The URL can be used to link to this page

07080063BUILDING DIVISION PERMIT BUILDING ADDRESS. PERMIT NO. 19133 MURIEL LN DAVID MI.GUEL 07080063 OWNER'S NAME: PERMIT ISSUBDATE DAVID MIGUEL 19133 MURIEL LN 12/05/2007 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 LICENSED CONTRACTOR'S DECLARATION m F I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z ry with Section 7000) of Division 3 of the Business and Professions Code, and my license is ! w in full force and effect /_ i� License Class Lic. K (l' ! / U1 understand my plans shall be used as public records .0. o y Licensed Professional i y OWNER - BUILDER DECLARATION T hereby affirm that I sm exempt from the Contractors License Law for the p Oc following reason. (Section 7031.5, Business and Professions Code: Any city or county °, ti which requires a permit to convect, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement I that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) tar that be is exempt therefrom and the basis for the alleged exemption. Any violation of Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of not more than fix hundred dollars ($500). ❑ I, as owner of the property, or my employes with wages as their sole compensation, win do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employes, 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 Conuactnes Li- cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ I am exempt under Sec , B At P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby stunt under penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Workers 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 Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is issued. My Workers Compensation insurance eartier and Policy number are: Cartier._ � Policy No.: dO Z�D(c Z CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (S 100) nr 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 Workers Compensation provisions of the Labor Coda you must O forthwith comply with such provisions or this permit shall be deemed revoked. CA CONSTRUCTION LENDING AGENCY r-. I hereby affirm that there is a construction lending agency for the performance of ld > the work for which this permit is issued (Sec. 3097, Civ. C.) Q Lenders Name Z Lenders Address Q I certify that I have read this application and state that the above information is Hcored I agree to comply with all city and county ordinances and state laws relating to C..) building convection, and hereby authorize representatives of this city to enter upon the U above- mendoned property for inspection purposes. y fy (We) agree to save, indemnify and keep harmless the City of Cupertino against y to liabilides,judgmens, costs and expenses which may in any way scenic against said City in consequence of the granting of this permit rte- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOU E REGU / z — s —o7 Signature ofAp icant/ 6 or Date H DOUS MATERIALS DISCLOSURE WIN the applicant or future building Occupant Store or handle hazardous material is dcMcd by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defend by the Bay Area Air Quality Management District? ❑ Yes Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Coda Section 25505.25533 and 25534.1 understand that if the building does not currently have a tenant. that it is my responsibility to notify the occupant of the requi ens which m met prior to (ssfance of a Certificate of Occupancy. n P, c /� Z ' 'S ' — (,--? Owner or auth mud age Date Job Description ADD 678' REAR OF HOUSE,DINING,BEDROOM, MULTIPUROSE RM. PORCH 96'. REMODEL 100' UPGRADE — WINDOWS- PLUMBING,—SEWER- -& V ATER- Sq. Ft. Floor Area $125000 Valuation 3 7508008 A(FtT Number Required Inspections Issued by: Re -roofs Type of Roof Type Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPERTINO Can OF PERMIT APPLICATION FORM CUPERTINO ADDITION /REMODEL 2 APN # ?� �— O 8 0 Date: 7 uo b Building Address: 1 8133 /�IurL «L L� Mailing Address (if differen from fauildin - adds ss): P� �� 9'So�S` AJ 6 A� Owner's Name: L YNPA *f P,4 tIlp /74 /,6 Phone #: 7g/ -3;;8 o� 83;10 Contractor: Phone: 781' Z *3 State License #: G 7 `l V ,DM CO S77U -G j/0 N Fax: Contact: Phone: _ a Cupertino Business License #: 'PAUI,v )2 Fax: Building Permit Info: R_ Bldg LY Elect Plumb L7� Mech 0� Job Description: What is being added? Xe*2 d� L~ J<1STi1%fG> SSE t T r What is being remodeled? �' � y A-vt_ ex STIA14 WtN 9&Wf / tw a&ti r `,r I .c a c� 02 •.e (c a2,,,t' t �i� /,t4-1,1 � '� -�*-�` K fV U Residential Commercial ❑ Remodel Includes Re -Roof: Yes Q' No ❑ Remodel Includes Structural: Yes E�' No ❑ Square Footage: Addition: 4,78 Remodel: 4MV �� Garage: Porch: Ito Z -_ Deck: Other: Cost of Projec • Ls� °� Occupancy Group: . 2 l Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard d Large ❑ Major ❑ *For office use only* . ❑ Over the counter 1 of 3 r E.w CM OF CUPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax (408) 777 -3333 Building Department JOB ADDRESS: I�3 P e4,9I1�c Z A-t PERMIT # 0 `70 S-00 d-7 OWNER'S NAME: 1-b G Y&IPA 1W 16aFL PHONE # 791-3283- 836-0$28' GENERAL CONTRACTO xl&lz FAX # I am not using any subcontractors: % 0 Si tore Date Please check applicable subcontractors and complete the following information: er /Contractor Signature Date 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 er /Contractor Signature Date