05080045 (2) CITY OF CUPERTINO "•" ' "
r BUILDING DIVISION PERMIT CO+TTIUCT,OR INFORMATION
BUILDING ADDRESS: M-TRAN CONSTRUCTION, INC PERMITNO.05080045
18861 LOREE AVE
OWNER'S NAME: PERMrr ISSUE DATE
CANH THAN 348 SURBER DR. 2005
ONE: SANITARY NO. CONTROL N0.
(650) 996-6099
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGCS ELECTO PLUMB MECHO
uoo LICENSED CONTRACTOR'S DECLARATION JbrDdsc�ip[ion
I C I lu mby alicensed
ffirm that I am under provisions of Chapter 9(commo
encing fit s a,U
b with Section 7")of Division Sof NC Businwnd aProfsurinnv Code,and my license is a� D
n y in(oil f ndeffea 'Lo .TEMP. POWER POLE / 1
j Z License I ce Lic.N n
f w Dau Contraemr M-YWIZAV
r /rJ��Y •v
ii ARCHI7ECTSDECLARATION
N a 1 mrdcuund my plans shall W used as public mends
s a.G Licensed Professional
OWNER-BUILDER DECLARATION
<E I Wrthy offrm'hit I am eacmpt from the Cirmirm o's License Law for the ttt��� ISs�T
0O rollrwing reason.(Section 7031.5,Business and Professions Code:Any city Or county which
� $250
m which requires ami
Filled
to mrslur.improve,slimprove,demolish,or repair any cadmiure
_ze
pd.,mus issuance..1.requires dre.,ican'for such permit to Glc asignedommem
that he is licensed pummel in the provisions of the Contractor's License Law(Chapter 9 Sq. Ft.Floor Area V Valuation
YI=-$ m mmencingwimsection7W)of Divisirn3nfine Businessand Prorebsinns Code)ar
y _ Na'he is exempt tMmfrom and the burs for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for•permit subjeeu the apploom a.•civil penalty of AVA WUW§cr Occupancy Type
not mane Nan five hundred dollars(5500).
D I,m owner of the pmp ny,m my employcu with wages u their sole comp mlion,
will do thcworlt and the swctum u Bel immndcd or Offered far salt(Stt.7O .Business
and Professional Code:The Comm cora Limnse Law does tot apply m an owner of Required Inspections
pmpeny who builds orimpmves damon,and who doessuch work himself or through his
own employ=,provided that such improvcmenb arc not intended or offered Muscle.If,
h.Ow,,the building or improvement is sold within one yeourofcompletion,memwncr-
builder will ha x the burden of pooling that he did not Wild or improm for purpose of
sale.).
D h as Owner of the property,am eaclusively contracting with licemcd commutators in
construct the Project(Sec.7(64.Business and Profestlmn Cade:)The Comracmrs Li-
cense law docs not apply in an owner of prnpeny who Wilds or improve thereon.and
who Centralia for such projects with a contractors)licensed pursuant to dm Contractor's
License law.
D I am exempt under See. .B k P C for Nu tenon
Come, Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pcttal'y of perjury one of the following declaration:
I ham and will maintain a Cenificam of Consent to self-insum for Worker'sCompen-
sation,as provided for by Section 37W of the Labor Code,for the peronnancc of the
wok(or which this permit Is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
37IX1 of the labor Code,for the performance of the work for which this permit is usual.
My Worker's�Compse,uauon le rs.comic,and Policy number me::
Comer.' /sia"Iat`I'�t/lsl� Policy NOI `I�-I5 I
CERTIFICA OTS F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W completed title Permit u fnrone hundred dollars(SIM)
or less.)
I cent fy that in Ne Performance of the work for which this permit is issued.)shall nal
employ any pennon in any manner an u m become subject in Ile Workers'Compewuon
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject in Ne Worker's Compensation provisions of the ItWr Code.you most
J O forthwith comply with such provisions or this Permit shall W deemed revoked.
Z "-' CONSTRUCTION LENDING AGENCY
PI lamely aRnn that there is a construction Pending agency for the performance of
C the work fur which this permit is issued(Sec.3097,Civ.C.)
W Lenda's Name
=z Lender's Address
U Q 1¢dfy that 1 have lead our apdiaion and sells that on,allow infomnauun is
W P correct 1 agree to comply with all city and county ordinances and sum laws misting to
0U building conswction,and hereby authorim mpresenu'ives of this city to enter upon me
C shove-menutued property for ito,muon purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
F" N liabilities,judgments.Cosa and cxpcnsu which may in my way accntc against said City
U Z APPUCANm"acT UND ---of on Nt unit osD WILL COMPLY WITH ALL NON-POINT Issued by: Date —_f-
UR E REGULA 0
or Re-roofs <<
signator rApPlica c nuactor Dau
HAZARDOUS MATERIAfS DISCLOSURE Type of Roof ,
Will de apPlicam sir fulum Wilding Occupant store or handle handous material
u defined by the Cupeninn Municipal Code.Chapter 9.12,and the Hcalth and Safety
Code section 25532(a)?.
❑d All roofs shall be inspected prior to any roofing material being installed.
Will mea Grant or m'em nnosn If a roof is installed without first obtaining an inspection,I agree to remove
pp g Occupant use equipment or devicu which
I,Im.dnm air contam;nams u defined by the Bay Area Ail Quality Management all new materials for inspection.
Wier,
Dy.
1 have read the bvaduus materials requirements under Chapter 6.95 of the Califor-
nuHealth&SafcryC Sc om25S05,25533 nx1)5534.'rack Mtherifthe Wilding
Jou Bol eOil-hy hasC un t.Nal it"ferry responsihilily o notary me Occupant of the
rem cels wnkh run W pis omarre ora Ccdhcalso a ny. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner ora o.. agent
Dau
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: 'CAN-N IPHONE #
GENERAL CONTRACTOR: Nl FtW c2v AX #
I am not using any subcontractors: S a.r,
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
CITY OF CUPERTINO
TEMP POWERCITY 01
OS
UPEkTINO PERMIT APPLICATION FORM
NE'APN # S„ J � Date: L5__vs
Building Address:
1138 ro 6�ti ih44�, ca No Cq+
Owner's Name: Phone#:
Contractor Phone: License #:
M_7 d qua%m(_ii0d i,vL 6So 6-60 �- 82 s
Contact: Phone: / Cupertino Business License #:
ma 1 F-*,J 9C-6o
Building Permit Info:
Elect
Job Description:
�-
Residential Commercial ❑
Cost of Project:
�2s0
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING