Polley No.Hts O 1f�.� 6'Z CERTIFICATE OF EXEMPDON FROM WORKERS COMPENSATION INSURANCE i nnkaectiad need amixcanplemd If Ile permit ufaane hum beddooan(2100) nr beta) I canary that in me performance of Um work for which this permit Is Issued.I shell not employ any person in my mannerw As W become subject to the Worker'Compensation Laws of California.Dam ApPllam NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should become subject W the Worker's Compensation provisions of the lahar Code,you most vJ O forthwith comply with such provisions or this permit shall he domed revoked. ti tiCONSTRUCTION LENDING AGENCY [r 1 bewby niftier that there ie a construction lending agtacy for tie perfonnance of gYr> the work for which dust permit is issuW(Sec.3097.Ch.C.) QLenders Name D z lenders Address U O 1 cemly That I haw read this application W atsm that the above informaum is w F comm.I agree to comply with elf city and county ordlmomes sod MM,laws relating W OU building construction,and hereby authOtiM wpwsenudisv ofthis city to Cron upon the 0. above-memioned PMPCny for inspccdon Purposes. (We)agree to mw,indemnify and keep harmless the City of CV,Mbro against f'+cm IlablllUa,jud c osis aM expwa whichmay In Any way accmeagaimn midCity 04 in consegoan eat lin this permit. ri APPLICA UN STA AND WILL COMPLY W A L NON-POINT Issued by: Date SOURCER GUL NS. Re-roofs Signuure ofA UCARDOr Data AZARDOUS MATERIALS DISCLOSURE Type Of ROOF WII1 the e C lamer fuu ni building e.Chaptnorc and th hamaons mamrial As deRnN by the Cupeniaa Municipal Code.Chapmr 9.11,and the Health And Safety Crack,Section 25531(¢)7 All roofs shall be inspected prior to any roofing material being installed. 41 Dyes ANO Will the applicant or future building Occupant taw equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit havaNaa air contaminants a darned by the Bay Amo Air Quality Mwagnmenl all new materials for inspection. Dlslrict7 ❑Yea PNO hew mN the hMaNtsu materialswquiwmeats under Chapmr6.95of the Califor- ni "Safety Coe.Saetiom25505.15533VW25531.1undcruWthnifil building n erre w a mna.L Nat It is d9)sresponsibility W notify tie occupwt of the qui tax most be mat prior Wulnitccofacemricamofcup tr. Signature of Applicant Date i]lY'1 l OG All roof coverings to be Class"B"or better mead agent Dam. . CITY OF CUPERTINO TEMP POWER OPUPEkTWO PERMIT APPLICATION FORM APN# Date: 3(dZ--: -—o3� /0 )& Building Address: I rJTEP—� 0 PL- Owner's Name: Phone #: 4-0 - 4 q • 13 o Contractor: Phone: License #: Q a �� i, c0 a- g� toq Co tact: Phone: Cupertino Business License#: os 315 i;a-e8 Z-1 Building Permit Info: Elect ❑ Job Description: A 1.1. v- �wE �bL2 Residential Commercial Cost of Project: o �Q • Qty. if Applicable Fee ID Fee Description Fee Grog BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING • CITY OF CUPERTINO em 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36222030 . 00 DATE ISSUED. . . . . . . : 07/11/2006 RECEIPT # . . . . . . . . . : 35184 REFERENCE ID # . . . : 06070045 SITE ADDRESS . . . . . : 1114 HUNTERSTON PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : DAMLE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : CARLOS ORELLANA CONTRACTOR . . . . . . . : CARLOS ORELLANA LIC # 27468 COMPANY . . . . . . . . . . : MANA GENERAL CONTRACTOR ADDRESS . . . . . . . . . . : 1839 TAMPA WAY CITY/STATE/ZIP . . . : SAN JOSE, CA 95122 TELEPHONE . . . . . . . . : (408) 375-4288 •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