05050075 (2) CITY OF CUPERTINO _' " +-
BUILDING DIVISION PERMIT „CON.TRACTOR TNF RMAT,ION ;
BUILDING ADDRESS: ACME & SONS SANITATION/ELEI!?gY"05050075
,OWNER'S NAME: PE UISSUE DATE
CENTEX HOMES 1408 HITICA12 AVE,
ONE: SANITARY �ftOL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLO ME�CH
�OQ LICENSED CONTRACTOR'S DECLARATION
1 hemby arflrm that 1 am licensed under Provisions or Char,tor 9(commencing Ct tI
m with Seen.7000)of Division Sof Ne Buunwmdprof siomC anlm licenser
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Licensed Professional
OWNER-BUILDER DECLARATION �I��
� 1 hereby elinin that I am exempt from dm Conuanah License Law for dm
C O O following moon.(Section 7031.5,Business and Profession,Code:Any city m County L
3 which m4olms a Permit on comuucl aier,borrow.demolish,or repair any stroctum
_z1 prior on its Issuance,also mouses the applicant forsuch permit 10 file a signed statement Sq.Ft.Floor Area Valuati0
Nat be isliecmedPursuantroh
theprovisionsoftheContracmLicemeLow(Chapter
(commencing with Section 7000)of Division 3 of the Business and Professions Cede)or
that he Is exempt themfrom and the bob for the alleged axempden.Any violation of
Section 7031.5 by arty applicant for a Permit subjects the applicant in•civil Penalty of 3 6V1V*I*PI0 0 Occupancy Type
not mom than five hundred dollars($500).
0 1,an owner of the property,in my employees with"Res an their anis compensation,
will Jo the work,and the strunum is not intended in offered for safe 7014,Business Required Inspections
and Profe.WOm de:CoThe ConVlemYs License raw dem not apply m an awMf of q P
property who hull ds w improve,thereon,and who does such work himself car through his
Own employers.provided Natateh improvements are notin orded eroneced for tela If.
however,the building or Improvement is mid within on,you of completion.the owner.
builder will have the huNen of proving that he did an,Wild car improve for purpose of
.In I.
0 1,As Owner of the properly am exclusively connecting with licensed contraction W
consumer the pmjm(Sec.70”.Business and Profession,Code:)The COnuwetues Li-
cense raw don,not apply m an Owner Of property who Wilda or Improm theme.and,
who contrans for each projects with a comrmmr(s)licensed Panamint m the COAArs or'l
License Law.
0 1 am exempt under sec. .B k P C los ON tenon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby anlrm under penalty of perjury Our of the following declarsdons:
I have and will maintain•CeNfiate of Conant as self-insure for Worker's Counter.
7C331,00
don,u providod for by section 3700 or the IaWr Code,for the performance of the
rk for which this Permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
of Ne tabor Code,for die performance of de,work for which Nis permit Is issued.
Y Worker' ompen, In,urance amu and Polityrtier. - Polity No
cEKTI^GTE OF EXEMPTION FROMWORKERS'
COMPENSATION INSURANCE
(This secdon need notWcompleed If the permit U forone bombed dollars($1010
sir lou.)
I certify that in the perlmmanee of the work for which this permit Is issued,I shall not
employ any penan in my mannerso as in become subject in dm Worked Compen,sdon
Laws of California.Dam
APPllcant
NOTICE TO APPLICANT.If,Alto,making Nb Certificate of Eacmption.you should
become subject m Ne Worker'.Component previsions of the Ica w Code,you most
.,O foMam
with ply with such provisions or Nmit is pershall W ed me
doomted.
Z Z EN
CONSTRUCTION LENDING AGENCY
'H I hereby affirm that were is a construction lending agency for the Performance of
Cd> the work for which this permit Is Issued(See.3097,Civ.C.)
W�Q lender's Name
Lenderss
's Addre
V z Q I certify that I hero rad this application and sum that the show information is
is.,P� correct.I agree to comply with all city and county ordinances and sum laws relating m
OO Wilding construction,and hereby anNorlic aprrxnudm of this City m enter upon the
t2j shove-mentioned property for Inspection pu4mas.
y (We)agree or now.indemnify and keep harmless the City of Cupertino against
pj
liabilities,judgments,Cents and..panes which may In any way accrue against said City G�
O Z in comequenn of the grenting of Nis permit.
APPLICERBTANjLS AND WILL COMPLY WITH ALL NO POINT Issued by: Date s
SOusc c oath //ya WITH
75
p C Re-roofs
Sigw of AppliaHAZA for r'rRE Dam
NAZA US MATERIALS DISCLOSURE Type of Roof
Willy dicC Cupecants rtino Municipal
Wal Coe.Chaptgoreo aortic Heard andue SARial
As dcOned by tie Cupertino Municipal Code.Chapter 9.12,and de,Health and Safay
ode,Sccd 532(.)7 All roofs shall be inspected prior to any roofing material being installed.
t� ON.
Will the applicant in future building=upset era equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
it hazardous air contaminants As dcOned by the Bay Area Air Quality Management all new materials for inspection.
isuia7
12481' 0 Nu
I have mad the hundousmamrialsmquiremcnu un&rCMpar495 ofNeCalifor-
nuHcul SafelyCode,Seedam 25505.25533 it 25534.1 understand Natlfdm Wilding
does haw a Nat it ts my rospn,iNlilY m mdfY Ne aceup t o(Ne
n,4 on ich o prier I.naneeaisCcniRcaenr a Signature of Applicant Date
O nor orauthomcd agent Dae All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
&C
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT# J��rp 07, " —
/�f�/IU,Qvzl� ,diQ
OWNER'S NAME: PHONE# S— d D
GENERAL CONTRACTOR C —50FAX#
I am not using any subcontractors: WZe d
1,7Z
Signa a Dat
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical emr (Jl S 7�1y
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/4tontractor Signature ate.
CITY OF CUPERTINO
TEMP POWER S
ICUPER,TINO PERMIT APPLICATION FORM
APN# 3 69
/ 9 u / Date:
Building Address: 8,111
Owner's Name: Phone#• 0/ , J�
Contractor:,� � �/v s Phone: � License#�/�/
Contact: -z0 r �/N� Phone: _ Cupertino Bus ls�.License#:
Building Permit Info:` �//J y
Elect ❑
Job Description:/ / /N�Iq/ U_ 1 �dLk 7 M WL
Residential ❑ Commercial �ryv[ /' 1
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
If BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
V / 7