The URL can be used to link to this page

07080139 777-7 CITY '3F CUERTINO y ClI ��T I�tFOR1�A�I�1�I. !: BUILDING DIVISION PERM 1� PERMIT NO, BUILDiNGADDRESS: WILLOW GLEN ELECTRIC INC 0708 1 10353 M I RA VISTA AVE PERMIT ISSUE DATE OWNER'S NAME: BOCCHIERI CARMELO J AND ADELE 1085 WAE S A CONTROL NO. E: (408) 289-9725 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ARCHITECT/ENGINEER: Z LICENSED CONTRACTOR'S DECLARATION Job Description C I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 70(10)of Division 3 of the Business and professions Code,and my license is 200A OVERHEAD, SURFACE — MOUNT PANEL UPGRADE - in full force and eCfec Lic. Z License Class Contractor Date O ARCHiTECTSDECLARATION a I understand my plans shall be used as public rcrnr s r� Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the Ofollowing reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,altar,improve,demolish,or repair any structure Ft.Floor Area Valuation prior tit its issuance,also requires the applicant for such permit to file a signed statement that he is liccrtscd pursuant to the provisions of the Contractor's License Law(Chapter 9 `9' $3200 (commencing with Section 7000)of Division 3 of Business and Professions Code)or Occupancy Type that he is exempt therefrom and the basis for the alleged exemption.Any violation of A��1 Number Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 35702 0 4.L . U U not more than five hundred dollars(5500)• 0 I,as owner of the property,or my employees with wages as their sole compensation, 044,Business Required Inspections will do the work.and the structure is not intended or offered for sale(Sec.7 and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or thmugh his own employees,provided that such improvements are not intended or offered for sale If, however,the building or improvement is sold within one year of completion.the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Cntractoes Li- cerise Law does not apply to an owner of property who builds or who contracts or such projects with a c nira or(s)licensed pursuant to the Contactors License Law. ,B&P C for this reason 0 I am exempt under Sec Date Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations tJ I we and will maintain a Certificate of Consent to self-insure for workees compen- sation,aas provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation insurance,as required by Sectio 3 00 of the Labor Code,for the performance of the work for which this permit is issued. My Worker4CEI mpensabon insurance carrier and Policy nu a7CE Cartier .1 / Polity No.: �r vOW FI TE Of EXEMPTION FROMRS' IP COMPENSATION INSURAN QI vltti�4 (This section need not be completed if the permit isndred dollars($100)or less.) i certify Utz!in the performance of the work for which tis issued,[shall notwnploy any'person in any mnncr so as to become subjecrkers'CompensationLaws of California.Date ApplicantNOTICE TO APPLICANT:If,after making this Certifiemption,you shouldbecome subject to the Worker's Compensation provisionaor Code,you mustz forthwith comply with such provisions or this permit shall beeemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) a A Lender's Name Lender's Address �z �� I certify that I have read this application and state that the above information is all city and county ordinances and state laws relating to correct.1 agree to comply with O building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. ya (We)agree to save,indemnify and keep harmless the City of Cupertino against ti liabilities,judgments,costs and expenses which may in any way accrue against said City Date 'Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b SOURCE R GUIyATjQNS• Re-roof: Si6fnaA of pplicantlContractor Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE YP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Codc,Chapter 9.12,and the Health and Safety Code,Section 25532(a)7 [All roof;shall be inspected prior to any roofing material being installed. 0Yes ° If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which Ldoes ardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? Yes ° have read the hazardous materials requirements under Chapter 6.95 of the Califor- h&Safety Code,Sections 25505,25533 and 25534.i understand that if the building currently have a tenant,that it is my responsibility to notify the occupant nC the Date ents which must el prior to issuance oC aCertificate of Occupancy- Signatu-e Of Applicant All roof coverings to be Class"B" or better ate or authorized agent CITY OF CUPERTINO a1rffYF PERMIT APPLICATION FORM CUPEkTINO 6, -7 0 CPN# Date: Building Address: r Mailing Address (if different from building address): C 4- 57 t Owner's Name: Phone#: -/ c->a�- :2t5 do -7i Contractor: License#: ow (e-C-A--r �)-`� / ';, - G Contact: Phone:y cam Cupertino Business License#: Fax: --y`'Y- 5 Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: n ��►�- i Residential ® Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: roject Size: StandardU Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI E oiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 BcHer> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX ]nd/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING lkONSTAXH Hotel and Motel BUILDING BCONS r t C onstax—Resi/Mobile BUILDING BELEC 1000 E-lec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 El ac Svcs 600V<= 200A ELECTRICAL / BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OI' CUPERTINO 4 ITEMS OF 4 PERM-'T RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: B--k: Lot: APN 3!5702041. 00 DATE ISSUED. . . . . . . : O8/15/2007 RECEIPT #. . . . . . . . . . BS000002383 REFERENCE ID # . . . : 0' 080139 SITE ADDRESS . . . . . : 10353 MIRA VISTA AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BOCCHIERI CARMELO J AND ADELE ADDRESS . . . . . . . . . . : 10353 MIRA VISTA AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2718 RECEIVED FROM . . . . : WILLOW GLEN ELECTRI CONTRACTOR . . . . . . . : LO)NDRE, MARK T LIC # 15897 COMPANY . . . . . . . . . . : WILLOW GLEN ELECTRIC INC ADDRESS . . . . . . . . . . : 1 )85 WARREN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : ( 108) 289-9725 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BELEC200 METERS 1. 00 29 .43 0. 00 29 .43 0. 00 BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 .86 0. 00 BSEISMICRE VALUATION 3, 200. 00 0.50 0. 00 0.50 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 103 .16 0. 00 103 .16 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 103 .16 12191 --------------- TOTAL RECEIPT 103 . 16 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 3-04 ROUGH ELECTRICAL 505 FINAL ELECTRICAL