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09120068 CITY OF CUPERTI NO BUILDING PERMIT BUILDING ADDRESS: i0885 N ST1 I.LING RD CONTRACTOR.-POWER PLUS PERMIT NO:09120068 SOLUTIONS CORP OWNER'S NAME: VALLEY CHURCH OF SANTA CLARA C 1210 RED GUM AVE DATE ISSUED: 12/11/2009 dNER'S PHONE: ANAHEIM,CA 92806 PHONE NO:X714)765-7511 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 13 COMMERCIAL License Class 110 C0/1031 Lie.#j 9373-30 TEMP POWER ContractorPpW(y &S S,ojt t/Date /Z -11--9 1 hereby affirm that i am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. i hereby affirm under penalty of perjury one of the following two declarations: i have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2500 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32607027 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that i have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relatirg WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above menti,ned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,'lie applicant understands and will comply issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section _ 9.18. q RE-ROOFS: Signature__ _ _ _Date IZ��,'—0/ AI!roofs shat:be inspected prior to any roofing material being nstalled. If a goof is _ installed without first obtaining an inspection,1 agree to remove all e";w materials for inspection. Li O%VNER-BUILDER DECLARATION Signature cf At;Klicant: Date 1 hereby affirm that 1 am exempt from the Contractor's License Law for one-if the following two reasons: .ALL ROOF COVERINGS TO BE Cr ASS"A"OR BETTER 1,as owner of the property.or my employees with wages as their sole compensatio 1, will do the y;ork,and the structure is not intended or offered for sale(Sec.7044, Business&Piofessions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the proje_1(See 7044,Business& Professions Code) 1 have read the hazardous materials requirements under Chapter 6.95 of the California 11"It;i&Safety Code,Sections 25505,25533,and 25534. 1 will hereby affirm under penalty of perjury one of the following three maintain comhlian:e with the Cupertino Municipal Code,Chapter 9.12 arid the declarations: Health&Safety i ode,Section 25532(a)should 1 store or handle hazardous 1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Auditionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued. will maintain comolianee with the Cupertino Municipal Code,Chapter 9.12 and I have and will maitttain Worker's Compensation Insurance,as provided for by the Health&Safely Code,Sections 2555q545533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:._ __^Date:_ permit is issued. I certify that in the performance of the work for which this permit is issued,i shall not employ any person in any manner so as to become subject to the W'orker's Compensation I%!ws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject:o the Worker's Comoen ation provisions of the Labor Code,1 mutt I hereby affirm tha,there is a construciion!e:,uing zgency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work';for which this hermit is issued(Sec.309;,Cr•:C'.) Lender's Name APPLICANT CERTIFICATION Lender's Address__ i certify that i have r--ad this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relatir g 1 to building construction,and hereby authorize representatives of this city to enter anon the above mentioned property for inspection purposes.(We)agree to save nnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION .s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public r,cords. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulaLionE per the Cupertino Municipal Code,Section Licensed Profess*,nal 9.18. Sienature Date CITY or . CITY OF CUPERTINO ig TEMP POWER CUPERTINO PERMIT APPLICATION FORM APN# � 2C0 0--7 OZ-7 . Date: 0<S, Coq Building Address: lOft's tl�- 3 e6 �qd - Owner's Name: VA)IC�dVN� ow Sqh I� Grpr9 Phone#:eV , I t& ar 1 oo Contractor: P o"x Pu( Phone#: R k 10 . 503- 1013 Fax#: U`5-1k- UZI Contact: n - 1n Phone#: Contractor.License#: Q3-115b 0 Cupertino Business License#: Job Description:`-VCM q V LAX POLC -�N Q VD6L �M >,Oq —W V—W . I / Residential ❑ Commercial Valuation (cost of project): ,�J—�v— Type of Construction N A Quantity Fee ID Fee Description Fee Group Permit Type IERT<200 Res. Temp Pcwer<200 E 1REAP14 Amps 1 ERT2001 K Res. Temp Pc wer 200-1 K E Amps 1 EPERMITFE Electric Perm I Issuance 1BCBSC Cal Bldg Standards B ALL PERMIT Commission lee TYPES 1BSEISMICR Seismic Resicential B 1TRAVDOC Travel & Documentation B Fee Revised 06/12/09 CITY OF CITY OF CUPERTINO TEMP POWER CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICO Seismic Commercial B 10EAP14 lECT<200 Commercial Temp Power E <200 Amps l ECT>1 K Commercial Tomp Power E >lK Amps 1ECT2001K Commercial T,;mp Power E 100-1K Amps 1 ELCPLNCK Electric Plan Check E 1 TRAVDOC Travel & Documentation B Fee 1 BUSLIC Business License B n «. Community Development RA 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '-UPEkTINO Building Department JOB ADDRESS: PERMIT# EBBS 5+611VIA Q. c tAvlo CA I SON OWZ Dob& OWNER'S NAME: Vo e CG vrc D� 5rjN,La CT-Ord PHONE # (HIS) 30Y 9 4 00 GENERAL CONTRACTOR: Poway KvS FAX # I am not using any subcontractors: 0 _ 2 - 1/- 0� Si gnat e Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical � �v P1 VS 5/ 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 12 Owner/C ntractor Signature Date