09070159 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7880 MC CLELLAN RD CONTRACTOR:JEHOVAHS WITNESSES PERMIT NO:09070159
CUPERTI IO C
O4"NER'S NAME: JEHOVAHS WITNESSES CUPERTINO C X880 MC CLELLAN RD DATE ISSUED:07/23/2009
ER'S PHONE: 4088294111 CUPERTINO CA, 95014-4264 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDGELECT � PLUMB
License Class Lic.#
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REACTIV PREV SIGNED MONUMNT
(commencing with Section 7000)of Division 3 of the Business&Professions 3ERMIT,08040042,EXP'D
Code and that my license is in full force and effect. i/27/8
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.
1 have and will maintain Worker's Compensation Insurance,as provided for by ;q,Ft Floor Area: Valuation:$510
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
CPN Number:35902017.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18• Issued lb Dater-'2_3 i' '
Si---'lure Date
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that 1 am exempt from the Contractor's License Law for one of nstalled without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: nspection.
I,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, signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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,Iiz Uq
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: z I
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
up ?above mentioned property for inspection purposes.(We)agree to save Lender's Address
it ify and keep harmless the City of Cupertino against liabilities,judgments,
cow. ,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature + Date 7
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk : Lot :
APN . . . . . . . . : 35902017 . 00
DATE ISSUED. . . . . . . : 07/29/2009
RECEIPT # . . . . . . . . . BSC00008305
REFERENCE ID # 09C70159
SITE ADDRESS . . . . . : 78EO MC CLELLAN RD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JEF:OVAHS WITNESSES CUPERTINO C
ADDRESS 78EO MC CLELLAN RD
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4264
RECEIVED FROM . . . . : KIDGDOM HALL OF JEH
CONTRACTOR LIC # *OWNER*
COMPANY JEF:OVAHS WITNESSES CUPERTINO C
ADDRESS 78EO MC CLELLAN RD
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4264
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY 1,MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
1BCBSC VALUATION 510 . 00 1 . 00 0 . 00 1 . 00 0 .00
1BSEISMICO VALUATION 510 . 00 0 . 63 0 . 00 0 . 63 0 . 00
1ESIGN UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
-- ------ ---------- ---------- ----------
TOTAL PERMIT 43 . 63 0 . 00 43 . 63 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 43 . 63 #1130
---------------
TOTAL RECEIPT 43 . 63
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL
CITY OF C-UPERTINO
00 SIGN
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Descriptic n Fee Permit Type
Group
1 SIGNDIRECT Directional B
1SIGN/RF Ground/Roof/Projecting Signs B
1 SIGNMASCK Master Plan Sig-1 Check B
1 SIGNREWRKG Rework of any existing Ground B
Sign
1 SIGNOTHER Other Sign B
1 SIGNREINSP Re-inspection F.-e B
1 SIGNWNONEL Wall/Awning &gn,Non- B
Electric
1 SIGNWELEC Wall, Electric E
ESIGN Sign, Outline Lighting System E 10EAP5
or Marquee sup?lied from one
branch
I ESIGNADD Additional Brar ch Circuit on E (' 10EAP6
Same Sign, Outline System or
Marquee
1 ELCPLNCK Plan Check Fee E
_LEPERMITFEE Electric Permit Fee E
1BCBSC Cal Bldg Standards Commision B ALL PERMIT TYPES
Fee
SEISMICOM Seismic Comm-,rcial B
SEISMICRE Seismic Reside ltial B
RAVDOC Travel & Documentation B
USLIC Business Licence B