06030137 • CITYOF CUPERTINO ^� �• r�z: ""' � ?
BUILDING DIVISION PERMIT �CONTRP,CTOR INFORMATIQN
,h._ 'i i'u_'. �1..�"d4..Y., FM a3 L ,.$.`c^�lt•
BUILDING ADDRESS: PERMIT 1,1
1040 TUSCANY PL
WNER'S NAME: PERMIT ISSUE DATE
SCOTT JERRY L AND APRIL L 03/23/2006
HONE: - SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uOp LICENSED CONTRACTOR'S DECLARATION
S1 hereby affirm that 1 am licerucd under provisions of Chapter 9(commencing Job Description
with Sc,tion 70110)4f Division Sofdse Business and Professions Code,and my license,is
POOL REMOVAL
o m in full force and effect •O Si,1 3
,yz LiccnscClass Lk.p b _ CONTRACTOR: KNIGHT LANDSCAPE CONSTR. INC
Continuator
e£o nam ARCHITECPSDECLARATIONI t 1670 S . 7TH ST, SAN JOSE CA 95112
C 1 understand my plans shall M used as public meoN4 6 ,S 31 t G.
1.0
k C� Licensed Protection.]
<g 0.11..OWNER-BUILDER DECLARATION �'�► gs
I I hereby a1Brm Net 1 am esempt from the Convacto/s License law for the 'p`r■•v///p�'e
00 following reason.(Sccbm 703 1.5,Business and Professions Cale:Any city or county
<28'. which requires a permit to construct,alter.impmw,demolish,or¢pair any structure
LED
prior to its issuance.also requires the applrcanl for such Permit o file a signed staemenl
thin he he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 S(L Kt. Floor Area Valuattp�000
y�0 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or /ASI+ t-- 2006
a7
y�$ than he is exempt Nuefom and the hssu for the alleged cacmptico.Any violation of
Settled 7031.5 by my applicant for a permit subjects cm eplifcall to a civil Penalty of ane NNumber Occupancy T
not mum than five hundred doers($500), P Y YPe
0 L. .a of the property,or my employees with wages as Noir sole compensation,
will do Ne woh,end the swctum is not immn&d or offered fors...(Sec.7014,Business
and Profensiens code:Th.Conuaoorb License Law dons Inst apply m..owner of III arequired Inspections
Property who builds or improves thereon.and whodeassuchwmkhimsclf or through his
own employees,provided diatsuch improvements are not amended oroffered torsade It,
however.the building or improvement is sold within ane Year of completion.d,e ewuer.
builder will have the burden of proving cut be did not Wild or improve for purpose of
sale.).
0 1.a owner of the propcny,am exclusively contracting with licensed contractors o
convect the project(Sec.7064.Business and Profutsiona Code:)The Conmcter's U.
cense law docs not apply to an owner of property who Wilds at improves the mon,and
who contracts for suets pojects with a ci nuacear(t)limned pursuant to the Cenwctors
License law.
❑l oro exempt under Sec. B k P C for this..on
vett Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury sum of the following declantioes-
0 1 have and will maintain a Certificate of Comm to self-insure fm Worker's Crmpem
'.tion,as provided for by Section 3700 of the Labor Code.for the Performance of the
work for which this permit is issued.
0 I bow and will main'.;.Workers Compensation Iesurnme.as rtquired by second
37M of to labor Code,for the pedicrroa en of the woh for which this Permit is issued.
My Worker's Compensation Insurance.artier and Policy number am:
J
Carrier:MMC �� Policy FROM
.WOR 1y Li l—ZWto
CE FlCAOE PE EXEMPTION I FROM WORKERS'
COMPENSATION INSURANCE
(Thisscnicn reed not becwnpked ROe Permit is for one hundred dollars($1010
or less.)
1 caoily that in the perfotmane.of Ne work for which this Permit is issued.I shall not
employ any person in any manner an a to become subject to the Workers Compensation
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:IL after making this Cenificam of Exemption,you should
become object in Inc Workers Compensation provisions of the Labor Croke you must
.,O forthwith crmpdy with such pov visiaor Nu .it shall be deemed revoked.
'ZV5 CONSTRUCTION LENDING AGENCY
F-r I hereby affirm Natthere isaeonsuvctinn bodngagency fortheperfurmanceof
fY
the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Under's Name
=Z dander's Address
U C) I certify that 1 have read this applia,ion and sem the,the above motmation is
lyP correct.)agree to comply with all city and county ordinances and see laws Misting to
C)U building connotation,and hereby authorite represenutivot of this chyo cram,upontbe
,r a shove-mentioned property for impeed n purposes.
(tact)ogee o cove,indemnify and keep harmless the City of Cu arral s against
j..0.
Ilacoisiequence of
growing
expenses which may in my way ieCNe igairm,aOid city
U z A APPLICANT
of thegranting S A permit.
fir SOUR�GBAj��,U�JN�DE�'RO�NS NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
T! DNS
Signmembf plumuConnactor Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the applicant tar future building occupant stow or handle haardous material
as defined by dac Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code.section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes �'u
5rfi Ne,a licant or future building oma rat mere If a roof is installed without first obtainingan inspection,I agree to remove
pp 6 W c Ail Qu or devices which p
emit District?
us air contaminants u defined by Ne Bay Arco Air Quality Managcmcnt all new materials for inspection.
Distrin? VIN.
�,s/,.
O Yea VIN.
1 have mad the harardous m de iaismyuirem ons undcrCUpmr 6.95ofNe Califer-
nial ser la ,yCadc.Sections 25505,25533 and 255X.(unrstaee
dend dud ifWilding
do.no cu yhawa mnam,Nat it is my rapmehility in nrdry du..'am of the
.quirew ' adxmetprioroiasanmofaCmtirmaeofDcmpaney. Signature of Applicant Date
Own2r tar mheri'rcd agent Z- �� roof cover
All f in s to be Class "B"or better
aDam g
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: christya
COPY # 4
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . . 35929040 . 00
DATE ISSUED. . . . . . . : 03/23/2006
RECEIPT # . . . . . . . . . : 33709
REFERENCE ID # . . . : 06030137
SITE ADDRESS . . . . . : 1040 TUSCANY PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER SCOTT JERRY L AND APRIL L
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4352
RECEIVED FROM . . . . : ESTIVARIZ/ALFREDO
CONTRACTOR . . . . . . . : LIC #
• COMPANY . .
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- --- -------
BPERMFEE VALUATION 9, 000 . 00 158 . 76 0 . 00 158 . 76 0 . 00
BPLANCHK PERMIT FEE 1 . 00 83 . 16 . 0 . 00 83 . 16 0 . 00
BSEISMICRE VALUATION 9, 000 . 00 0 . 90 0 . 00 0 . 90 0 . 00
-
--------- ---------- ---------- ----- - ----
TOTAL PERMIT 242 . 82 0 . 00 242 . 82 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- -- - ------------- ----------- - ------------------
OTHER 242 . 82 VISA
TOTAL RECEIPT 242 . 82
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--704 DEMO
•
Community Development
10300 Torre Avenue
.� Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
SEUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
X64'
OWNER'S NAME: J PHONE # oi-Ig CONTRACTOR: IFAX # (7 406) -
bl
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
O Tile
Owne /C retractor Signature Date
• CITY OF CUPERTINO
'WA
CUPERTINO PERMIT APPLICATION FORM
APN # 3,�a �_ O � 4 Date:
I 'OO 23.06
Building Address: pf
I 01-I0 JsGnN4I l p( = V n qSOS
Owner's Name: _ Phone#:
( t'l zS- Iq
Contractor: License #:
k/ ��� i. �� .vU1-0 .j l�C - �� J L/
Contact: Cupertino Business License #:
Building Permit Info:
Job Description:
Residential: (SCI Commercial: ❑
Sq.Ft. Floor Area: Cost of Project-
q.000 - 00
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BSEISMICOM Seismic C I rLax BUILDING
BSEISMICRE Bldg Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•