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06020100 CITY OF CUPERTINO <ac�.+� ' - �-� _- BUILDING DIVISION PERMIT CONTRACC©R II 'ORMATIQN:�� _..t.:e�,;,._.... v.. ' z mss, BUILDINGADDRESS: JM BASALDUA CONST PERMITND.06020100 .10339 BYRNE AVE OWNERS NAME: PFRMTr ISURDA'n? ANDY DEBATES 15 HARTNELL RD 02/16/2006 NE: SANITARY NO. CONTROL NO. (831) 754-4788 ARCHOEC'T/ENGINEER: BUILDING PERMrf INFO BLDG ELECT PLUMB MECLI 300 LICENSED COmRACfOR'S DECLARATION O O I booby affirm tba�I am lircn°ed unhr Provlalma of CTatri 9(mmmrxing Job Description with llf 70fp).r0iviion 3.f Ne B1m,ea wd Pmrmvum c.de..m mrlkmax4 / nrmlrna.wu / TEMP POWER POLE yaZ Lkcnac loll � IJc.♦ 0r3%(O � . n F q Duc Cmlramm ,7th ARCHRECYSDECLARArON how $a 1 undo amam my Plalu shall be uaa5 u Public recnrN L'rmucd Pmf,..:.....t OWNER-BUILDER DECLARATION 1�\ a� F 1 horny affirm Nat I am ucmpt I.the Cmtaactor's Lia.1aw for too 00 following rtuon.(Stolon RD 1.5,Busineu and Pmfe+dwu Codc:Any coy«county S_ which rtylnrta a Pomlt to coautmct.a1w,,impm C.dcmoludl,«mpalr my Q,oct,oc $100 Prior in its iaaoe,.lut octan.thcapplicaum fmauch Moonllo fikaaigncd sator.1 < that hcislianacdliumunt1.rho ryoNslosuofthcContrxwrLLlJscnsLa.(Cbaplcr9 Sq. Ft. Floor Area Valuation x�S (Cammcucing width Scuim 7")C(Diviaion 3 of the Bushes and LYofasi.Conic)« — thu he 4 esempt thvcfmm and the beau for tK alkgcd eaempd.n.Any miatfi n of Sccdm 70315 by any applicant for a Petmlt aabjccu the applicant b a toll pmalty of er Occupatl,CY Type w « t me than fiw hundred dolura(SIM). ❑L u awm of the propcny,a mY cmplgcu w W wage u thetr sok campenvJm. wiB do the v«k,std the ummurt u nmmmmw aroRVW fmuk(Sec.ION,Butloeu and Pmraaimu Code:Tie Cmaractora Lmnnot Law docs t apply to an owner of Required Inspections Properly who wild;at imi roau tharon,and who Oocaauchwmt hLoarJf m through his own M*yua.Pmridcd out ouch Impmwmema art oatin¢rmrd moRoed fcc s If. howo, ,the wilding or hnf,oae mh add within ax yellofmmplmion,doe owrro. buil a will have the buNcn of Proving that K did tom build or unmme for Poof am.). I,as war of tis properly,am uclu only emtu icring with I am, mooamma to comwm the project(So.7044,Buirest rad Pmf.W.Cock)The Cor cart Li Co.Law don ant apply m an owner of pmpcny.who boilda«imi rows thereon,and, who contracts for aua wojaw with•comm w(s)lisrued ptraunt m the CoauctoYa Li Coe law. I am uc.P,,Jy,Me�Ses ,BA PCfa thio rcuon Ow ry rr/l)Si_ l,.a.�/r'a Date WORKERS ldMP TION DECLARATION 1 hateby affirm gander penalty of perjury me of the following declantiwu 1 have and will malnuio•Cewfieue d Consent to ad(-maum for W«k«'a Campen. - 1C331.(Wm`thC ar.u pravldcd r«by Sotion 37M of the Labor Code,for the perfmaoarcs of the rt for whin thio Prnoit u laroCL I haw and will maintain Wmox,s Compewtion Itw .,.0 mgdrtd by Semon Latour Code,f«the Perf«more.(Ne wog fa which NU Permh u inn W«ke .Compeauvu.latnrana aurr r and Polity w9-2--701 mm�(d A-auz��...... d4Y N..: /5 f�Z?o/ CERIT CATS OFFXEMPTION FROM WORKERS' COMPENSATION INSURANCE 01h1a serosa oed MI becompksd if the Permit 4 far..hortdrtd doBara(SIM mkt) 1 cagily that in tux polarmama of the w«k for which thus Permit 4 Lamod,l shall n« employ arty peram in any manor at u au bantne subject to the Ww",C«npmuJm Lawn of califorria.m,• Applkmt NOME TO APPIJCANT:IL alto making this Certifiac•d EaentpJm,you shund became aub)CCt b the Wohu'°C.mpenvtlm prmOmn,of the Latour Cade,you mull ,Jz foMwith Comply with such prinisioa or this permit shall w dcunN rtwakN. 'Z'O CONlmIUCTTON LENDING AOFNCY 1acrebyaflirm that Jere 4 aanunsllmt lalling aguey for an.,pmf.rmaaax of C tie wart f«whkb Nis Pamir 4listed(BCC.3M.Ci,C.) ALendcea Namc ,=z Lender'.Addeeu U C) 1 artery out I haw rod thus application and sur that th,.bow Oform.dm 4 Ly F' cmrtc�1 agta N comply with all city and county mdirunaa and tum It.relating to building Cvnamslion.all hacby autlmrirz mPrCYn4Jw3 a Nu city b COW upon th r 137 abow-mmtimtcd Property for Wfac i.a Purpose, (We)aSse to saw,indemnity old aCCP haranka tM City Of COPmim alai. N lubilitks,judgmcnts.eons all eapcnca which nay in any way accrue aguat a a id City U in PLICc Of tKa APPLICANT UNDERSTAN S AND WILL COMPLY Wfr i ALL NON-POINT Issued by: Date SOURC�.RecgIATIONS. e /7i� Z541,,/,✓.__ /G��6 Re-roofs Sigar of ApplicattuC HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicant«factum wilding o.Coco tort a haedm haraldom matcrioul u dcfiod o the Cupmim Munklpl Coll.CdPkr 9.11,all tux HuIN wrd Witty .x.sE]Y.us3z(°)' All roofs shall be inspected nor to an roofing material being Installed. ❑Ya � P P Y g 8 Will ft triflmamorfirtta,building.auPari up,cquipnent«ticv=which If a roof is installed without first obtaining an inspection,I agree to remove IL hvardou our c.numian4 as dcf d by the Bay Arca Air Quality Muugemmt all new materials for inspection. Diuricr7 ❑Yu S ' 1 hac mad the haou 4. ucru4tegnmmems unikr QRr"O,95.rOx Calirm. out Ikal hSalclyCcdc,Seeuoo 15505,25533 and 25534.1tutdcravd tharifrw wilding dna rot currently Nm a rata«,that 114 my ropomibilhY'a notify Jho oovPanl of ale rtq.imtrcnts wmetpi«tu uanaa CmJllax.fO6oP.'-y Si re of Applicant Date 0.nu«. rind agent Dcuc All roof coverings to be Class"B"or better r t Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY F Fax(408) 777-3333 ,*UPERTINO Building Department JOB ADDRESS: PERMIT # O 6 207 pp /a OWNER'S NAME: IIYL,,ZV DeG PHONE # 03 /— -5 4— es GENERAL CONTRACTOR -)- ,Aj Zc sr 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 Owner/Contractor Signature Date CITY OF CUPERTINO SIC— TEMP POWER bCITY OF OCUPERTINO PERMIT APPLICATION FORM APN# Date: 7 /yo2 � Building Address: 33 Owner's Name: /� S Phone #: pe- Contra (� Contra tto : Phone: License #: 11—Y, 4�t/, 63% 60 ?IPS Contact: Phone: Cupertino Business License#: - 159 — 5 -76c� Building Permit Info: Elect zfnm Job Description: Residential Commercial ❑ Cost of Project: C�C7 Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING 3 -3