05100228CITY OF CUPERTINO
BUILDING DIVISION PERMIT
ZI OC, RACTOR INFORMATIQN
BUILDINGAODRESs: '
45 ASTER IN
NORMAN & VICKI PESTANA
PER""'No 05 10 022 8
ERS NAME
PERMIT LBUE DATE
NORMAN & VICKI PESTANA
01/10/2006
NE
SAWrARY NO. CONIROL NO.
ARCHI"IECTIFNGINEER:
BUILDING PERMIT INFO
BLDGELECT PWMB MWH
0 0
LICENSED COMRACIDRs DECLARATION
Job Description
1 bcreby affirm tW I w Ikcvcd u pmN na of Chaper 9 (c«m ing
MIN scNan 7000) of Dirirfoo Sof the Buairc and Profcadt,no, Cmc, am my Ilccock
iv full fora am eRem.
ADD 154'-KITCHEN/LAUNDRY/NOOK
Leenso Clm Is.♦
Dae Con
ARC SDECLARATION
k uaDEC
I uMcrauW my plana Nall h atm As Public recmN
Lkcmed Pntfcnidnal
OW NEI-BUILDER DECLARATION
1 hath, affirm that I .m acmpt frm th Cminacur. Lane law for the
folbwint nam. (se tion 7151 S, Bui» am Pmfir m Code: My city «county
which rcqulma a pump to cmmrua. alw. mprve. dwWhh, or oconIr my muctme
$95000
Prior n Its issu.mc, aha Moon., the ApPlkmi for t peril r file Mtad 9atemal
Ft. Floor Area
Valuation
tlw he hfiumcd .art to ft pra.i.na, d dna Cmlrxl«'t umnco Law (Coa ur9
Sq.
(mmmcaci., with stcdm 7") of chvvion 3 of the Buai«ua and Prfadom Cmc) or
,
that he It eumpi thmfrom and the bait f« th alktrd c Ptlm My vidation of
r
Occupancy Type
section 7031.5 by any applicator for •Permit anbye lh.ppluam to rMl peralky of
not ..than five hutdred dollar. (S500),
❑ I.uawmrofth popsty,«Rry aAplysc.with wagauthksok mnpnvdm,
pp
eq Ired Inspections
will do th wort am lbe.bmrrtumtimeoded«alfeon1furulc(Sec.7014,Butircn
am Prfc.siom Code: The Cons I.keme law cleat mt Appy u an craw of
proputy who builds «impovca churn, and who dmss¢h work kimuu«1Mmth M.
soon croployeu, pmvWcd tout mcb imptoauenu art tut IntcMm of officmd f«ark. If,
bawcv , Ne building or impro.t 1, sold widest arc year of mmpic m the.Apar.
' t'��.'
lr�
hu00n wi0 have t4 bmndm of poving Out h did nm bdld «huprm fm p«ponc cf
�_ �oo]
rak.).
1
c®.traa th proj= (sec. RW, Bmlam and Pr(ctiom Code:) Tic Cmtracr«'s LL
1. As owxs of th poPW., am eatlf ,oiymP
ingwith limmcdcenuavonb®�
{qp�
Ywint
ague taw d«a oat appry n an .wits mprapmy.wbo hilN «improv thenen, am .
who caneua f«zu h procto with a contractor(.) fl a pvrauawt b the Cmuauoes
'V 'tBOpt tlhrt/pt7
Licence law.
lam acmpuntlmsm .BB PC foaLlus earn
r Oare
WORKERS COMPENSATION DECLARATION
I booby affirm nAc, potty N perlmy one of the roilowint declunbrtt
� -
1 hs.c am w01 Maintain msoM n aCcrtifiae of Cb elf-Thune f« Worta'.C«opm-
perform. of
utko, u poWdc l for by seaim 3700 do Labor bor Code, f« rhe tic
it f« which this 'nat la Issued.
❑ 1 Nvx .m will mMtwin W«tcY. C«npenwbn lasurarec, u rtyuirtd by Betties
)100ofdc labs Cmc,(of ftcrfir ofth wort f«wMch lhbpermh h hued.
My Warte , Comperaatim Inturuta aniu am Policy murk, art:
C.nrier: Polity No.:
_
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
. , flidt smim nmd ipt 4 tangled dth lenoit 4 fame hundrN do0u. (5100)
a lot)
1 urtif. W t In the performm� of tk which thh permit h iced. I NaII not
employ any ptson no my r W rb4tto do WohaY C«opumtbn
Law. of Calif«Nt -
Appliau— 1D INOME
TOAPPLICANT: fr. Nes mal g N C bC.., of Frr,non, yon NuoW
beeenne soblect to the Wooer. Contl ,nzation proriic n, a lh labor Cmc, yon tmu
forthwith comply with such proviiom or this pernit.hall k dctunm resoled.
CONSTRUCHONLENDINGAGENCY
Ilcr by that chert 1.amMrvct for tlr prfmnarccN
which 3097.Co.petty
the south for which Nh prtnit b lsstua (Sec. J097, Cv. C.)
Lender. Name
lamer. Addrm
1 I certify that 1 Iuvc tad this Appliutim am sue this de above INanm.tim h
' canrct 1 ogre b comply with all city and cavity ondinmu1 am we laws rtlNnj b
bu1101ot rmnneian, and hcneby.uth«Ine rtfamenut of dds city to enter upon lh
ahme mrnutecd popmty for imp=m putpoci
(Wc) agrte to xa a io emnify.rd te<p hamlra. ft City of Cupenino a0ron
j 11.1tilitiu, judlmma, cacu and eapemrs which may In my way acere against aid City
in mttugattci of lh graving of this permit
APPLICANT ERSfAND ND WILL COMPLY WGif ALL NON-POINT
Issued by: Date
souRq� LQAV�
Re-roofs
sitnuum m AppicmurCantracfor Dalc
HAZARDOUS MATERIALS DIsCLOsURE
Type of Roof
Will the applkant« futtne Miffing occupant a=of handl baa mmaterial
u dcfimd by the Cupedm Mtmld* Code. Chalry 9.11, am th lkalth and Way
532(.)+
. SmtiYa
All roofs shall be inspected prior to an roofing material beinginstalled.C3
Orai
If a roof is installed without first obtaining an inspection, I agree to remove
Will lh .rglicant «Imre liking omp.m ate cgafpment a dcrlua whirs
It Wmoo is air mnumlmna u def d by the Bay Ara Air QoNty Mututcmcnt
all new materials for inspection.
Any
0Yo, QNu
1 hoc unttr Claper495 aft CAlll«.
w Halth k Wmy Codc.s«tiam 253415.15533 and 25534. I mkrvatd thutirth buiWbg
dm mtcart«I . it is my Ma cmir ility to notify ftoavpmt of the
t toian-a7e>a.Cerdlkuedoccupancy
Signature of Applicant Dale
"' , !�7 �4A 2
All roof coverings to be Class "B" or better
Owner or.uthorired agent D.to
i �.
�UPERTINO
Community Development
1 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
�I Fax (408) 777-3333
Building Department
JOB ADDRESS: l ,/� / !L
PERMTr #
OWNER'S NAME: Or/r�z 2
iC Q a J
PHONE #4O9 ,a 6
GENERAL CONTRACTOR 0 M F 01? 5e7r6 Gt;&
FAX #
CarLv5 Farta n
I am not using any subcontractors: 11� 117�11_GZi o2" 5 �2 0 b
Signature Date
Please check applicable subcontractors and complete the following' 0 tion:
Owner/ Contractor Signature
X21- 5-0
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
Owner/ Contractor Signature
X21- 5-0
Date