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08120006 CITY OF CUPERTINO `xt smuo nc rlvlsloN PERMIT �O1�ITR?iCTORI uQItMATION-« BUILDING ADDRESS: PERMIT NO. 1039 NOVEMBER DR ALLEY ELECTRIC nRi2noni; OWNER'S NAME: PERMIT ISSUE DATE 11_R�4 P AND MARIAN 404:46 LEST.1B SIP NE: A CONTROL NO. n (510) 573-0427 ARCHITEC IENGINEERs BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 O p LICENSED CONTRACTOR'S DECLARATION Ib Description U 1 Immby&man Nat 1 am licensed under provisions of ChapmOOSCTIP r 9(commencintt MN Seen on 7001))of Division 3 of dm Buanevand Professions Coda,end my license is +�d infull Cls}lraneand errm G �(� e UPGRADE MAIN TO 200AMPS INSTL 6 CKTS - Z LiO LW.N can= 7� ^p Da¢ ! I Conuuaor < 709 AACHRECI-S DECIARATIO i 6 U eI undersand my plans"I be used as public mcmrds In Licenced Rufami...I OWNER-BUILDER DECLARATION s� 1 hamby affirm that I un cumpt form Ne Contractors License Law for 1)e 1 p o following moon.(Sao=70 IS.Bumass and profusions Cade:My City of county t$� which acquires a paamit m--almost that.improve.demolish,of minor my sanctum u z i Prior to its issmrue.also requires the applicant for such permit m We ngned wamm., < Nat heufimmedpursuantmdmpmNshomofineContractor's lxcnsaLaw(ChapW9 Sq.Ft.Floor Area Valuation EZF� andamnein wida Section 70M)of Division of Ne Business and Pmfcssions Code)or i $ at he u e¢mpt tlmretrom and On basis for he allotted esempdon.Any violation of 2807 Section 7051.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mole Nan five hundred dollen(SSW). 36216007 . 00 ❑Las owner or d pr Nesioand Nprempertmmsy neamNPmlonymeudar cu wadgdes r Nei(sole Mca0mpeBvatio anal professions structure ve Corrscmra Licesselaw docs out apply lf an comer Onf, Required Inspectionsections property who orinsp ea Hereon,analwhodoessohworkhamsselrsir drougM1 his mostemployees.provided Oat each improvements are nonmnded oraaered for ale B. hawoser,0e Wilding u impmwmeatg aid within os Sear of mmove for the ownu- builder will law Ne burden of proving Nat h did M,build or improve far purpose of ale.). ❑1.as comma of de properly w aeluavely contracting,with licensed conuusan an mnswct On pmjat(Sec lad.Bowness and Professions Cada')The Cooaaemrs Li- cove law dors not appy N an owner of property who WSIN or impmws Ncwan,sed, w W cmuacts nor surd pmjecu with,cmnuacmKs)licensed panom tu de Conuacto's License Law. ❑lam accept under See .BAPCfm'NismMma Owns Dae WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury,am of the following declentions: haw and will maintain a Ccrabam of Consent m air-usum for Workers Comma - as as provided for by Section 3709 of Ne Labor Cade,for lie performance of Ne work for which this penal,is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Sermon 37W of de Labor Code.fa the performance of t e work for which this permit Is Isaue6 My ban. Wartime.cco1mwen peti � o� caries and Polity numart ber : Carver, f/.'J,eta.fe 1.A# S Gam_Polity N., P£Ay100% 4110.2 CERTIFICATE OF EX ON FROM WORKERS' COMPENSATION INSURANCE ' rlhu shim wase Mtncom ple nd frute permit urarane hundred doBua(SI09) or less) 1 certify Na,in the parm...of Ilse work fn which Nis parch I,issued.I shall em, employ any person in any masra as to became subject code Wohms'Compensation - Laws of California.Dam Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should become subject tithe Worker',Compensation previsions of NO Labor CCM,you moo �Z foMwiN comply with such provisions or Nu permit mail Wdamad Puked. ZO CONsrRUCTION LENDING AGENCY [-i Ianaby am.Nat there isacmmuctim Waldo,agemy far W perform.of (Ya. i the work for which this permit is issued(Sec.5097,Civ.C.) y.Q LeaMrs Name =,z LanMrs Address U 0 1 annuity that I ban read this application and sum thou Ne chose information is I, F const I agree an comply with all sty and county ordinances and sum laws relating N DU building conswction,md notably mutation reprosenaties of Nu chy to cw=upon ale W above-mmaoMA propmy for inspeuiM purposes (We)agmn to save,indemnify and imp harmless thm City Of Cupertino against y IiabilitieijWgmenu.eons and expenses which may In any way aces against said City U Z in amount.of Ne gamma.;of this permit APPLICANT UNDERSTAlhIPS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE R U TIONS .,at {1 pl !� Re-roofs Signature of App i Can r AZARDOUS MATERIALS DISCLOSURE Type of Roof Will Nc'Plicam or future Wilding occupant uom m"Wt.havatdoo mamrial ' as defined by Ne Cupertino Municipal Code.Chapter 9,13,sad Ne Halm and Safety Cade,section 35533(1)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yu /9No Will,he applicant or future Wilding Occupant use cqulpment or devicrs which If a roof is installed without first obtaining an inspection,I agree to remove t hasalloo air contaminants as defisd by Ne Bay Area Air Quality Management all new materials for inspection. i 0uict7 CYu �No 1 haw mod On haadau maeriats mquim rents under Chma,6.95 of Ne COW- - ansF"OA SafnyCOM-Smions 355(15.25533 mu 25534.l underamul Nd if ft Wilding does not c mend,haw•Imam, is my msyensibility 0 Mary de oceupam of de regaimma saw,"f n MM.L mias11L1eeafaG rleamofDaapantY. Signature of Applicant Date /)-1 All roof coverings to be Class'na'or better Owncror uthorised1ferK Dam' CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36216007 . 00 DATE ISSUED. . . . . . . : 12/01/2008 RECEIPT # . . . . . . . . . : BS000006714 REFERENCE ID # . . . : 08120006 SITE ADDRESS . . . . . : 1039 NOVEMBER DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ECKLUND STANLEY D AND MARIAN G ADDRESS . . . . . . . . . . : 1039 NOVEMBER DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4122 RECEIVED FROM . . . . : ALLEY ELECTRIC CONTRACTOR . . . . . . . : ALINA & WESLEY SEDAIN LIC # 29330 COMPANY . . . . . . . . . . : ALLEY ELECTRIC ADDRESS 40146 LESLIE ST CITY/STATE/ZIP . . . : FREMONT, CA 94538 TELEPHONE . . . . . . . . : (510) 573-0427 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL --- ---- ------------- ---------- ---------- -------- ---- -- - 1BSEISMICR VALUATION 2, 807 . 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 #6937 --------------- TOTAL RECEIPT 122 . 87 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: /� PERMIT #U (`l 0 OWNER'S NAME: S1,holf-v IPHONE # 510 5-73 0 GENERAL CONTRACTOR: FAX# I am not using any subcontractors: gnature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting e 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 GCC , CITY OF CUPERTINO CUPEk1lNO GENERAL BUILDING PERMIT APPLICATION FORM APN # (P U 0-7. 0 0 Date: CCrn1yII IST �U S 'r Building Address: WY[ ljove4 r Air. Mailing Address (if different fro building address): I o3 MJ r. Owner's Name: Phone#: .5 Tali&yyob 257 RV7`6 Contractor: GPhone: 31`j 57-S, a 4�7 / Of Y (ecrr G Fax: 20 573 aU,�-7 Contractor License #: g73�G� Cupertino Business License#: Contact:) ' 1 Phone:/fit fj) b-73- 09-`67 �je<je/ ! PeLlnl,411 Cje n l • Fax: Residential Commercial Job Description: up c� ra�e ���n -f-U qM ps CKs II �j C.f:TS Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ 11/11I B, IV-HT, V-B ❑ A-st- Lace Valuation: �D Square Footage: Project Size: Express ©Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. • Points Achieved: For help, contact Build it Green at www.builditgreen.org Revised 10/20/08