04050124 CITY OF CUPERTINOrks, � � r
BUILDING DIVISION PERMIT ,CO_NTRAGTIOR INFORMATION Y;
BUILDING ADDRESS: PERFECT TOUCH CONSTRUCTION PERMITN.b4.050124
OWNER'S NAME: PERMIT ISSUE DATE
AM TENNYSON HEEN 14110 WO
ONE: SANITARY NO. CONTROL NO.
(408) 2S8-4928
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
X00 LICENSED CONnRd moderSDECons of CON
tu I ion? )of that I an licensed under provisions of Chapter 9(commencing Job Description
with Section7IXN3)of Division 3of the Business and!Profrsriuv Cade.and mylieenu is
^may inmllmrteandcfrect' TEMP POWER
5�?
License Clain Lk.g
n F gs am
Dale Comror
iARCHITECTS DECLARATION
aI understand my plans dull he mind as public records
J.0
Bot-^ Licensed Professional
OWNER-BUILDER DECLARATION
s2 1 hereby affirm that I am exempt from the Conm emrs License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
u$ which mquims a permit t0 eonsuue.elm,.morrow.dcmolkh.or repair any strewn
Fi< prior m its issuance.also mquims the applicant for such permit to rile a signed summent
that he is licensed pursuant to thc provision of On Conoacmrs Umome Law(Chapter 9 Sq.Ft. Floor Area Valuation
,al-$ (commencing with Section 7000)of Division 3 of the Business and Profeuions Code)or
_
Out he is exempt therefrom and the basis for Ne alleged exemption.Any violaddo of
Section 7031.5 by cry applicant for•permit subjccu the applicant to a civil penalty of 3 24a04I1Q131163e10 0 Occupancy e
not mom man five hundred dollars($3003. P Y TYP
❑Las owner of the proprny,or my employers wire wago utile"v ink compensation.
will do the work and themmeture is not intended conflicted forsale(Sec.7016,Business
and Professions Code:The Contacwr's License law dols not apply in in owner of Required Inspections
property who buildson improves mcr u m and who docs such work himself or through his
own employees,provided Out such improvements are not in ended mroRerrA for sale.IL
however,the building or improvement issold within one year of completion.the ewucr-
builder will have the burden of proving that he did not Wild of improve for puryou of
sale.).
C]1.as owner of the propeny,am exclusively convening with licensed convectors in
construct the project(Sec.70".Business and Professions Code:)The Contracmr's Li.
cove law docs not apply inc u owner of merm(s who builds rs improves OrionContra,and
who se Levu for such projects with aeonuamoKs)liceved pursuant in On Contnclors
License law.
❑1 sem under See. B&P C for Nu moon /
Own Da S/ ��
WO ERAT]'S COMPENSATION DECLAR /
I hereby aRrm under penalty of perjury one of the following declarations:
I have and will maintain a CmdOca ,of Consent mulf-insure for Workers Com imi.
1c,
ion,as provided for by Section 37W of the Labor Code,for dm pe,fmmmnce of the
W
far which this pcnnit is issued.
1 have and will mainmin Worker's Compensation Insurance,as myvired by Section
W of the labor Cade,for the peffurmanee of die wort for which this permit u issued.
y Workers Compensation Insurance carrier and Policy number are:
rrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu It.redoor ecomplcud if the permit is for.huMmd dollars($100)
car loss.)
1 terrify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner an as to become subject to the Workers Compensation
Laws of Cridk ice.Dau
Applinm ��.•cc))
NOTICE APPLICANT:If.alum making this Provisions
Of of Exemption,you Mould
most
.J rZbona jmp y the Woher oComp at this provision of the lobar Cade.yam must
forthwith comply with such provisions at this permit shall h deemed revoked.
Z O
P:r7 LENDING AGENCY
Ihereby afli,m that there is a construction lending agcucy for the performance of
x the work for which his permit is Wood(Sec.3(197.Ci,C.)
W�Q Lenders Name
2 Lender's Address
U0 I cannily that I have read this application and Mule that the above information is
CL F-' Conon.I agora to comply with all city and county ordinances and sou laws mlating w
O U building construction.and hereby suthatire rtprearnutivrs of this city m enter upon the
1 above-menuoncd.u.property for ivpe.purposes.
(We)agree to save,indemnify and image h omilai a the City of Cupertino against
rat incoitiesjWg,of dw vuand of this permit. may in any way orotic against said City
U 2�(
A APPLICANT
of thegranting of Nis per mit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: DatNOe
SOUR REGULATIONS.
gwum a(App"anJContracwr
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Dau Type of Roof
Will the applicant or future building occupant nom or handle havamfous material
as defined by the Cupertino Mu iiripal Code.Chapter 9.13,and M,Health and Safety
code. riyeazssu(a)7 All roofs shall be inspected prior to an roofing material be n
❑Y No P P Y 8 g installed.
Wit]me applicant or future building ecu hint mu equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit harardous air contaminants as dc0ned by tM Bay Area Air Quality Management all new materials for inspection.
Dis rict'
❑Yes Perdu
I have mad the M andous materials mquimmenu under Chapter 6.95 of the Califon
nice Health&SafmyCudc.Seetiov 355115.M533 and 75530.1 understarW drat ifthc building
d�n of eunendy hose a"M"
nne mat it is my uspoosi0ilny re nn��'Iy-�a uccupant of the
rcrkrimmcnts which muu be mctprior w' vancc ofa cettit.m.ar 0du�n''. Signature of Applicant Date
wort oraufho W dagent /Dole All roof coverings to be Class"B" or better
CITY OF CUPERTINO S 2
CC�- l
POWER U
TEMP
UPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
iD$31 3C-3ro-vk,e, fir ;\
Owner's Name: Phone#:
I 6M l� eev. tiv 7.
Contractor: Phone: License#:
Pff4-e- B- T� c(. _)6 g- Y't2 8 7 933 a7
Contact: Phone: Cupertino Business License #:
b� x•ISS 31t(�
Building Permit Info:
Elect ❑
Job Description:
Residential ® Commercial ❑
Cost of Project: -7
01
•
ty. if
A 1' abl Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
4 93 0 2.