07100008 CIT� OF CUPERTINO ° ' ` �T '
BUIiDING DIVISI�N � PERMIT ���� �����}������� `
BUILD N ADDRESS: PERMIT NO.
.��55 HUNTERSTON PL BJURMAN CORP 07100008 .
PERMIT LSSUE DATE
OWNER'S NAME:
MIKE LAITILA 1250 HI�;HWY 101 10/01/2007
SANITARY NO. CONTROL NO.
�HOHE: ( 831) 72 �-9907
BUtLDING PERMIT INFO
ARCHITECT/ENGiNEER:
BLDG ELECT Pt,UMH MECH
� � � �
i p p LICENSED CONTRACfOR'S DECLARATION JOb DeSCT1pClOf1
; V C I hcreby af[irm Ihat I arn liccnscd undcr provisions oC Chap�cr 9(commcncing
; z�� with Secdon 7000) of Division 3 of ihc Busincss and Profcssions Cndc and my licensc is DEMO P�' � L & BAC R F I L L
� � y in fuil (orcc and effecL �' � •L �
� v� Z Licensc Ctazs L�. #
: E ,,, r p Datc Contractor � -
� � ARCHITECTS DECI.ARATION
i a a l undcrstanJ my plans shall bc uscJ as pu6lic rccords
)yU
' u. F' Liccnscd Pn�fcssional
� y � OWNER-BUILDER DECLARATION
r 1 hcreby alTirm U�at 1 am exempt Crom �c Coniractor's Liccnsc Law for the
� p o following rcason. (Scction 7(131.5, Busincss and Profcssions Calc: Any city or caunty
�,°, �i which rcquiccs a pertnit to conswc[, altcr, improvc, dcmolish, or �cpair any swcture
� Z y priar ui i�s issuancc, also rcquires thc applicant for such pertnit to filc a signcd stucmcnt ,. Valuation
:_ � ihat he is liccnscd pursuant to thc provisions o( thc Contractor's Liccnsc Law (Chaptcr 9 ,,q. Ft. Floor Area � 9 O O O
u F- $ (commcncing wi�h Scction 7000) of Division 3 of thc Busincss �nd Profcssions Cadc) or
,, �.. ihat he is exempt theicfrom and t�e basis for the allegcd exempaon. My violaGon o(
Section 7031.5 by a�ry applicant for a pennit subjccu ihe applicant to a civil penalty of p�$i Number Oeeupaney Type
not more Ihan fivc hundred dollars (5500). 3 6 2 2 1 � 1�
❑ I, as owner o( ttrc property, or my cmployces with wages az thcir solc compensauon,
wi:l da ihe worlc, and ihe suucture is not intended or uffeced for saie (Sec. 7(W4 s�� Re uired Ins ections
and P�ofessions Cade: The Canuactor's License Law does not apply to an owner af 9 P
propeny who 6uilds or improves thercon, and who does such work himseiCar tluough dis
own employccs, providcd that such improvemenis are not imended or oRered far sale. lf.
however, the building or improvement is wid within one year of wmpletian, tlie owner-
buitder will have the burden ot proving that he did not build ar improvc Cor purpoae of
salc J.
❑ 1, as owner o[ the property, am ezclusively convacting wi�h licensed rnnvactars to
consuvct ihe projea (Sec. 7044. Business and ProCasions Code:) The Coauacwr's Li-
cense Law dacs not apply w an owner of propeny who builds or improves tAe�eon, and .
who conuacts for such projects with a conuactar(s) licented pursuant W the Contractors
License I.aw.
❑ 1 am uempt under Sec . B dc P C far ihis reasan
Owner Da�e
WORKER'S COMPENSATION DECLARA170N
I hercby afficm under penalry o( pe�jury one of ihe falbwing declantions:
❑ I hsve and will maimsin a Cenificate of Conunl to self-insurc (or Workcrs Compen-
sarian, as providcd for by Sectian 3700 af the Labor Code, for the pedormarce of �Ae
work for which this permit is issucd.
Q I have and will maintain Worker's Compensation Insunnce, u required by Section ,
3700 oC ihe Labor Codc. Cor �hc pcdormancc of We work for which this permit is issued.
My Warke�s Compensation Insurancc carricr and Policy number arc:
Cartier. Policy No.:
CERTIFICATE OF EXEMP'!'fON FROM WORKERS'
COMPENSAT(ON iNSURANCE
(This sectian necd not bc campletcd if the permit is for onc hundccd daAars (5100)
or Icss.) �
1 cenify �hat in thc performance of thc work for which ihis permit is issued. I shall not
employ any person in any manncr sp as ta become�bject to the Workcrs' Compenution
L.aws of Califprn�Da�_ � ' � � '�°
Applicant Y
NOTICE 7'O APPLICAM: 1(, af�cr making ihis Ceni�ca�c o( Exemption, you shoulJ
bccome subjcct to ihe Worker's Compensation provisions of ttic Labor Codc, you muu
� O fonhwiih comply wi�h such provisions or [his pecmil sha116c dccmcd rewkcd.
Z "" CONSTRUCTION LENDING AGENCY
(- � i hcreby aftirm �hat thcre is a conswction Icnding agcncy for thc perfurmancc of
a, ✓ thc work (or which �his permit is issued (Sec. 3097, Civ. C.)
W� A Lendcr's Namc �
� z Lender's Address
(� � ! certify that I havc rcad this application and state U�al the above in(ocmauon is
w � cortcct. 1 agrce to comply with all city and county onlinances and s�ate �aws relating to
� U building conswction, and hcrcby authori�e rcprescnutivcs of ihis ci�y to cntcr u�n thc
� a above-mcntioncd property for inspecuon purposes.
(Wc) agrce to save, indemni(y and kccp harmless U�c Ci�y of Cuperuno against
,,,H, � liabilitiu, judgmcn�s, cos�s and ezpcnscs which may in any way accruc against said City
V z in conseq�xncc o[ ihc gnnting of this permii. Date
� APPLICAN'I' UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicanUContractor �a� Type of R oof
HAZARDOUS MATERIALS D[SCLOSURE
Will Ihc applicant or futurc building occupantstorc or handlc ha•rardous mazcrial
as dcfincd by thc Cupertino Municipal Codc. Chaptcr 9.12, and the Health and SaCety
c«k ,Scction25532(a)? All roofs �hall be inspected prior to any roofing material being installed.
❑ Ycs ❑ No
�II the applicant or fmure building occupant use cyuipmenl or devices which
If a roof i> installed without first obtaining an inspection, I agree to remove •
cmii harardous air contaminan�s az dcfincd by the Bay Arca Air Quality Managcmeni all new m aterials for inspec*ion.
o�s�;���
❑ Ycs ❑ Nu
I havc rcaJ the ha�ardous mamrials requirements under Chapter6.95 of �he CaliCor-
nia Hcal�h & Safcty Codc, Sections 75505, 25533 and 25534.1 utufcrstand �haz if �he buiWing
docs no� curtcnUy havc a tcnant, �hat i� is my responsibiliry io noafy ihc occupant of �he
en�a which must be me ,' tu issuancc oCa Cenificate of Occu Signature of Applieant Date
�� /� � ��'' � All roo coverings to be Class "B" or better
Owncr or authorize cnl ���
CITY OF' CUPERTINO �� t `� � � � �
� � I)El�-IO
CITY OF
CUPEi�TINO PERMIT APPLICATION FORM
APN # Date:
��� l��
Building Address: � � � �
Owner's Name: Phone #:
m' � � ��) ��� ����3
Contractor: License #:
� ur�� � �k;,-.� e�. �,,� - � �7 3 � -�
Conta t: Phone #:
� � � ,: � � ,,.�..� � s� � � o � -�' �
Applicant/Contra tor:
' ding Permit Info: ,
Bld Elect b Mech
Jo escription: ^ 1 �
Residential: ���� a� �`�� �✓� c�- � � 1 Comtnercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
��
Type of Construction: Occupan y Group:
Qty. if
A licable Fee ID Fee Descri tion Fee Grou
BPERMFEE Bld Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUII.IDNG
BPLANCHK Plan Check Fee BUII.IDNG
BUSLIC Business License BUILIDNG
CITY OF CUPERTINO
3 ITEMS OF 3 PERMI�' RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: B11:: Lot:
APN ......... 36:?21016.00
DATE ISSUED.......: 10,'01/2007
RECEIPT #.......... BS�)00002834
REFERENCE ID # ...: 07:_00008
SITE ADDRESS .....: 11!i5 HUNTERSTON PL
SUBDIVISION .......
CITY .............. CUl?ERTINO
IMPACT AREA .......
OWNER ............: MI]:E LAITILA
ADDRESS ..........: 11!i5 HLTNTERSTON PL
CITY/STATE/ZIP ...: CU:?ERTINO CA, 95014-5068
RECEIVED FROM ....: PH:=LLIP D BJURMAN
CONTRACTOR .......: PH:=LLIP O BJURMAN LIC # 23653
COMPANY ........... BJIJRMAN CORP
ADDRESS ........... 12!i0 HIGHWY 101
CITY/STATE/ZIP ...: AR()MAS, CP, 95004
TELEPHONE ........: (8:31)726
FEE ID UNIT QUANTITY ��NiOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -�--------- ---------- ---------- ----------
BPERMFEE VALUATION 9,000.00 158.76 0.00 158.76 0.00
BSEISMICRE VALUATION 9,000.00 0.90 0.00 0.90 0.00
BUSLIC FLAT R.ATE 1.00 107.00 0.00 107.00 0.00
-�--------- ---------- ---------- ----------
TOTAL PERMIT : 266.66 0.00 266.66 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 266.66 VISA
---------------
TOTAL RECEIPT : 266.66
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
704 DEMO