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07050026 CITY OF CUPERTINO NN BUILDING DIVISION PERMIT PERMIT NO. BUILRII�IG�RT'kENIC BLVD NATIONAL CONSTRUCTION 07050026 OWNER'S NAME: ]TA-h-S PERMIT ISSUE DATE JEFFREY W MYERS 1355 FILIPE AVE 05/03/2007 jNE: (818) 221-6057 SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 i 00 LICENSED CONTRACTOR'S DECLARATION Job Description %uI hereby affirm that I am licensed under provisions of Chapter 9(commencing z L with Section 7000)of Division 3 of the Business and Professions Code.and my license is TEMPORARY POWER POLE t yin full force and cffe t^ 7(4 U z License Clara _Llc.N I t to Dam ARCHITEC I S contractor 7 C.a < 1 understand my plans shall be used as public records >yU ' U.y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the C p O following reason.(Section 7031.5,Business and Professions Code:Any city or county <m V which requires a permit to construct,alter,improve,demolish,or repair any structure z y prior to its issuance,also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area $300 O O Valuation Z t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L 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 Number Occupancy Type not more than five hundred dollars($500). 35702014 . ❑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 or offered for sale(Sec.7041,Business Required fired Ins echo RS and Professions Code:The Contractor's License Law docs 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.If, 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's U. cerise 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 Contractor's License Law. ❑I am exempt under Sec B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Cotte easadon!mince carrier and Policy number are: Cartier. Policy No.: 'j' CERTIFI TE OF EXEMPTION FROM WORKERS' _(C2 il L) / COMPENSATION INSURANCE (This section need not be completed if the permit is for anc 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 California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate 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 (~.o►�-� I hereby affirm that there is a construction lending agency for the performance of the work work for which this permit is issued(Sec.3097,Civ.C.) aQ Lender's Name a z Lcndees Address U O 1 certify that 1 have read this application and state that the above information is (L t-r correct.1 agree to comply with all city and county ordinances and state laws relating to C) U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned roperty for inspection purposes. (We)ag to ve,indemnify an keep harmless the City of Cupertino against t) liabilities,judg nts sls an expenses hick may in any way accrue against said City V Z in consequence f ranti of s pc it APPLICANT N ST ND COMPLY WITH ALL -POINT Issued by; Date 9m(&w SOURCE R ON. Re-roofs Sign re o p i ontractor Dato HAZARDOUSfCod-c, ALS DISCLOSURE Type Of F oof I the applicant or future but. cupant store or handle hazardous material as ft d by the Cupertino Munici Chapter 9.12,and the Health and Safety cn don 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes �o Will If a roof is installed without first obtaining an inspection,I agree to remove ll the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection. District? ❑Yes juhaWt. e hazardous teria)s requimmcnis under Chapter 6.95 of the Califor- nia Hea505,25533 and 25534.1 understand that if the building docs nlumyresponsibility tonotifytheoccas ani of de require toissn certificate Signature of Applicant Date All roof coverings to be Class"B"or better o err tharizcd agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B1Jc: Lot: APN . . . . . . . . . 35'702014 .00 DATE ISSUED. . . . . . . : 05 /03/2007 RECEIPT #. . . . . . . . . : BSIM001201 REFERENCE ID # . . . : 07050026 SITE ADDRESS . . . . . : 10,121 SCENIC BLVD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JE:?FREY W MYERS ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2719 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537 COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS ADDRESS . . . . . . . . . . : 13 -35 FILIPE AVE CITY/STATE/ZIP . . . : SA:1 JOSE, CA 95122 TELEPHONE . . . . . . . . : (8L8)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 REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 100.47 #118 --------------- TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF C'UPERTINO aat - TEMP POWER CUPERTINO PERMIT APPLICATION FORM 0-3T600AO APN# c, �J .l �� , ( Date: Y_ �/41 Building Address: G Owners Name: Phone #: -) W 1` /-/oS- - L��' - 321k Contractor: Phone: License#: Contact: Phone: Cupertino Business License#: 0 v rc�� 2 Building Permit Info: Elect X �c v" La4-e-r cote- Job Description: 0 Residential Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group / BTEMP T,;mporary Power ELECTRICAL f EPERMITFEE E ect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING Community Development 'g r ,� 10300 Torre Avenue D �' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEI�TINO Building Department JOB ADDRESS: _ PERMIT# o U- 6 C-C-vq C It 0- --OC) OWNER'S NAME: e -e—C ' PHONE# yZ-l6 -12,7 K GENERAL CONTRACTOR: l FAX# - 7— -76 UG I am not using any subcontractors: Si;;nature Date Please check applicable subcontractors and complete the following information 21 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical r- ,A(e VN 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 6/1��er/Conl� r Signature Date