06060061 CITY OF CUPERTINO a°Rzx A ' ' �`
NUILDING DIVISION PERMIT ..00NTRACTO INFOItMATII)N •:'
BUILDING ADDRESS: NATIONAL CONSTRUCTION REN .±ahff NG06060061
10305 WUNDE
OWNER'S NAME: PERMIT ISSUE DATE
CHRIS LEE 1355 FILIPE AVE
E:
SANITARY NO. CONTROL NO.
(818) 221-6057
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
;aa LICENSED CONTRACTOR'S DECLARATION - Job Description
1 hereby affirm Out 1 m licensed under provisiaru of Chapter 9(mmmcoem,
to with Section 7000)of Division 3 or the Business and Professions Code.and my license is
j=„ mmnmrt.am.rmm. INSTALL TEMPORARY POWER POLE
t M Z License Class Lic.0
i F p Date Contractor
ARCH fIEC,S DECLARATION
i I understand my plans shall be used as public records
iy0 �j
.,n Licensed Professional ///''+++
5 OWNER-BUILDER DECLARATION
Conte ON j
q I hereby.(Arte Nos 1 1. ,Business
from the Contractors o License Law for N.
.p p following moan. erten t RY3 s3,Business ode Professions Code:Any city or county
Sm tn which requires a permit m ennsuue4 aloe.rmpnsvc,demolish,or mash any suuetum .4$450
Z y prior m its issuance,also mquirm the applicant for such permit to file aligned ssamant
te
< that he is liccmcd pursuant to the prMisiom of the Comment's license Law(CTapter9 Sq.FL Floor Area Valu [ion
2ti-a (comomd,with Section 70(10)of Division 3 of the Business and Professions Code)or
_
that he u exempt therefrom and the basis for the alleged emmptiou.Any violation of
Section 7031.5 by any applicant for a permit anbjecu the applicant as a civil penalty of r Occupancy Type
not more Nan five hundred dollars($500),
I,as owner of the property,or my employees with waiter as Nob sok compensation,
will du thcwoda and the awetum u unintended oroRemd forest.(Sec.7014,Bummer,
and Professions Coda:The Corrientes License Law dors not apply loan owner or Required Inspections
property who bur Ides or improv thnm n.and w ho dors such wart himself m through his
Own employers,provided that such improvements Lie notinteMed oroQered for ssle.If.
however.the building or improvement is sold within one year of mmpleuon.Ne owner-
builder will have the burden of proving that W did not Wild or improve for purpose of
sale.).
❑1,as".of tW property,am ex.lusively contracting with lirebeed mnuactnrs to
mmruct the project(Sec.7014.Business and Professions Code:)The Contreemes U.
come Law does not apply In an owner of property who Wilds or improves da moq and
who contracts for such pro%as with a eonuaebKs)licensed pursuant in Ne ConuacmYs
Late.taw.
❑ler on under Sec E.B@PC(e tpis0
Owner /^{/'l//f�Jf/,l(j Dam
��Wb KER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following dalaratiotu:
I ham and will maintain a Cenificate of Consent to self-insure for Worker'mCropper.
.ad.n,as provided for by Suction 3700 of the labor Code,for Ne puformame of Ne
work for which this permit is Wood.
❑I have and will maintain Worker's Compensation I suras¢,as required by Section
37M of the Labor Code.for Ne performance of the work forwhich this permit is issued.
My Worker's Compensation Insurance carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tbb section need not W completed it the permit is for once hundred aurin($100)
or less)
1 unify Nm in the perform
arrce of the
work f r which Nis permit is issued.I shall wt
employ any person in any manner,0.'.to15ca6mmsaEipc't r6Ttlte Workeri Compcnsalion
Laws of Calironna.Da ' /.ham/ t
Applicant -
NOTICE TO APPLZXNt.If,after making Nu Certificate of Exemption,you should
become subject m Ne Worker's Compensation provisions or the Later,Code,you most
.J O foMwilh comply with such provisions or Nis permit shall W deemed rev.ked.
Z!:n CONSTRUCTION LENDING AGENCY
t"^ I Wrcby affirm Out dtert us cannot".lending agency per the performance of
> in,work for which this permit u issued(Sec.3097,Civ.C.)
VjQ Lender's Name
U C) tender's Address
U O I coolly Nar 1 have mad this applrcuron end mute this th.above information is
I, correct.l agree In comply with all city and county ajdinances and tau laws relating to
DU building construction,and hereby authon7c reprnenutives of this city to enter upon the
HaR] move mentioned ms.c s for Irmo p secs.
(We)ag,ce to save,indemnify vharm City of Cupertino against
fA liabim-meso ofu,emu uta cape char t yway attme against said City
U z A APPLICANT
of the grandnB o(this ire
w. APPLICANT ULDFjt$TA F)f W OMPLY WITH ALL NON-PO NT Issued by: Date e"_
sOURCEREGULATION 6 �� 1
t/J Re-roofs 2
Sit...of .mmct r thum
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future Wilding occupant store or handle haosem—material
as defined by Oe Cupertino Municipal Code.Chapter 9.12,and rhe Health and Safety
Code.section 25532(,)7 All roofs shall be inspected nor to an roofing material being❑Yes m P P Y g g installed.
Will Nc applicant or future building occupant nuc equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit dear ante air comearinsnu as defined by the Bay Amo Air Quality Management all new materials for inspection.
Darict7
Ym
I have mad the Wind not ialmm re maunder .Chapmrti.95uftheCalifor.
nu 7khh SafctyCode, X15. 3 2553d.limderegoddutifthe Wilding
don not j
.ba Nati retev9nsiM1ilityb notirY Nc upanl carthe
mquimmIp �gOac.rtifi..mp . 09Signature of Applicant Date
ownered....I Date All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37516020 . 00
DATE ISSUED. . . . . . . : 06/08/2006
RECEIPT # • • • • . . . . . : 34745.
REFERENCE ID # . . . : 06060061
SITE ADDRESS . . . . . : 10305 WUNDERLICH DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHRIS LEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : CHRIS LEE
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 1355 FILIPE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (818) 221-6057
•FEE 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
----------------- ------------ ------------------
CHECK 100 .47 2392
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--------
103 UFER 304 ROUGH ELECTRICAL
•
Community Development
f 10300 Torre Avenue
Cupertino CA 95014
11 It`"'^"'� Telephone(408)777-3228
CITY OF Fax(408) 777-3333
4UPEkTINO
Building Department
JOB ADDRESS:
PERMIT #
OWNER'S NAME: .,� JPHONE # _7?/3- -777!t-
GENERAL
, 3- 777 'GENERAL CONTRACTOR: AX #
I am not using any subcontractors:
Signature ate
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's
ner,,Contractor Signature Date
CITE' OF CUPERTINO
1* CITY OF
UPEkTINO PERMIT APPLICATI®N FORM
APN # �.".b/Jn Date:
Building Address: J
d Z�, 3 Dk .
Owner's Name: Phone#:
G��gt2 / c� goi-313— -7-)')f
Contractor: %6T o h1 hone: License #:
Contact: Phone: Cupertino Business License#:
Building
Permit Info:
Elect L7
Job Description:
Residential Commercial ❑
Cost of Project:
• SCJ
Qty. if
A lic le Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
el EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•