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07030278 CITY OF CUPERTINO n BUILDING DIVISION PERMIT 1. RMjR I�1Ft}RM�tTIr BUILDINO ADDRESS: PERMIT NO. 1411 ASTER LA LIGHTHOUSE ELECTRIC 07030278 PERMIT ISSUE DATE OWNER'S NAME: CARLITZ, STEVE 236 BURNII,'G TREE DR 03/27/2007 SANITARY NO. CONTROL NO. ,NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: ELECTRICAL PANEL UPGRADE TO BLDG ELECT PLUMB MECH � 0 0 0 ZO LICENSED CONTRACTOR'S DECLARATION Job Description V P: I hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z UW with Section 7000)of Division 3 of the Business and Professions Cod'dm y license is tad in full force and effec GG j n Z Licensc Clas Lic•# F c Date Contractor W A HITECTS DELLA A ON �,EctT2/�1 i x a 1 understand my plans shall he used as public records � >aU 'm Licensed Professional a OWNER-BUILDER DECLARATION ja 1 hereby affirm that I am exempt from the Contractor's License Law for the :n C following reason.(Section 7031.5,Business and Professions Calc:Any city or county e w fi which requires a permit to construct,alter,improve,demolish,or repair any structure Z prior to its issuance,also requires the applicant for such permil to frac a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area t o (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 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 APN Number Occupancy Type not more than five hundred dollars($500). ❑1,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 sae(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of q property who builds or improves thereon,and who dos such work himself or through his own employees,provided that such improvements are not intended or offered for sale.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,). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's U- ccnse Law does not apply to an owner of property who builds or improves then-on,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a certificate of Consent to self-insure for Worker's 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 Worker's 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.r_MPM7/iq*�tV Policy No.::21 Z 16 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This 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,1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z— CONSTRUCTION LENDING AGENCY E^'-o rA I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ,C.) QLender's Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to rJ- building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes. (\\` C>r (We)agree to save,indemnify and keep harmless the City of Cupertino against iA liabilities,judgments,costs and expenses which m y in any way accrueagainst said City U Z in consequence of the ranting of this pc >~ APPLICANT UN DS AND 1 MPLY WITH ALL NON-POINT Issued by: Date 'C77 SOURCE REG _0 Re-roofs Signature p rcantl on actor Date HAZARDOUSATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Chapter 9.12,and the Health and Safety Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Ycs o Will the applicant or future building occupant use equipment or devices which If a roof is instz.11ed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Ycs LjD+tt� I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth&Safct Code,Sections 533 534.I understand that if the building does not curt: y h v:a tenon that' i y risibility to notify the occupant of the requimmen mtstbe t issu of a certificate of Occupancy. Signature ofAFplicant Date owner authorized agent Dae All roof coverings to be Class "B"or better CITY OF CUP ERTINO clf PERMIT APPLICATION FORM CUPF�TII`JO 0030,21f3 Date: APN # 2 7"d / Building Address: Mailing Address (if different from building address): ' Owner's Name: Phone#: Contractor: License #: Contact: t 047V 6/L Phone: S"-q U is J Cupertino Business License#: Building Permit Info: Bldg ❑ Elect Plumb ElMech El Job Descri tion:p -- -,N ve-� 20 Residential R /2- Wk17e`i' Yd 07 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Groun: Type of Construction Please check this box if the project is a second-story addition: El Project Size: Standard ❑ Large ❑ Major ❑ Quant—ity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> OOK to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off'Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hote: and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elee Svcs 600V<=200A ELECTRICAL BENERGY anergy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Inve:,tigation fee BUILDING 1 of 3 =` CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Si,;ns Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatric al Lighting Fix ELECTRICAL BREMVENFAN Vent Fain Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismio Commercial _ BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tem or try B1Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Elecirical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechmical sq. foot MECHANICAL MPERMITFEE Mech P�rmit Issuance MECHANICAL PPERMITFEE Plumbir-g Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3 Community Development :. 10300 Torre Avenue a Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 7UPERTINO Buildin De artment JOB ADDRESS: PERMIT# 0-7M5p;2 -70 OWNER'S NAME: S - Met PHONE# CONTRACTOR: j .7Z01 _ # �-cke� K � -;C7?7� I am not using any subcontractors: 42 Signatt:re 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 Date er/Contrat r ignature