05060107CITY OF CUPERTINO�?
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BUILDING DIVISION PERMIT
3CON-TRACTQRT,NFORMATIO.'�N ,
BUIIAING ADDRESS:
PERMIT N0.05060107
10378 NORMANDY CT
OWNER'S NAME:
PERMIT ISSUE DATE
SHAY & MINA BENCHORIN
Ht
SANITARY NO. CONTROL NO.
ARCHITECI'yENGINEER:
BUILDING PERMITINFO .
BLDG ELECT PLUMB MECH
O f�
LICENSED CONTRACTOR'S DECLARATION
lob Description
P .
I beauty affirm that I w licensed under provisions of Chapmr 9 (commencing
with Section 70(116 of Divldan 3 of the Businesawd Indications Contract] my license u
In full fore. and effort.
ADD 6061 ( FAMILY & 1.5 BATH) &
License Clua Lic.N
Dam Contractor—
KITCHEN REMODEL
ABCXITECse DECLARATION
I understand my plana shall be uvea u public rsords
Licensed Profe,tlaul
OWNER -BUILDER DECLARATION
1 hereby afro that I sen exempt from Je Convenor, License Law rot ted
fallowing reason. (Section 7031.5. Business and Professions Code: My city or county
_
which requ(me a permit ed comer cL alis. Improve, demolish, or repair any ahtcmrc
priorto it, t,mance, also mquiroa do applicant forwch pemsit m flic a signed st,mment
Sq. Ft. Floor Area
ValuESi816760
that W lslicemed pursuant ro Je pmvsion,afdm Convacter's License Law(Chapmr9
(commencing with Section 7000) of Division 3 of tho Businmwd Pmfmiona Codo) nr
Jct ha 6 attempt therefrom and to bull for the alleged eumption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit objects the applicant to a civil penalty of
not mom than five hundred dollars (5.500).
36929026.00
❑ I, u wise, of t e pmpmy, a my emplaym wbb wage u Jeb wk enmpw dwn,
Required Inspections
q P
will do the work, and the,vunure 1, wt intended urdrtued tweak (Sm. 7014. Business
and Professiona Cade The Convwwh Listens law dm cot apply w an owner of
property who Wilda orimproaea thercun, and whddm,uch wart himvJrwthwvgh his
wave employes, provided uwauch improvements are mtintaMed crofrud for aide If.
however, the Wilding or Improvement t, sold within ons year of completion, the owner.
builder will haw the burden of proving that M did net Wild nr improve for purpose of
all.).
I. u owner of the Property. am aaclusively contracting with licensed contrecmn w
o Iron the project. (Sea 7014, Business and Prefessirs Code:) The Conuacmr'S Li-
mon law dm not "Ply to w owner of propenYwha builds or improve thammr, and,
who comment for such project, with aeanvutur(s)lican dpunWntmthe Commcmrs
Lice. Law.
Alan eemptundmsee, .B&PCfor Nu
I
Owner. P' I"" i7Qia..a�L_ Dam 1Z
W ORKER9 COMPENSATION DECLARATION
I hereby aRrm under penally of perjury dna of the following dedianllaN:
ave and will maintain s CaruOu , or Conn, to Ylf-Iom. for Workefl Compem.
n, u provided for by Section 3700 of der Labor Code, for the Performance of nae
work for which this Permit is issued.
❑ I haw and will m.]loin Workers CompensaJu luuranm, u myvimd by Sectu
,
3700 of Jen labor Codo,(aW PrRormwcoof the soak fwwbkh Nu pemitisluueE.
My Workers Compensation Insuwex curie, and Policy number art:
Greer. Policy No.:
CERnRCATE OF EXEMPTION FROM WORKERS'
' COMPENSATION INSURANCE
'
(This senior neon wtbucompleted if tic permit t, furan, hundreddaRara (5101)
or loan)
I coldly that In the performance sof the work for which this permit is issued, l small not
employ an non In mwm�w bevy b b L0 to Workers'Com nation
pe
v% YPe Y �ty�Ynl
Laws of Califspp�tt} Dain t,`
Applicant Lit I S
NOTICE O APP Ocnificam, of you should
APPLIGNr:IL after
Later, od
subject oadon provitions of nae labor, Cada you con
become abjmp w the wahu', C
Compensation
comply with,u<h Providans or this permit ahatlbudmmon mwkeQ
.m
CONSTRUCTION LENDING AGENCY
Iherebyamrm that den Is mmomednn lending agency for de Pcrf—m0Cco of
the work for which this Permit t, Limon (Ser. 3091. Civ. C.)
Lenders Name
Lcndera Addmaa
1 sanity, that 1 have mad this application and state the Ne above Infdrmaduw is
rnrrm. I agree w comply with W city and county ordinances no Itm laws telling w
Wilding construction, and hereby authorme represwatiev of this city to enmr upon the
albowni aiamed property for inspection purposes.
(We) agree m save, kralmo tify and keep hamsters the City of Cupertino again
Ilabilida.judgment,, cora and expenses which may in soy soy acnes against aid City
in
PLICof this D
APPLICANT UNDERSTANDS ANWILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE RIlOULATIONs.
Yvlt V ((a<
Re -roofs
Type of Roof
Signature of Applica d/CPnvwmr Dam
DISCLOSURE
HAZARDOUS MATERIALS
Will the applicant or future Wilding uccepwtnarc or handle huamou memo.]
an dcflmd by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Call, section 255324)7
❑Yea L�No
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
Will the applicant Or future building Occupant an equipment or devices Mich
haamnuair ,onumWms u defned by the Bay Amo Air Quality Management
all new materials for inspection.
,n
❑Yen 1)f7u
I have mad the hnamoess materials mquWmew uncerChap cr 6.95 of the Callfor.
nil Health& Safety Code. Sectors 25505,25533 sod 25534.1 uakntaM that If dm building
dm cot currently how: a mnw4 that It is my responsibility to will'y Jen uceupwt nr the
mqulremenot which cwt be mel PJar�m laimwm tiro Cortifnae afa
Signature of Applicant Date
K. 12 �2 'f "S
K" � ��Jt
All roof coverings to be Class "B" or better
Ownanonutbarbed agcnlDaI to
CUPERTINO
,CITY OF CUPERTINO
0
PERMIT APPLICATION FORM
0-ro 6 C)
APN # 7 / � _
Date:
Building Address: Mailing Address (if different from building address):
10-b-1 8 cj c�j P02---7+ o C -A 9 s o t
Owner's Name:
5 }� N--( �t I NPS �NGKn P -A M
Phone #:
�
Contractor:
License #:
. -12
Contact: Phone: 61-a-IcZx
Cupertino Business License#:
3a-2 FOZ-1 KN sTr PAL^ 1 OFOax: (Ls--)�Sg 2685
Boiler > l OOK to 500K Btu
Building Permit Info: 3°
Bldg Elect 2 Plumb—/ ech 0
L�
Job Description:: t-1 f Y -Z- A k n S
Residential t0lePC--q- r -i Commercial ❑
Sq.Ft. Floor Area:
$/Sq.Ft.: j�06 �c r Zo �`L7Lo
(p O (p
a
Cost of Project:
Occupancy Group:
Type of Construction:
Please check this box if the project is a
v
second -story addition: ❑
Project Size: Standard 2" Large ❑ Major ❑
BUILDING
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBOILERI
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler > l OOK to 500K Btu
MECHANICAL
BBOILER3
Boiler > 500K to 1M Btu
MECHANICAL
BBOILER4
Boiler > 1M to 1.75 M Btu
MECHANICAL
BBOILER5
Boiler > 1.75M Btu
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for BQ Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax - Resi/Mobile
BUILDING
BELEC1000
Elec 600V <=1000A
ELECTRICAL
BELEC1001
Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
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1 of 3
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CITY OF
CUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
10 3+$ No r✓n q w a( ,�
PERMIT # d 50 (o p 10 -4-
OWNER'S NAME:
PHONE # tig 93 2—1 2 �,
GENERAL CONTRACTOR
FAX #
I am not using any subcontractors: 9--- O OK,
Signature Date
PIease check applicable subcontractors and complete the following information
e 4 , � a7C-4
Owner/ 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
e 4 , � a7C-4
Owner/ Contractor Signature Date