07090150 CITE'OF CUPERTINO
BUILDING DIVISION PERMIT � R�! I� ?R1 �ON• ;
PERMIT NO.
BUILD�Np A4PQFS$:1_ORETTI DR NATIONAI, CONSTRUCTION 07090150
OWNER'S NAME:
PPERMIT ISSUE DATE
JENNY LOUIE 15319 CHATSWORTH ST 09/21/2007
)NE: (818) 22:.-6057 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0O LICENSED CONTRACTOR'S DECLARATION Job Description
W
P: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
:Z ud with Section 7000)of Division 3 of the Business and Professions Code,and my license is TEMP POWER POLE.
t H in full force and effect.
> ? License Class Lic.a
t- Date Contractor
ARCHITECTS DECLARATION
i z a I understand my plans shall be used as public records
)aU
oy Licensed Professional
y:1 OWNER-BUILDER DECLARATION
, 1 hereby affirm that 1 am exempt from the Contractors License Law for the
jO following reason.(Section 7031.5,Business and Profccsions Code:Any city or county
e m which requires a permit to construct,alter,improve,demolish,or repair any structure
Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement r,
• < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ,q.Ft.Floor Area $350
Valuation
i l-- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 7 516 0 5�) �Number Occupancy Type
not more than rive hundred dollars($500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law dols not apply to an owner of 9 p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sake.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.).
as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
ccnse Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑1am exempt e A B&P C for this
Owner Z /� /� Date a 0
�40MOttSCOMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as 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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(]his section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to bccom ject to 1!!!ri Compensation
Law
Applicant,s of Califo
,
NOTICE TO A LICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z V) CONSTRUCTION LENDING AGENCY
Ems.t►�. I hereby affirm that there is a construction lending agency for the performance of
r1, the work for which this permit is issued(See.3097.Civ.C.)
W Q Lender's Name
az Lender's Address
U C) I certify that I have read this application and state that the above information is
U,t—" correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
LL (We)agree to save,indemnify and keep harmless the City of Cupertino against
rn liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
APPLICANT UNDERST DS AND L COMPLY WITH ALL NON-POINT Issued by: - 2 P
SOUR N
Re-roofs
11-15,Si of plicae for Daif
T Of R')Of
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(x)? All roofs.,hall be inspected prior to any roofing material being installed.
E:]Yes upe,
,
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as fined by the Bay Area Air Quality Management all new materials for inspection.
District?
C]Yes No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.[understand that if the building
does not c hfavcF�cam.that it is my responsibility to notify the occupant of the
�rcqu' cots wmet p uance of a certificate of txcupanry. Signature A Applicant Date
` All roof coverings to be Class"B"or better
Awncr or orircd agent tc
CITY OF C'UPERTINO
` MP POWER
CUPEI,TiNO PERMIT APPLICATION FORINT
APN# Date:
3 75 c?5 o O D Ma (1,0-7
Building Address:
0GPCH
Owner's N , Phone#:
.—
Contractor: Phoifc: License t :
vor�/Oftcx O a , #c9 2 SoL/-> 6 7 16 6)
Contact: Phone: Cupertino Business License#:
Tez--I-Lt r10L
Building Permit In o: 07 o7O/p a
Elect ❑
Job Description:
UP",u, 0 -K G
Residential Commercial ❑
Cost of Project:
3�U
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 37516059 .00
DATE ISSUED. . . . . . . : 09/21/2007
RECEIPT #. . . . . . . . . : BS000002723
REFERENCE ID # 07090150
SITE ADDRESS . . . . . : 10490 MORETTI DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . JENNY LOUIE
ADDRESS . . . . . . . . . . : 10490 MORETTI DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JENNY LOUIE
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 15319 CHATSWORTH ST
CITY/STATE/ZIP . . . : MISSION HILLS, CA 91345
TELEPHONE . . . . . . . . : (818)221-6057
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 40.79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 102 .89 0. 00 102 .89 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 102 . 89 #1674
---------------
TOTAL RECEIPT 102 . 89
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
Community Development
{ 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF
';UPE(�TINO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT #
42�62 &LCf:6 R- ,. q4�N
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractorr. 91,9 P7
Signature Date
Please check applicable subcontractors and com -lete 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