08120008 CITY OF CUPERTINO y
BUILDING DIVISION PERMIT C�NTRACT(TVIIF,URMAT
BUILDING ADDRESS: PERMIT NO,
7553 WATERFORD DR TBD - TO BE DETERMINED 08120008
OWNER'S NAME: PERMIT ISSUE DATE
NE: etAWYLWO. CONTROL NO.
ARCHIT (ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u0p LICENSED CONTRACTOR'S DECLARATION lob Description
UF I maby af0rm that 1 am Ikcnecd under pmvWou of Chpmr 9(commencing
m OSecmtiaonor Division Sof tle Budneu and Profcssiom Code.aM my liccn¢u REPLACE ELECTRCL PANEL
o666N ,aLG/o $'� �29
NOTE: PACIFIC GLOBAL ENERGY, INC. PD FOR BSL
eARCHITECTS DECLARATION N�y
L < I undarsund my plans thall be mad as Public acon6 /A3C 12/1/8
D U
Z G t; Licanted Pmf.oknal
,a3 OWNER- UILDERDECLARATION
i�E I bcmby afarm that i am.'apt from the Contractors License Law for the
E O o following ammo.(Section 7031.5,Bu(aees and Pmfeaamm,Calc:My city of county
,2V which mqulms a pconit to construct.a1w.improve,d.mnlim,or mp.i,any mactma
y prior to its iuumce,alm mquims tho applicant forsuch permit to ftic a signed statement
< that ha u licemcd purmant an the provisimu of the Conancmra Ucema Law(Chapur 9 Sq.Ft.Floor Area Valuation
y�D (commencin{with Su4on 7o00)of Ditvian3nf de Busiassantl Professions Cade)a
y $ this he is exempt IM,4cfmm and the buis fa Ne alleged eaemptian.MY violation of $900
Section 703IS by any applicant fa a permit anbjects tki applicant 0 a civil Penslty of APN Number Occupancy Type
not roam than five hm amd Eallan(LTM 36617026 . 00
I,u owner of Use pmpmy,or my employcu wIW w rA m Ne'v mk comK=uhan,
will Po Newark,antlthe h,comthnots statim LRemdTorula(See.to am owner
caw Rof.Wbu Cndc Tb,Canmctor,Dame Isco tush+m.apply m an owner is Required Inspections
P mploha .proa mtt Ihimn,andwho aaessuelt work himoJfarMroughhu
hon,or.ficas,ldingmdthatsueh improtemenuarem.ear alcaoQemW fWom a-
have ar,the building u improvemant u mid within are)ear of mm snot for theimm of
builder will kive the imNan of purring that k did not build or improve for pugose of
CoWJ.
❑I.as owner of Ne property am ucluaivcly conuudng with liaved convacsus to
muuun the pmjco(Sec.704,4.Buskesa aM Professions Cada')M Convannrs U,
cense Law dao Out appy an an owner of properly who Wilds or impmw therm.and,
who canuacu fa such projects with amnvacmr(s)licensed pursuant m the Contractors
License Law.
❑lamuemptundm Sens .B&PCforthismaon
Owner Date
W ORKFRS COMPENSATION DECLARATION
I bunchy affirm tinder penalty of perjury,arc of Ik rnlWwing declamations:
I I. i
—nd will maintain a Car ficam of C...t In self-imum for Workers Commpe
don,
as provided far by Section 3700 of the Labor Cade.far Ne perf oat.of We
more for which this permit is ioatl.
❑I have and will maintain Workers Compenudon Insurance,u ru nond by section
3700.1'de Labor Cadc.for the performance afthe wart for which this permitmound '
My Worknes Compewdon bmunaea carrier and Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus section amid an,W completed if the permit Isfurone hundred dollars(5100)
or list)
1 certify that In the performance of Ne work for which this permit is bound,l skill not
cmpI.Y any parann in any mann r m u m baamemYlecI to the Wohcn'Compensa0m
Laws of Califamia.hon _ CL..[[CC
Applicant /�
NOTICE camesbjec oche Wa :IL Commatin{dins Ccniftnc of the Labor CniyoushmW
becamesubject.
Comp y the Worker`,Compensation Or Lot!
PmviL mal of Ne ISMr Code you muss
�,� foMwith comply with salt puvislam a Nu permit shall be domed mwkcd.
.Zi O
CONSTRUCTION LENDING AGENCY
I hereby affirm drat thereera cmtmmil.knding.pucy fm the perrormaum.1
a Nc work fa which this permit is issued(Sec.3097,Civ.C)
fg3
Lunda',Nue
04z Lenders Address
U 0c 1 amity that I have mad Nit application and r ma Nat the above infamadun B
U. :,V ebrtaL I atom m comply with N city and county aNinamef and auk laws relating W
.O Wilding Construction,and hereby amboria mpmmmmives of this city in enter upon Ne
Gq abovcmmtioad pmpwy far impaction purposes
G I%)ague to nave,indemnify and lamp humkss Ik City of Cuponino again,
f~ cn liabilities,judgments.coats and experucs which may in any coy aattue against Cold City
UZ in consequence of the&=fn&of this purmiL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEgecULATfONS.
A U iz�ioop Re-roofs
Si umof IimXom.wCUa Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or futum building occupammuc or kindle hanardou manurial
as defined by Ne Cupertino Municipal Cod..Chaper 9.13.and the Hu1N and Safety
Conk.S.cti.n 25532807 All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will Nc applicant or fumm building occupant an,equipmonl m deticot which If a roof is installed without first obtaining an inspection,I agree to remove
It hvuNou air cmuminants as Joined by the Bay Am Air Quality Mani&-men. all new materials for inspection.
u ct7 /
❑Yu pP
I have mad the boandous maerials ra,m mems under Chmtn6.95 of Ne Califory
out HWN A SafcyCadc.S d.25505.25533 and 25534.1 unm,und Nm dorm building
dm an,cuncndy lave a tenant that it Is my mipomibility to notify the aaupant of Ne
r.quimmentsw 'hmtmbemetiss ofaCutifeaeoI Signature of Applicant Date
own. rmma edsmt /2 Data All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 36617026 . 00
DATE ISSUED. . . . . . . : 12/01/2008
RECEIPT # . . . . . . . . . : BS000006717
REFERENCE ID # . . . : 08120008
SITE ADDRESS . . . . . : 7553 WATERFORD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. NAKANO RONALD K AND MARYLOU L
ADDRESS . . . . . . . . . . : 7553 WATERFORD DR
CITY/STATE/ZIP . . . : HILO HI, 96720
RECEIVED FROM . . . . : LIGHTS R US ELECTRI
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 900 . 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 #0649
---------------
TOTAL RECEIPT 122 . 87
•
Community Development
10300 Torre Avenue
z �sv �' Cupertino CA 95014
p" Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building De artment
JOB ADDRESS: -7S-,<-3 W a4vtr-F�40 /five- PERMIT # fes/ U O
OWNER'S NAME: /a,/W X01,4 -4Al o PHONE # $oe-�o
GENERAL CONTRACTOR: ,,i� C'lodaa �H ,u FAX #
I am not using any subcontractors: c
Signature bate
Please check applicable subcontr ors 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
44� 1z
Owner/ ontractor Signature Date
CITY OF CUPERTINO
• CUPEf1T1NU GENERAL BUILDING
PERMIT APPLICATION FORM
APN # D �p 00 Date:
3 Y 42 oe
Building Address: �1553 WAr2,eFoe-OW GUPEIeTin/0. Gig 9S0/
Mailing Address (if different from building address):
Owner's Name: Phone #:
bona+ .1/4,419 <ov 19A9.AV0 $c99s= Cool - 3328-
Contractor: — AUFi c G Ao 6pL E kwe�i yl .ZA4, Phone: X080- $S8,-gaO
PO, /30x ///30a
CArnp64LL/ CA 96-D// Fax:
Contractor License #: C Ag — 60 9
Cupertino Business License#:
Contact: 3 oF� � R/LLO Phone:
• _
Residential Commercial Fax:
Job Description: ELEG7-)eIcs1L_ �PAA1Ct- .
Building Permit Info:
Bldg ❑ Elect 2", Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ I1/III B, IV-HT, V-B 0
Valuation: Square Footage:
Project Size: Express Standard E] 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