05070182 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CQNTRA.CTQR INF012MATION4;
a ax
BUILDING ADDRESS: JULIO MEJIA CONSTRUCTION PERMIT N0.05070182
30491 SCENIC BLVD
OWNER'S NAME: PERMIT ISSUE DATE
REESE, M 361 W. VIRQTNTA ST 07 /9R /900S
WN E; SANITARY NO, CONTROL NO.
(408) 529-3634
ARCHRECf/ENGINEER: BUILDING PERMIT INFO
BLDGO ELECTO PLO �
30'3
-LICENSED CONIRACTOWSDECLARATION Job Description
tY I hereby afflrm Net I am licensed under provisions of Chapter 9(commencing .
with Section 7000)of Division 3 of the Business and Profeuiom Code,and my license is
+� infnllfomewdeffect. INSTALL NEW WATER SERVICE LINE TO RESIDENCE
License clana
De¢ Connector FUTURE NEW MATER METER
KK ARCHI'IECI'S DECLARATION
4 O IL¢ckmannd^yplypeh kturedupublic_mcnrN L1
e �a Lkco� mocasione ,YL T
5� OWNER-BUILDER DECLARATION
< I hereby affirm that I am exempt from the Convectors License Lew for the
D 0 following mason.(Section 703 1.5,Business and Profmalom Cade:Any city or county
$ which require,a permit Ill construct,alter,borrow,demolish,or repair my structure
zy prlM to its istuarcc.alm requlmJ dCepplKLn forsuch permit in III...iIncd Wlemenl
< that he is licensed pursuant to Ne provisions of the ComscWrs License law(Cheptcr 9 Sq,Ft.Floor LD - ValuatiOl$600
$ (commcndng with Section 7000)of Divhlon3 of the Busineuwd Pro(essiou Code)or
Net he h exempt therefrom and the huh for the Alleged exemption.Any Vmmdon of rA
nmoR03 aKnmcelideons(iM) ltsubjecuNeapplicantinacivilpentltyof APN Number Occupancy Type
I.asownooftve 35606017 . 0 _ 5
❑ property.mmYcmploycea"offenul uuthe(Sac.7ampeeaarwas
and PrMild.Nasion,,and the he Con bice Nundcdwowdoes ran appapply 70th,Buircu Required Inspections
and property
bas Code:The Conuanars ndwhoLiam law does orran himn lf rt owmr is `�
propertywhaes,Idsom dthat suthesesn,andwho daoomniwank himwlfedduaugh6f.
ownem.thebuiprog or Nalwmch Improwemwtsarene car ofded
llercs me come. BU N
Wilder the building hoMProvemwtien,, ndid one year of completion,du owe of
Wilder will have the When of proving Net he did not Wild o Improve for purpose of
❑1,As owner of the property,am exclusively contracting with licensed com a ctms In
comtmct me project(Bee.70w.Business ad Profmsiam Cade:)The Conuu,mes U.
coma law does not Apply to an owner of property who builds or improve thereon.and,
who contracts for such pmjecu with a contractor(s)licensed pumuant to the Contrwtors
Lkemse Law.
❑1 am exempt under Sm. .B&P C for this reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby effnm under penalty of perjury one of the fallawmg declarations:
ham and will maintain•Cenifiate of Consent to self-insure for Workers Compm-
nation,u provided for by Section 3700 of the labor Code,for the Performance of the
work for which this Permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as rtqumcd by Section
3700 of the Labor Code,for the performance of the work for which this permlt is Issued.
My Workers Compensati 1 amer and Policy numberam:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Club it.need notbeeonplumd ifth permit Isforone boosted dollars(3100)
or lean.)
1 coolly Nat in the performance of dte work for which this permit u issued.l Nall net
employ any person in A,on CamafukjCfJ In Ne Wohera'Compemulon
Laws or CalifomiLDa¢ •7 �}�O'-
LawsApplsal ,%
NOTICE TO APPLICANT.It.after making this Ccnifiate of Exemption,you should
become subject to Ne Worker's Compensation previsions of Ne labor Code,you mum
.,0 foMu wide comply with such provlsioor Nu permit doomed!W doomrevoked.
Z ti CONSTRUCTION LENDING AGENCY
[-r l hereby affirm that Nem is a conatmctinn lending agency for Ne performance of
C> the work for which this Permit is Issued(sec.3097,Civ.C.)
W Q Lenders Name
.7. z Undoe's Address
U Q I certify,that i have mad this application and mm Nal the abowe information Is
Dr comm 1 agree to comply with all city and county ordinances and some laws relating to
Q building construction.and hereby mtholm reprewnudwa of this city to enter upon the
W ahovo-mentiom0 property for inspection purposes.
L7. (We)agree to save,indemnify and keep harmles,the City of Cupertino Against
r.a W Iiabilitius,judgmenu.cmu and cxpenws which mayin anywayacmc againstnald City
In uence of me Startiof this rmit.
APPLLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -7i2 --0 S
SOURC TIONS.
Re-roofs d
Btgnname of Appliant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applicant"future Wilding occupant am orhendle huardom material
as dented by the CupertinoMunicipal Code.Chapter 9.13.ad the H,Alm and Safety
Code,Section25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya V<
PmWillthe applicant or future building occupant seequipment m devices which If a roof is installed without first obtaining an.inspection,I agree to remove
harsmnm air comminants as de0md by the Bay Area Air Quality Management all new materials for inspection.
alrw ict7
❑Yes o
1 haw and the hasardous mamrials mquimmems under Chapter 6.95 ofthe Califor•
nhHeslthh SaletyCode.Sections 25M5.25533 w125534,1 understand thuifue building
does not currently how A¢nenh Nat it is my responsibility to notify the occupant of the
mful hmhmtruW/t darmW,g wcaaracen;new fampancy.ED L Signature of Applicant Date
ZAll roof coverings to be Class"B"or better
Owner or amhorimd agent Dau
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aC17YF Fax(408)777-3333
`UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE # L/08- 7 Z
GENERAL CONTRACTOR FAX# IfQF- (6 0 1)`0
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 e r (V MW C_ 0
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
Om 1 of 1 PERMIT RECEIPT OPERATOR: christya
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35606017 . 00
DATE ISSUED. . . . . . . : 07/28/2005
RECEIPT 4 . . . . . . . . . : 30558
REFERENCE ID # . . . : 05070182
SITE ADDRESS . . . . . : 10491 SCENIC BLVD
SUBDIVISION . . . . . .
CITYCUPERTINO
. . . . . . . . . . . . . .
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : REESE, M
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4751
RECEIVED FROM . . . . : BOBS
CONTRACTOR . . . . . . . : JULIO MEJIA LIC # 25252
COMPANY . . . . . . . . . . : JULIO MEJIA CONSTRUCTION
• ADDRESS 361 W. VIRGINIA ST.
CITY/STATE/ZIP . SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 529-3634
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ----- -------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPERMFEE VALUATION 600 . 00 83 . 16 0 . 00 83 . 16 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BPWSVCS WATER SERVICE 1 . 00 9 . 00 0 . 00, 9 . 00 0 . 00
---------- ---------- ---------- ----- -----
TOTAL PERMIT 165 . 39 0 . 00 165 . 39 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 165 . 39 441
TOTAL RECEIPT 165 . 39 .
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--------
---------------------------- ----------------------------
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
050701 8z
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
ISCUPEI,TINO PERMIT APPLICATION FORM
APN# 366 06 O) 7 .
(D Date:^ Zk—O)�
Building Address:
Owner's Na me- /I Phone#:
� 3`7
a 2�
Contractor: Phone: License#:
Contact: Phone: Cupertino Business License #:
—^ (o`[( - -500
Building Permit In : NS 1 t L Nfevi Lkf(m-�L 5(-:A va Q i1 C— jU A�75 (Q� NC
Bldg ❑ Elect ❑ Plumb
Job Description:
Ei.</
Residential Commercial ❑
Cost of Projectu.0
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Pi in S stem Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i eofFixtures PLUMBING
BPFDXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
77777 BENERGY Energy BUILDING
BUSLIC Business License BUILDING