08120033 CITY OF CUPERTINO ��a,�
BUILDING QIVISION _ PERNUT * oL�°R• � Q Q V
BUILDING ADDRESS: PERMIT NO.
1
OWNER'S NAME: PERMIT ISSUE DATE
A O. CONTROL NO.
510 432-624
ARCH17EC 1ENGINEM: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u o o LICENSED CONTRACTORS DECLARATION lob Description
U 1 hembY affirm Net I am linnesd under provision or Chapter 9(commencing
with Section 70(q of Division 3 of de Business and Profesdoru Code.and my licenso u
ut full force and efromTEMP POWER POLE
j q— Licence Clan Lia.a lA C'z/ /
�Fp Dam Contractor
e 7W ARCHITECTS DECLARATION
vi U
p 1 undersand my plans Nall W tied ss Public records
DI
!U
Lkerued Prafeaional
OWNER-BUIIDER DECLARATION
I Wreby aRrru that I not exempt from tW Comanno's Liecnm Law far the
o o rolkwing mason.(section 7031.5,Businrm and Profusion Cole:My city or County
s m which nequims a Pumi,to cca suucL alter.improve,demolW,or repair any structure
i y prior to its issuance,also inquires the applicant for such permit no 0k asigned women,
< titer he a focused famrts,w to provisions of sire Communes lJaem¢Law(Chapter 9 Sq.Ft.Floor Area Valuation
x�8 (commencing with Section 7000)of Division 3 of tW Business and Profestion Code)or
Was Im Is exempt thaeudocare and Ne bases for the alleged eaampdom My violation of
Section 7031.5 by any appikent far a permit subjects the applkant on a civil penalty of APN Number Occupancy Type
not mom Nan Rw hundred dollars($500).
Q I.n owner of Ue proP.ty,a my wpirym with wags u thew sok eompewdon. 36227035 . 00
will do the wart.and Iho swnum isnotkunded proffered tarsale(Sec.7044.Business
and Prefnssian Code:The Conusotor's Lim..Law ten ant apply an an awrmr of Required Inspections
prop.,ywW Wilda orimptoves thocon.and whodocatuch work hionefatMmugh his
awn employs.provided that such improvements are not intended oroffemd fasale H.
bovever,the Wilding or improvement issold within one Sea,of Completion.the owrvn
Wilder will have the W due of proving Chat Im did trot Wile or improve far purpose of
1,ar owe.of the Property w eaclusiwly contracting with boned Conuactera to '
Construct the project(Sec.706x.Business and P,ofessom Code:)The ConuacmYs U-
cense Law does not apply to an owner of property who Wilds or improves daemon,and
who comae.forsuch projects with a comessum(s)licensed pursuant to the Contra mos
License Law.
❑lamncmptatderSee .BApcfa Nisrtasnn
Ovvne, Das
WORKER'S COMPENSATION DECLARATION
I hereby,affirm ander penury of perjury can of the following declarations:
Ove and provided
aComm�troCode,furehe Work6Ya Camp de ,
tion•r provided for by Section 3]00 of Ne Ichor Code,for the perfonnana of dao
work far which this puma ii tissued.
1 have and will maintain Worknes Compensation Insurance,as ne9u'ued by Section
700 of can LJWr Code,for the performs.of the wrk for which this permit is ime.d. '
My Wmize.Compensation bar.carts.and Policy number am:
Cartier.ft)n tSA s�T Policy No.: �A 0 CSW
CERfIFI.(TATE OF E%EMMON FROM WORKERS
COMPENSATION INSURANCE
(This weGm Iced trot W eonpl.nd if the permit is Forane hundred do0ara($100)
or ins)
1 awfy dant in We performance of to work for which this permit is issued.)deal not
employ any person in any mannerse at an become subject to the Worl¢n'Canpmuadow
Laws of California.Dau
Applicant ,
NOTICE TO APPLICANT:If,after making this CcNRaue of Eicmption,you Houk
become subject to the Woaker's Compensation provision of the Laba Code,you must
QZ forthwith Comply with such proveimu.this pevnit Nall W doomed k,d.
zCONSTRUCTION LENDING AGENCY
[—t IWreby affirm Nat there is a construction lending agency Car the Performance of
due work fa which Nis permit is iaaA(Sce.3097•Civ.C.)
Q
Lender's Name
.7 z Lend<ts Mdma
U Q I certify that l haw read this application W sum than tW show informadon is
I,H ca mum 1 agree to comply with all city and county ordinances and sum laws relating te
.Q U Wilding construction,and hereby authods representatives of Nis city m emu upon de
I� aWw-mentioned property for inspection purposes
grtr:7vml;Sltdemtdf less the City a(Cupenino against
rv.t rn titin,judgmenu.caw endapenu which mey inan againuad City
U 2 m consequence of Ne 6nndng of Nis permlL
^� Pmts ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
UR REG ATIONS as
C Re-roofs
Signatu -o pplianl[Co acme_` Date ti
H DOUSMATERIALSDISCLOSURE Type afRoof.
Willtheapplicantser forum Wildingaaupapwg.1amd hmIOwmasri,y
ss dcfioA by da Cupertino MunictWl Code.Cltapun 9.11,and site HnIN and Safeq
Code.Section 15531(a)7ttMttMvvvv,,,rrr...... All roofs shall be inspected prior to any roofing material being installed.
❑Yrs �d a
Will the applicant or future Wading occupant um Nuipmen,m devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
s hmrdous eI,ectuamimmus as defined by the Bay Area All Quality Management ]l-new'j7(a[iRl'[lf-fj)T^itt$pECti9f{�
CE?
❑Ya �No
I hew ma,y au(Y3-. 533i Murder Chapter6.95ifdu Colston
nes ctyhawCodaseedmu e s my r and 15536.1 In notiunt a ocau c building TL / 2- 3, US
fd
trot IY hew s tenant Nu it is my nespomibility u notify the auuPant of the �'-' C C.LIJC
nine It hkhmuse metpriormiuOanCoaraer rdmofoecupar y. Signature`ot pplicant Date
? " 3`�
owner sewrrd seg t DataAll roof coverings to be Class'�W'or better
'
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . .. 36227035 . 00
DATE ISSUED. . . . . . . : 12/03/2008
RECEIPT #. . . . . . . . . : BS000006743
REFERENCE ID # . . . : 08120033
SITE ADDRESS . . . . . : 1083 WEST HILL CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHRISTIAN GUYOT
ADDRESS . . . . . . . . . . : 1083 WEST HILL CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5063
RECEIVED FROM . . . . : BENJAMIN GUTIERREZ
CONTRACTOR . . . . . . . : BENJAMIN GUTIERREZ LIC # 30074
COMPANY . . . . . . . . . . : BENJAMIN GUTIERREZ GENERAL
ADDRESS . . . . . . . . . . : 850 W SUNSET BLVD
CITY/STATE/ZIP . . . : HAYWARD, CA 94541
TELEPHONE . . . . . . . . : (510) 432-6249
tFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 300 . 00 0 . 50 0 . 00 0 . 50 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 82 . 08 0 . 00 82 . 08 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- --------- --
CASH 82 . 08
---------------
TOTAL RECEIPT 82 . 08
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- --- --------------- -------- -------------- -------
402 TEMPORARY POWER
•
,nCommunity Development
4 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
*UPEI�TINO
Building Department
JOB ADDRESS: PERMIT # ll p f,� (-)U
OWNER'S NAME: \kkQt PHONE # 80S –g
GENERAL CONTRACTOR ('kc— a c 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
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
r _l a
er/ ntractor Signature Date
0j"I 33
CITY OF CUPERTINO
i M wo
TEMP POWER
CUPEQTwO PERMIT APPLICATION FORM
APN # � � �a �� Date: �
Building Address:
& �aQeT
Owner's Name: Phone #:1��_
1 C� Civ 6 T
Contractor: Phone #: Do— 1132 C2 9
l 622J✓y Fax #: 9 n l
Contact: Phone#:
Z&--UTA W^.k r,/
Contractor License #:
Cupertino Business Licensee #: I ob L
Job Description:
rLqil a Sou
Residential Commercial
Valuation (cost of project): Type of Construction: N/A
Ov
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 200-1K E
Am s
IEPERMITFE Electric Permit Issuance E
IELCPLNCK Electric Plan Check E
J 1BSEISMICR Seismic Residential B
/ 1TRAVDOC Travel & Documentation B
Fee
CITY OF CUPERTINO
TEMP POWER
CUPERTwO 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
100-1K Amps
1TRAVDOC Travel & Documentation B
Fee
IBUSLIC Business License B
Revised 6/16/08 •