06090266 (2) CITY OF CUPERTINO
BUILDINGr DIVISION PER MIT -CONTRwllA.CTQRIINFORMQTIO.N `
a..x2's yep •r. .ti wH i �..«.
BUILDING ADDRESS: ACME & SONS SANITATION IN PE"MITNo.06090266
10716 STEVENS CANYON RD
O W NEWT NAME: PERMIT ISSUE DATE
40 STEVENS CANYON VILLAS 3408 HILLCAP AVE 09/28/2006
NE: SANITARY NO. CONTROL NO.
(408) 379-5811
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I�
ICZ
!w0 LICENSED ENSU CONTRACTOR'S DECLARATION Job Description
1 ion 7 affirm that 1 am li¢nmd under and
Professions
of Chapter 9(commencing
?,m wits SectionndefecDivision Jof the Business and Professiom Code,atMmqyliccnse is
;py in full forte andcffecL / TEMPORARY POWER POLE
a n a License CI L'm.N 7
I F p Dam Co.am
s mail =i DECLARATION �r1/
I w U I tinders sonand my plans shall he used u public¢cartes
cal_
,0N Licensed Pmfessianal
7 S Oat I am exempt
from
DECLARATION V�
2
COG
I hereby.(Sect on 1 am exempt from the Comns Co Licence Law for the 1/
❑O (allowing moon.Permit
t ](IJ 1.5,Business and Pmlculum Code:Any city or aunty
<$o' which requires a pmmit to cnrutmm,alter,improve,demrrail t are pair any ummam $500
_Z<u-m at he its ceased Purse Dims dtca Icaro for such gn
p req ppi petmil to file asi eJ smmmem
Ft (commencing
encingucJpunuammlheproviviouofthe ofOnBusinessniavcLaw(Code)or Sq.Ft. Floor Area Valuation
41-a$ that he 3e xempt therefrom
and thf Division n 3 the al eg Business Professions lmi, r
that be u exempt thertfrom end tbe buts for the alleged exemption.Any violation ar
Section 7031.5 by arty applicant for a permit subjects the applicant m a civil Penalty of er Occupancy Type
not mart I.five hundred doRus(SSW).
❑1.as Owner of the property,or my employees with wages in their sole eompenssdon,
will do the work.atW umewcwreanot intended crofgand Tor sade(Sce.](M4,Bummus Required Inspections
and limitations Code:The Commemies License Law does not apply to an owner of q P
property who Wilds or improves thereon.and who does such work hirom f or through his
awn empleyces.provided thusuch impmtements art vat inmMrd aroRemd foraalt lL -
hawevcr.the building or improvement is sold within one year of completion,the owner,
builder will have the burden of proving that he did net build or improve for purpose of
sal:.).
❑1.as owner of the property,am exclusively contracting with lienmed contractors to
construct the project(Sec.7044.Business and Professions Cade)The Contractor's U.
cense law it=not apply to an owner or pre any who builds or inu mer demon,and
who contracts for such projects with a contncmr(s)licensed pursuant in the Contractors
License Law.
El 1 am exempt under Set ,B k P C for this moon
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby sffum under pemlty of perjury ore of Int fallawin6 declaratiam:
1ha•!andwillmaintainaccf rleamof Contentt0self-;nsumrm WOfkela Dompen.
.tion,as provided f«by Section J]W of the Labor Cade.for the performance of Inc
work for which this permit is;ssued.
1 have and will maintain Worker's Compensation Insunnce,u mquimd by Section
QJW of dte lahear Co e,for the performance of the work for which Its Permit is issued.
My Workers Compensation Insurance amfm and Policy number am:
Cartier.4T66 T-.ea,.t(� Polity No.:R�
CE— RIFICATE OF E%EMPg10N FROM WOI RS'
COMPENSATION INSURANCE
Crus section treed nut W completed if On Permit is fa one hundred dollars(SI W)
ar less.)
I certify Nat in the performance of the work for which Nis Permit is issued,I shall not
employ any person in any manncrot as m become subject a the Wmlmra Compensation
Laws.(California Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certi Ocam of Exemption.you should
become subject m the Worker's Compensation provisions of Ne Labor Code,you must
.J 0 foMwith comply with such provisions m Nu permit shall be deemed revoked.
'Z''"" CONSTRUCTION LENDING AGENCY
5: 1 hent affirm that there is a construction lending a
F Y P temY far dm performance of
Uj > the wars ter which wee Permit is;ssucd(set 309I,Civ.C.)
W�Q Lendmes Name
L. ..
Z cndeh Address
U O 1 terry Nat I have mad this application and start that the above information;s
La, v- correct.I agree to comply with all city and county ordinances and sum laws rtIaLiRg W
0 building eonsumetion.and hereby anchorite minesentaims of Ws city to enter urns the
Uabove.mentioned property for imrection purpous.
E6. (We)agree to save,indemnify and k«p harmless the City of Caper inti IS,
" fq liabilities,judgments,costs and expenses which may in any wayaccme almost mid City
U2, aincOqunGUfO,(.ming of Nis permit.
N STANDS AND WIL COMPLY WITH ALL NON-POINTIssued by: Date NS. / O
Re-roofs
Stgwurt of haH Z6ADam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ar future building«cape lstem or handle becoam umaterial
u defined by On Cupertino Municipal Code.Chapter 9.12,and the Health and Sett
Code,Section 25312(a)T Yes No All roofs shall be inspected prior to any roofing material being installed.
41 Will the applicant or future building Occupant use a If a roof is installed without first obtaining an inspection,I agree to remove
p a Air est or devices est g
emit harardnu air conmminants u Jcf d by the Day Area Air Quality Management all new materials for inspection.
DisuictT
❑Yes u
I have read the nvaNrwsmaterials requimments under Charmr6.95 orthe Califor.
ria Health&Safmy COde,Secmm 25W5,25533 and 25534.1 undenund this if the building
docs not c ly h a mnanl Nat it u my pomibility m notify tbe acupant of the
myuiremc wh mmlbemeorm; «enee a Signature of Applicant Date
ownaroomMarcmda,ol D,m. All roof coverings to be Class "B"or better
Community Development
e 10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE # //,o$ J1 0 0
GENERAL CONTRACTOR: FAX # 14 —16 7_ �
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
60 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
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: _Blk: Lot :,
APN . . . . . . . . : 35603047 . 00
DATE ISSUED. . . . . . . : 09/28/2006
RECEIPT # . . . . . . . . . : 36241
REFERENCE ID # . . . : 06090266
SITE ADDRESS . . . . . : 10716 STEVENS CANYON RD
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER STEVENS CANYON VILLAS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : ROCKWELL HOMES
CONTRACTOR . . . . . . . : YOUNGBLOOD, FRANK LIC # 742
COMPANY . . . . . . . . . . : ACME & SONS SANITATION INC
ADDRESS . . . . . . . . . . : 3408 HILLCAP AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95136
TELEPHONE . . . . . . . . : (408) 379-5811
•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 VISA
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
�C�Cr
CITY OF CUPERTINO Q��W�
TEMP POWER
WUPER.TINO PERMIT APPLICATION FORM
APN # 047 Date:
Building Address:
Owner's Name: Phone #:
Contractor: G�IEe Phone: License #:
w e v ✓vi e S -a -a 67--9qo-6 `'b - 7 1-f1
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Elect
Job Description:
Residential Commercial ❑
Cost of Project:
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•