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090901315 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � Z � � � BUILDING ADDRESS: PERMIT NO. 10295 WUNDERLICH DR MANA GENERAL_QQNT_RACT_QE__ 09090135) OWNER'S NAME: PERMIT ISSUE DATE PHO —0-—T_A] S A CONTROL NO. (408) 37' -4288 ARCH1 i1 CT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a 0 a a u p C LICENSED CONTRACTOR'S DECLARATION JOb DCSCTIptIOn m !hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code.and my license is =H in full force and effect. TEMP POWER POLE ? License Class Lle•# n Date Contractor ARCHITECTS DECLARATION oft< 1 understand my plans shall be used as public records JyU 4 C y Licensed Professional n OWNER-BUILDER DECLARATION X 1 hereby affirm that 1 am exempt from the Contractors License Law for the 00 following reason.(Section 703 1.5,Business and Professions Code:Any city or county K m ff which requires a permit to construct,alter,improve,demolish,or repair any structure 't rn prior to is issuance.also requires the applicant for such permit to file a signed statement z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;>q.Ft.Floor Area Valuation ytZ- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $500 > that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 3 7 516 01) . 00 ❑I•as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Conuacmrs License Law dors not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.IL however,the building or improvement is sold within one year of completion•the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑I am exem t under Sec. B&P C for this reason Ow� Date • O N-DHCt'ARATION�� I hereby affirm under penalty of perjury_rc of the following declarations: I have and will maintain s Certificate of Consent to self-insure for Workers Compen- in,as provided for by Section 3700 of the Labor Code,for the performance of the ..ork for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Cartier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of Califo Applicant NOTICE TOA , tet mWd Pertificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z"" CONSTRUCTION LENDING AGENCY [� 1 hereby affirm that there is a construction lending agency for the performance of CY the work for which this permit is issued(Sec.3097.Civ.C.) W A L.endces Name Z Lenders Address U C) I certify that I have read this application and state that the above information is 4. correct.I agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date t"r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOU I.ATIONS. ,IO �nX`� �'L� 14 Re-roofs sign�t re of r t/Contracmr' I I DateType of R sof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs:,hall be inspected prior to any roofing material being installed. ❑Yes 'IlNo T If a roof i:,installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new in iterials for inspection. arict? ❑Yes 1po 1 have mad the hazardous/ materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cedc.Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requim4nts which must be met prior to i era certificate of ap Signature of Applicant Date D All roof coverings to be Class'''or better mer or authomcd agent CITY OF CUPERTINO t TEMP POWER CUPEkTINO PERMIT APPLICATION FORM APN # 375 — I c 0 : L j U Date: Building Address: I o 2�15 W, 0i\ZU KL-1 '�` fi 1 D 9,1 V C , C,L K71ti'o , 0I Owner's Name: SRI N I V fl S 4v) Ax,V e�` Phone #: 4-4 6_, (66:)- Contractor: 662Contractor: tv i A N A t,N CAA L- C,%DNNTV-A C-r-o(� Phone Fax #: Contact: Cr A L Phone # Contractor License #: &2--g t o g Cupertino Business License #: Job ` Description: ' p � �:.�,i ova Residential Commercial ❑ Valua 'on cost of project): d eil+Type of Construction: N/A Quantity Fee ID Fee Description Fee Group Permit Type IERT>1K Res. Temp Poi ver>1K E 1REAP14 Amps 1 ERT<200 Res. Temp Power<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps 1 EPERMITFE Electric Permit: Issuance E I ELCPLNCK Electric Plan Check E 1BCBSC Cal Bldg Standards B ALL PERMIT _ Commission Fee TYPES I 1BSEISMICR Seismic Residontial B 1 TRAVDOC Travel & Documentation B Fee Revised 01/07/09 ' Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 `-UPEkTINO Building Department JOB jaDRr�ESS:� ,� � � � PERMIT # -� w c)(S C) 13 OWNER'S N 5 m r PHONE # 3-?-S7- "-I Zd GENERAL CONTRACTOR: FAX # 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 er ontractor Signature Date Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Building Department JOB ADDRESS: LjO rk serPERMIT# OWNER'S NAME: A PHONE # 0830 GENERAL CONTRACTOR: pig Moo Thf FAX # I am not using any subcontractors: ot ,�— Si ;nature lbate Please check applicable subcontractors an com )lete 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 O r/Contractor Signature Date