08110088 CITY,OFCUPERTINOr,tr ,.
BUIL`INODIVIsTON PERMIT ;COI�ITRAGTtTIi.III+OItMt�TIOkV
BUILDING ADDRESS: PERMIT NO.
18770 LOREE AVE TBD — TO BE DETERMINED nglinngg
OWNER'S NAME: PERMIT nUE DATE
AMTwobly 8aA CONTROL NO.
ARCNTTECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMMECH
�Op - LICENSED CONTRACTORS DECLARATION
Job DCSCTT UOn
V I hereby affirm Nal t Am licensed under pmvimons of Chapter 9(Commencing P
with SCouon 70 M1)of Division 3 of dm Business and Professions Code,and my license u
infullfotaandeffat TEMP POWER FOR NEW HOUSE
'4z Limns Gaza Lk.g
nF•q Dam Contractor
7W ARCHITECTS DECLARATION
a 1 understand my plans Mall W used az public recurtla
U
g C Licensed Pro fcssi mal .
c OWNER-BUILDER DECLARATION
ryI 1 hereby alum that 1 am esempt from the Conmactoel License Law for the
i O O following macon.(Section 7031.5.Busimss and Pro(essium Cade:Any city or county
$( which requires•permit be comuvct,after.hs prow,dcmalish,m repair any swme.
prior in is issuance.man requires Nc applicant fm such permit m 11I..signed movement
lust he h licensed initiation.he Na pmvisiona of the Comum's License Law(CTapmr9 Sq.FI.Floor Area Valuation
EyFD (co mmcmingwiNSeclion7000)MDivuion3oflhe BusinmudPrafesainm Co )or 500
y $ Nat he u exempt Iha nfrom and the basis for Ne alleged eaemplon.Any violation of
Section 7031.5 by airy applicant for a permit subp W the applicant It A civil penalty of APN Number Occupancy Type
em more than Bw bmdmd aollm(sSDo).
37515025 . 00
0 1,as owner of Ne pmpnty,m my empluym with wges u Nem Cole cornpanssdon.
will do the work,and the structure is notimndod or offered forsale(Sm.7044•Busirlm Required Inspections
And Pmn
fossmm Code:The CoromoYs License Law dm anan
Out apply m owner of q P
propenywho builciaorimpmw thereen.and whodoessuchwo is himsi(or Wough his
awncmploym,pmNded that seem improsemenss tie not inteMrd oroffeed for ale if,
bawever,Ne building or impmwment is sold within One Sear Of tempktion.the owner-
' Wilder will%ave the Written of pmHng that he did Ilan Wile m importune for purpose of
a owrc a the property am exclusively commanding with licensed Contractors Id
Comment the project(Sec.7014.Business and Professions Cotler)The Commune's Li.
come law dm not apply to an owner of property who Wilds er improv thereon,and.
who contracts for such prejects with a Contracurms)licensed pursuant N the Contractor's
License law. `
0 l w uemp1 undq Sm
Dam fm Nu mason
Owner S Dam
00. ER'S COM SATION DECLARATION
1 thereby dorm under lineally of pe0ury Om of the,fallowing dCClBmlans:
1 have and WI maintain a Certificate ofComenl to sl(--imam fm Warkds Campos-
on.
ampnfon.a powitled for by Saxon 3700 of do Labor Code.fm the performsem of the
watt for which this permit is issued.
❑I ban and will maintain Worker's Compensation Insurance.az Iequocd by Section
3700 of Ne Labor Code,for the performanrs of the want for which this permit is named
MY Wmkr's Compensaian hssunae carrier and Poijry number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
(Thu section need embocompkted UNe permit is from hun@eddoBus(3100)
or tea)
I comfy that in the performance of the work for which this permll Is issued.I shall not
employ anyperann in any minimize As in become subject to the Workers''Comptmadon
Laws of California.Dam
Applusnt
NOTICE TO APPLICANT:If,a(mr making this Certificate of ascription.you should
become subject to the Wo leer's Compensation provisions of the Labor Code,you must
0 O forthwith comply with such provisions or Nu Mumu,still W deeimminent.medimminent.z CONSTRUCTION LENDING AGENCY
(-cr Ihcsrby firmw rel•mmurausm lending time)'for the performance of
No work for which this pe 't u's awi0B7_Civ.C.I
W Q Lsndef]Namc
5 z
'Mer,
Andrea
U O 1 ani(y that I haw:read this application and sum Na Ne show information is
W F ca met T Agra an comply with all city and county mdinanes and mite laws reutint m
.Oconstruction.ilding construction.and hereby authorise representatives of Nu city to toter upon the
N 0Ubuilding
properly for inspection purposes.
(We)agto awe,indemnify anka
d p harmless the City of Capesdna against
cF,i ree fIl limodilm.judgement.nom and expenses which may in any Coy acme against said City
U ineonxyueocear Negranun ofthupesmiL
�--� APPLICANT UNDERSEA S ND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z L/
SOURCE REGULATIONS.
i1 AW It, Re-roofs ✓�
Sigwum ofApplicaAZARDOU Dam
HAZARDOUS '-
HS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or forum H
Wilding CoaCoNe
occupant mom m handle aNaaz material
az '
' de0ned by the Cupertino Municipal Cade.Chapter 9.12. si Health and Safely
Conn.Section 3.9532(.)7 alar-
Will
9*t� Albroofs shall be inspected prior to any roofing material being installed.
0Yes
Will the Applicant or future building Occupant Cot equipment in deices which If a roof is installed without first obtaining an inspection,I agree to remove
j harsrdous air contaminants As defused by the Bay Arta Air Quality Management all new materials for inspection.
.atrin7
0 Yes
I have mad the haAsdcas materials requirements under Chapter 6.95 of site Califon-
me
alifonme Health k Safety Code,So..25305.25533 and 25334.1 undersand thalif Ne Wilding
dm not cuonnl ha a'= Na iL h my respomihiliIy b notify the One 0ant or the
requlmmena w' tbcmelpriarsnauanm ora r..c;rmte of0.c Signature of Applicant Date
-L�ifi All roof coverings to be Class'W'or better
Owner urauthoriseda eni Dam
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37515025 . 00
DATE ISSUED. . . . . . . : 11/24/2008
RECEIPT # . . . . . . . . . : BS000006681
REFERENCE ID # . . . : 08110088
SITE ADDRESS . . . . . : 18770 LOREE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER ANTHONY FADAIE
ADDRESS . . . . . . . . . . : 18770 LOREE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : FADAIE ASSOCIATES
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
SFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0. 00
1ERT<200 UNITS 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1TRAVDOC FLAT RATE 1. 00 40 . 79 0 . 00 40 .79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 122 . 87 0 . 00 122 . 87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ------ --
CHECK 122 . 87 #1523
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- ---------------------------- --- --------------
402 TEMPORARY POWER
O
CITY OF CUPERTINO
* TEMP POWER
• CUPE(ZTINO PERMIT APPLICATION FORM
APN # 27515 U a 5, C) Date:
Building Address:
Owner's Name: Phone #:
402 — DDQIc�
Contractor: Phone #:
73 D Fax#:
Contact: Phone #:
Contractor License #:
Cupertino Business License #:
Job Description+40
: D
CL-) tit E C —�
Residential Commercial El
Valuation (cost of project): Type of Construction: N/A
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>1K Res. Temp Power>1K E 1REAP14
Amps
IERT<200 Res. Temp Power<200 E
Amps
IERT2001K Res. Temp Power 200-IK E
Amps
y IEPERMITFE Electric Permit Issuance E
IELCPLNCK Electric Plan Check E
/ 1BSEISMICR Seismic Residential B
1TRAVDOC Travel & Documentation B
Fee
CITY OF CUPERTINO
OF TEMP POWER
CUPERTINO PERMIT APPLICATION FORM •
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
IECT<200 Commercial Temp Power E .
<200 Amps
IECT>1K Commercial.Temp Power E
>1K Amps
IECT2001K Commercial Temp Power E
100-1KAm s
1TRAVDOC Travel & Documentation B
Fee
IBUSLIC Business License B
Revised 6/16/08 •