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10050120 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10181 PHAR LAP DR CONTRACTOR:D&D CONSTRUCTION PERMIT NO: 10050120 OWNER'S NAME: TOM GUNTLY&ANGELES DUFFY 1417 HAMPTON DR DATE ISSUED:05/14/2010 WNER'S PHONE: 6505156556 StNNYVALE,CA 94087 PHONE NO:(408)666-5298 ❑ LICENSED CONTRACTOR'S DECLARATION JCB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class Lic.# TEMPORARY POLE FOR POWER SOURCE. Contractor Date 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: 1 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:$500 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 AP N Number:32639054.00 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.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned 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 7_ granting of this permit. Additionally,the applicant understands and will comply Issued by: = �' Date: y�l� with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is insi ailed without first obtaining an inspection,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Sig iature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I h:.ve read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three ma ntain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self-insure for Worker's mal erial. Additionally,should I 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 I performance of the work for which this permit is issued. will maintain compliance with the Cuper m2 Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Ow mer or authorized agent: Date: l 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 Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I he-eby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. wor c's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save iemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ;ts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per he Cupertino Municipal Code,Section Licensed Professional 9.18. r^0 �k Signature "� , Date 1 CITY OF CUPERTINO TEMP POWER CUPEY OF PERMIT APPLICATION FORM loe�501do APN # X00 3(A 3Date: Building Address: IOt$ t Tor L,r�p ��r�e Owner's Name: �. Phone #: icTWl ltn�',,// i"Ic,CIC-S �� CqS�- 51�-C.QS�j�o Contractor: Phone #: `= vl ( <f08>)Wo—SS2gg Fax #: Contact: _ Phone #: Contractor License #: Cupertino Business License #: 3 Job Description: —'��,,,,�c,,�� po�L �� `�oweR Svv�c.Q Residential Commercial Valuation (cost of project): So() Type of Constructio : N/A Quantity Fee ID Fee Description Fee Group Permit Type IERT>1K Res. Temp Power >I K E IREAPI4 Amps 1 ERT<200 Res. Temp Power<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps IEPERMITFE Electric Permit Issuance E 1 ELCPLNCK Electric Plan Check E / 1BCBSC Cal Bldg Standards B ALL PERMIT _ Commission Fee TYPES 1BSEISMICR Seismic Residenlial B ITRAVDOC Travel & Documentation B Fee &0 Z/C— Revised 01/07/09 CITY OF CUP]?,RTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: LDt: APN 32639054 . 00 DATE ISSUED. . . . . . . : 05/14/2010 RECEIPT #. . . . . . . . . : BS000010403 REFERENCE ID # 10050120 SITE ADDRESS . . . . . : 10181 PHAR LAP DR SUBDIVISION . . . . . . . CITY CUPERIINO IMPACT AREA . . . . . . . OWNER TOM GUNTLY & ANGELES DUFFY ADDRESS 10181 PHAR LAP DR CITY/STATE/ZIP CUPER-INO, CA 95014-1113 RECEIVED FROM THOMAS GUNTLY CONTRACTOR ENDE WU LIC # 23939 COMPANY D & D CONSTRUCTION ADDRESS 1447 HAMPTON DR CITY/STATE/ZIP SUNNY'IALE, CA 94087 TELEPHONE (408) 566-5298 FEE ID UNIT QUANTITY AMOJNT PD-TO-DT THIS REC --NEW BAL- ---------- ---------- 1BCBSC VALUATION 500 . 00 1. 00 0 .00 1 . 00 0 . 0 1BSEISMICR VALUATION 500 . 00 0 .50 0 .00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1 .00 137 . 94 0 .00 137 . 94 0 . 00 lEPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 lERT<200 UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0. 00 1TRAVDOC FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---- TOTAL PERMIT : 265 .44 0 .00 265 .44 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- - ----------------- CREDIT CARD 265 .44 visa --------------- TOTAL RECEIPT 265 .44 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- -------- --------------------------- -------- ------------------- 402 TEMPORARY POWER