06050063 (2) CITY OF CUPERTINO
BUILDING�DIVISION PERMIT CONTRAC ,.ORiiNFOAMATION :
u mss _eta,_sr%'-mss, ^..-'t,'�.,4s, e5fC•.&, >s^vA lis
BUILDING ADDRESS: ' ABCO CONST PERMIT NO06050063
10620 S TANTAU AVE
OWNER'S NAME: PERMIT ISSUE DATE
JASON MILLER 14880 LLAGAS AVE 05/08/2006
Ir NE:
SANITARY NO. CONTROL NO.
(408) 779-7577
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
!00 LICENSED CONTRACTOWS DECLARATION lob Description
with Section
i Z C 1 Mrtby affirm Nat 1 ern licensed under provisions of Chapter 9(commencing
<tJ ]WU)of Division 3m`the Businev and Profession Could.od in,ticcnu is
>>„ in full to=add erfecl TEMPORARY POLE FOR POWER
>Uyz Lice.Dass Lica
�Fp Date CanVutar
7W ARCHITECTS DECLARATION
I 1 understand my Plans shall W used as public reenrts
u.pdu
a G Licensed Professional
1 OW NER-BUILOER DECLARATION
N
2 O C 1 hcrehy.(Baer Na 11. exempt tram me Canvutoea L Any c Law for IW
LIC following reason.(Smite 70 enIS,easiness and Pnfectians Code:Any city or[aunty
<$�+ which requifa a permit min.uet ppli i,for Such
h Permit
or repair any swttmit $600
Eery dim he its lens etc,also requires dtevision of for Contractors
to rich a,Law(atemcm
x
< thalbcisliccracJpursumuolhcprovisio.oflWConwcmriLIcenulaw(Chapter9 Sq. F[. Floor Area Valuation
E l-� thamn,is ing exampt Section7000)add of thadis n l of the Business ray and Frofcssio.Cade)or
;?
that io u exempt mererrnm and the pcb for Ibj caethe eumptimo Any violation of
Section 703M by any applicant rota permit habjccu the applicant m a dvil penalty of r Occupancy Type
not mort man five hundred dollen($500). '
❑1,as owner of the Property.Or my amplaycu to wages u their to compe.adon,
will ao the wek.nit the strunue,6 ad,intended m oRead for sale(Sec.7Ma,easiness
and Fretless..Cod[The Contravenes Lt..Law dome not apply in an owner of Required Inspections
propenywha
awn employees,iProvided that impgroaenmtwenhao dartnean.mintended orofferedthrnugb
fw.ule.If.
however.the Wiltbrimprovementuhalteeriead year of autumn for the.we of ^/
builder will have the buNrm of pmvin6 mat W did not WiW w improve far purpose of al(
Silo.).
Of.as ower of ct Sec.Property.am Business
convecting win licensedCmntraveoss U. l//6
trncs the project(See.]Oat,Bbor of rad Property
who..Code:)The Contrumr's Lid
cent law docs notch Prean owner of pmpeny wce Wilds n improve mermen,and,
who contracts for such Projects with a convutags)licensed parsuam l.lW Consumes
Cleev caw.
❑lame pt under Sec. .B&PCfor mss reason '
Owner — Data 0
RKER'S 1P^ AT ON DECLARATION
40 I hemby affirm truer penalty of perjury one,of the fallowing afatio.
❑1 have and will maintain aCer fimwof Conant Ioulf-insurefm WoM1 sCompeer
cation,as provided for by Section 7700 of the Labor Code,for the performance of the
wort for which this Permit is issued.
❑I lase and will maintain Wmkees Compensation Inwrrna.as required by Section
37W of to Labor Code,for the performance of the wart for which this permit is issued.
My Workees Compensation Insunme caricrrnd Policy number am:
Carrier. Policy No:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE a
(Thu sectlan need not W completed if to permit Is faroehunmW dollars(5100)
or Inv)
1 cenih that N the perform.of lW work for which this permit u issued,I shill not
employ any person in any m crhault Wcomesub�cto a .da,is Compe.a0on
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after mating duaCcrthfusim,of Exemption,you sbouW
become subject he the Wonera Compensation provisions of Ne labor Code,you most
O forthwith comply with such provisions or this permit alall W deemed onled.
Z h CONSTRUCTION LENDING AGENCY
[-+ I herby affirm that inert is.co.summ.lending agency for the perfmoname of
the work for which this permit u issued(Scc.3097,Civ,C.)
1 Q Lenders Name
Z Lenders Addmss
U0 I certify mat 1 haw rad Nis application and state that the aWse information U
Is. E^ correct I agree to comply with all city and county onlinanees and suite laws nalating Io
OfJ Wildin,mmswnim.and hereby autharis Mprcarnutiv(3 or this city 10 enter upon thc
-Were-mlndued pmperay forinleatian parleus
tipy (We)agmc to sate,indemnify and keep barred.the City of Cupmurm against 42 9
h liabilities.judgmens,costs and aphnus which may in any way accrue against said City
nsequenc
of doc grainfing of
C)z APPLICANTeUNDERSfANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGU/]110
Re-roofs
Signature.r ApplicamuCimuae., DP 1 �1
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willduapplicantorruturt WildingtavpantstomorMMleha onmateriel
as deflned by the Colombo,Municipal Code.Chapter 9.12,and the Health and Safety
Code,S❑m Yohns 25333(a)? ON. All roofs shall be inspected prior to any roofing material being installed.
41 Will the applicant or fdmrt Wilding occupant use equipment or devils which If a roof is installed without first obtaining an inspection,I agree to remove
emit beardo.air con arromnis as de0ned by the Bay Arta Air Quality Management all new materials for inspection.
Dislric17 1111�'�'
p Yes JkeSu
I have mad me baaardous\\materials requirtmenu under Chapter6.95 ordu Califor-
nia HC.lth&SalelYCode.Secd..25505,25533.d 2 53a.l undersand belittle Wilding
don not currently haw•more.Wl it u my responsibility b deny the fecupant of the
mya)mm whichmastbemerpai.rmiss raeerdre,te.raapi. � Signature of Applicant Date
Owncr or authmimd agentte All roof coverings to be Class'B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
2a . au P.Ye 66dSa66�
OWNER'S NAME: ttq o h M ( pGl HONE # O _
GENERAL CONTRACTOR: A6rQ 0 fAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
21 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
•
Owner/Contractor Signature Date
CITY OF CUPERTINO
eem 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 37537011 . 00
DATE ISSUED. . . . . . . : 05/08/2006
RECEIPT # . . . . . . . . . : 34302
REFERENCE ID # . . . : 06050063
SITE ADDRESS . . . . . : 10620 S TANTAU AVE
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JASON MILLER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : HAMID ABTAHI
CONTRACTOR . . . . . . . : LANA CULJIS LIC # 24759
COMPANY . . . . . . . . . . : ABCO CONST
ADDRESS . . . . . . . . . . : 14880 LLAGAS AVE
CITY/STATE/ZIP . . . : SAN MARTIN, CA 95046
TELEPHONE . . . . . . . . : (408) 779-7577
•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 1122
TOTAL RECEIPT 100 .47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------------ ---
103 UFER 304 ROUGH ELECTRICAL
005 o �C�`3
CITY OF CUPERTINO
TEYIP 1aOWER
OCUPERJINO PERMIT APPLICATION FORM
APN # � Dat
375- - -5-7 Z/0 ,
Building Address:
-1-Av AACL—
Owner's Name: Phone #:
�� - qn-
Contractor: Phone: License #:
Contact: Vv� Phone: Cupertino Business License#:
o,�
Building Permit Info: � P&�
Elect ❑
Job Description:
Residential Commercial ❑
Cost of Project: 600
•
Qty. if
A22licable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING