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10030091 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10132 DEEPROSE PL CONTRACTOR:JM CONSTRUCTION PERMIT NO: 10030091 OWNER'S NAME: DAVID GARELICK W AND ROBERTA G 562 DIVISION ST DATE ISSUED:03/16/2010 ER'S PHONE: 4082029902 CAMPBELL,CA 95008 PHONE NO:(408)379-9852 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB License ClassLi,# -73&05(0 MECH[_ RESIDENTIAL r— COMMERCIAL� Contractor LJ� -.. . Date b l I hereby a that I am lic nsed u der the provisions of Chapter 9 JOB DESCRIPTION:TEMP POWER UNDERGROUND (commencing with Section 70 f 'vision 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$7500 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36905020.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 7 with all non-point source regulationsner the Cupertino Municipal Code,Section Issued ✓� ""� Date:l 1(/ 9.18. ` Signature & I Date l to t n RE-ROOFS: V OWNER-BUILD ECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the p Health&Safety Code,Sections 25505,25533,and 25534. 1 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 Worker's Owau ze Compensation laws of California. If,after making this certificate of exemption,I r Date: J ( t G1 become subject to the Worker's Compensation provisions of the Labor Code,I mustu forthwith comply with such provisions or this permit shall be deemed revoked. CO STRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save unify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. with all non-point/;source regulations per the Cupertino Municipal Code,Section 9.18. ' Licensed Professional Signature Date V CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36905020 . 00 DATE ISSUED. . . . . . . : 03/16/2010 RECEIPT # . . . . . . . . . BS000009947 REFERENCE ID # . . . : 10030091 SITE ADDRESS . . . . . : 10132 DEEPROSE PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER DAVID GARELICK W AND ROBERTA G ADDRESS 10132 DEEPROSE PL CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3335 RECEIVED FROM . . . . : JIM EDINS CONTRACTOR . . . . . . . : EDENS, JIM LIC # 20955 COMPANY JM CONSTRUCTION ADDRESS 562 DIVISION ST CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 379-9852 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 500 . 00 1 . 00 0 .00 1 . 00 0. 00 1BSEISMICR VALUATION 7, 500 . 00 0 . 80 0 . 00 0 . 80 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1ERT<200 UNITS 1 .00 42 . 00 0 .00 42 . 00 0. 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 127. 80 0 . 00 127 . 80 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 127. 80 VISA --------------- TOTAL RECEIPT 127. 80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO ' TEMP POWER CUPEf�TINO PERMIT APPLICATION FORM APN# Date: Lo Building Address: a Owner's Name: '" Phone #: DQIAII Cy cyr r �� Z.C)a 1` 0 Contractor: Phone #: -�7 _ct 185 a 3 01) o v, �`�` .� c, t� n Fax #: 3?ct — 5 r7 Contact: Phone #: Contractor License #: -7 Zip 5 6 Cupertino Business License #: Job Description: �C e po(/Je r Residential Commercial EJ Valuation (cost of project): Type of Constructiopn S©0 Quantity Fee ID Fee Description Fee Group Permit Type 1 ERT>1 K Res. Temp Power>I K E 1REAP14 Amps / IERT<200 Res. Temp.Power<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps 1 EPERMITFE Electric Permit Issuance E 1 ELCPLNCK Electric Plan Check E 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES ' 1BSEISMICR Seismic Residential B 1 TRAVDOC Travel & Documentation B Fee Revised 01/07/09 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: e PERMIT# /00 ,— 0 OWNER'S NAME: �v: G re.�:c PHONE# 3?�'—� `� GENERAL CONTRACTOR: ;cn BUSINESS LICENSE# — 7 6 5b ADDRESS: - j CITY/ZIPCODE: Ca o Q' *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. , i �`4( 6 ` L 0 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date r/Contract ure