06010171 C CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAG"TQR INFORMATN.
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BUILDING ADDRESS: CB ELECTRIC PERM1TN0'06010171
22350 HOMESTEAD RD
OWNER'S NAME: PERMITISSUEDATE
THOMAS E. HARRINGTON 5765 WINFIELD BLVD STE 7 01/30/2006
NE: SANITARY NO. CONTROL NO.
(408) 574-0150
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDGt PLO l�
�Ow6 LICENSED CONTRACTOR'S DECLARATION lob Description
if 1 hfirm N
thereby affirm 1 am licensed!under prechapter visions of Char 9(mmandming
with Section 70f10)of Division 3offt Real ..0 and PmfeWoas Code.and my license is.
e�
1.fall fora sod eaem TEMPORARY POWER POLE INSTALLATION
j g j5 License Class Lic.x
9 Dao: Contractor
e ARCHITECTS DECLARATION
y 1 understand my phi Nall he used as public records
y Licensed Psafessiom \
^ OWNER-BUILDER DECLARATION ("
4<� I hemhy affirm that 1 am exempt from de Contractor's License Law for flum tJ
G o following mason.(Section 7131.5,Business and Pmfevdons Code:Any city or county
$ which requires a permit in cmdamet after,Widow,demolish,or repair my mucmre $2000
1,° prior m its issuance.shut requires the applicaul for such permit m rile asm signed sec¢me
E< that he is Raved pursuant to One pmvisiov of the Contractor's Limruc Law(Chapu+9 Sq.Ft.Floor Area Valuation
,SCS (commcving wide Section 7")of Division 3 of the B.M.and Profwiov Catch)or
3 g Net to is exempt Wcmfrom and the bub fa 0e alleged ewnptim.Any A.W1.of
Section 70313 by any applicant for a permit subjects the applicant is a civil penalty of NWIlMr U U Occupancy Type
not mom Nan flim lodu ad dollen($3170).
❑1,As owner of the property,a my employees with wages As gelr sale compensation,
will do the work and the awcmre Is not intentled or onead for ask(Sec.7044,Business Required Inspections
and Pmfeaiov CoMIA e Convm oven eector's Llcave law danot apply 0 an of q p
property who builds ar improws theroon,and who doessuch work himsel f a Immgh his
own employees,provided thatath imprawments am nm intended cro0ered Russia.If.
bowem.the building or improvement Is sold within we year of mmpledw.the Owners -
Wilder will haw the burden of proving that M did not build or imprne,for purpose of
talc.). l
es owner of the property,am excluiwly convicting with Iimnsed contnctera to
convect the pmlect(Sec.7044,Business tad Professions Code:)The Convacmr's Li.
ave law does not apply an an owner of prepeny-wha builds or imaova Warton.and,
who concocts for such pmjecm wide a mauacmr(s)licensed persuaded in the Contractor,
License Law.
❑tun uempe don Sec .B k P C'—fer_this/recon
owner Ddm,LLSzinto
2'u RIr13N9ATi0N DECLARATION''11_ 1
the red der penally of perjury one oftie following declarstiov;
1 have and will malnain aCenHtam of Covemsaself-ivum fa Workers Oanpco-
mon,as provided for by Sencdon 3700 of the labor Cade,for the Performance of de
wart for which this permit is Woo&
❑1 haw and will maintain Workers Oompent Wuanm,u required by Section
3700 of the labor Code,fa the performance of the work for which Its permit is issued
My Workers Compensation Insurance carrier tad Polity number art:
Cartier: Polity No.:
CERTIFICATE OF FXEM MON FROM WORKERS'
COMPENSATION INSURANCE
Cates Amman wooA notbemmplemtl gtie permit 6 form hundred dollars(5100)
or less.)
I coni[that In the performance of the work for which this permit b issued.I shall not
employ any person in any mannerw Ibeco mbjecI in the Workers Compensation
Laws of California. m
Applkant
NOTICE TO A P If,After making this Cenifiesm of Exemption,you should
baome mbjen in the ;er'a Compensation provlaiov of the laha Code.Y.muR
0z
foMwide comply witl ch provisions or this permit mail be deemed sewkrd.
!A CONSTRUCTION LENDING AGENCY
[r Ihemby"'.that them is construction lending agency for dee perfmmanm of
Ci he wod fur which this permit Is iaad(Sec.3097.Cih,C.)
Ie1 0 L mdera Name
2 lantleh Address
U0 I anify that 1 haw read lids application and sato that the show mformadw h
LU hcorrect.I agree to comply with all city and county ordinances and state Tawe Miming to
U building conttactlOa,and hereby suthorm,represenmim of this city to enter upon the
W above-mentiuvd properly for inspection purposes.
ty, (We)agree An taw,indemnify and keep harmless the City of Cupertino against /
i:y f0./1 liabilities,judgment.costs and expcwa which may in my way ammo Against said City �j
U 7 In consequence of the granting of seas pump "��]
G7
APPLICAVV U iDEISTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR GU ONS.
Re-roofsi��,
Sign 1hans/Coedncmr ale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
MI decappliant orfnure building occupant mom or WndlchusNoa mamriai
u del ned by the Cupertino Municipal Code.Chapter 9.12,and dee Health m Safety
Code,Seaim 2553:(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya f>-
mu
Will the applicant or future building Opanf use equipmem or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
Il hrardaus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yu pl
I haw read dee haaadeao mamrialaryuimmenu underCMper&95 of dee Califon
A es Hc7lthk SafexyCo@.Secvav 2550$,25$33 am12553/.i unhmand thnifde Wilding
dace tartan a moot that It is my mm onaibility m mdfy the occupant of the
nu must be met prior At Women of aCeniRcamaf Signature of Applicant Date
o nariamdagennDam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 4
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32601018.00
DATE ISSUED. . . . . . . : 01/30/2006
RECEIPT #. . . . . . . . . : 33006
REFERENCE ID # . . . : .06010171
SITE ADDRESS . . . . . : 22350 HOMESTEAD RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : THOMAS E. HARRINGTON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014
RECEIVED FROM . . . . : GARY LEITH
CONTRACTOR . . . . . . . : JEFF HULL LIC # 27182
COMPANY . . . . . . . . . . : CB ELECTRIC
ADDRESS . . . . . . . . . . : 5765 WINFIELD BLVD, STE 7
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 574-0150
4EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
_____________ __________ __________ __________ __________ __________
BTEMP FLAT RATE 1.00 62.10 0.00 62.10 0.00
EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
TOTAL PERMIT 100.47 0.00 100.47 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ____________ _____________-____
OTHER 100.47 VISA
------------
TOTAL RECEIPT 100.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
Community Development
10300 Torre Avenue
Cupertino CA.95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
&PEkTINO
Building De artment
JOB ADDRESS: -Zy3s� 1�otral�y� PERMrr#.
0(00 ) 0 ) 7
OWNER'S NAME. E - W. , PHONE # k_ pp
GENERAL CONTRACTO •CS F leco FAX #
X43 �S�acAfo
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
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
•
77wner/Contractor Signature Date
0(-Po o 1�
CITY OF CUPERTINO
TEMP POWER
&uPEROF
TiNO PERMIT APPLICATION FORM
APN# 3 2—(o ^ �\ _ c) Date:
Building Address:
2Z
qOw er's Name: Phone #:
r=
41 oc�
Contractor: Ph ^^f ne: License #: C--k-0
Contact: Phone: Cupertino Business License#:
AA 6 Zoo 6
Building Permit Info:
Elect
Job Description:
Residential E] Commercial
Cost of Project:
OOH
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMTTFEE Elect. Permit Issuance ELECTRICAL
BUSL•IC Business License BUILDING