06070182CITX.OFCUPERTINO
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BUILDING DIVISION PERMIT
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J B CONSTRUCTION
BUILDING ADDRESS:
PERMITNO'06070182
10122 JUDY AVE
OWNER'S NAME:
PERMIT ISSUE DATE
LUIS ROA
4532 MORNING BROOK
07/26/2006
NE:
SANITARY NO. CONTROL NO.
(408)595-5471
ARCHnECf/ENGINEEK:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm shat I am pleased under provisions of CMpw 9 (commencing
P
with Section 7000) of DMsioa 3ofOw Businmmd Profession, Cum.and my Iiceme u
in full to. ander
TEMPORARY POWER POLE
LkenscI a Lk.N
Dam Cmtracmr 0,
ARCHrfECrS DECLA ON
I understand my plans Nall be and as public mentis
Licensed Pmfcssinnal
OWNER -BUILDER DECLARATION
1 hereby olArm that I am mempt from the Canlracmr's License Law for the
.
following Masan. (Section 103 1.5, Business and Pmfessiom Cade: Any dry or county
which mquims a permit an construct. alcor, improve, demolish, An repair any mature
$430
print m its issuance, also requlma de applicant for such permit in file a signed swcmcm
Sq. FI. Floor Area
Valuation
that
m0) of Disiolu 3the c Business And Prmiaw(Chapw9
that (commencing with Sadon to M) of Division 3 of the Businmsend Prormwns Cade) car
with Section
that he is asempt t eaefmm and the bases for the alleged exemption. Any violation of
AFN f4titfiber
Occupancy Type
Section 7031.5 by any applicant for a permit subjecu de applicant to a civil penalty of
not mom dun five hundred dollars (5500).
❑ I,u..of de property, or MY employs+ with"So As their sok eonpeeadon,
Required Inspections
will do the "it and the stromen,Isatmunded or offered for sale (Sm. 7044. Business
and Prornssiom Cade common c000n Llama ta law daone apply m an owner of
9 P
property who builds a improves drown, and who doessuch walk himamr m duough his
own employees, provided thmsuch Improvements are not Intended oroRered facial, IL
Me
aollater the building mImprovement4hat Mthinarcyear or romovefor the owe r-
ro
howenwill have the burden Prawn{ Nn k did not build m improve for purpose of
❑ 1, m owner of the property am emlmively contracting with licensed comments In
construct the pmjm (sen. 7044. Business And ProfeWam Cade) The Coauacmra U.
t] t7
tensa Law does not apply to an owner of property who builds ar improve daemon. and,
who concocts for such Projects with a wnuacmrt Exceed Pnt m den Comnecwr's
••
�fl06
License law.
❑ I am mempt under Sea .B&P C for this reams
caner Dau
WORKERSCOMPENSATION DECLARATION
Ij µa �plQv tt �( l7
IP
IbeRby affirm under penalty of perjury ane or doe following dwlantiom:
\Yii1JAv L9 �r
1 haw and will maintain a Cardinwm afcoment to self-imuR for Workeel Compa-
sadon, as provided fee by Swum 3700 of the Lahm Code, fm the performance of the
wort foe which Nis permit is issued.
❑ 1 ban and will maintain Wortees Compensation Imuran, As required by Section
_
3700 of the labor Cade. for the performance of the work for which this pemait is issued.
'
My Worker's Costive ice In Tana Omer aM Policy number am:
-
Caml Poliry Na.:
CE • CAE F IPTON FROM WORKERS
COMPENSATION INSURANCE
CIhIs mNm need rot he completnl Uthe permit Is foranc hundred dollar (SIM)
or les&
I all list in Ne Performance of the work for which Nis permit is iuwd, t shall not
emplayanypasenin any m corm as m bccam 'cam the Workers' Conpemadon
Lams of Califomia. Dau
APPllont L4-.; .. 9
Camila , of ac, n. ld
NOnCE TO APPIJ : IL afar melon{ a
bttome subjttt m the 'orter's Campers inn provleiou of de Coda you roue
fautwuh comply with such provisions As Nis Permit mall be darned rooked.
CONSTRUCTION LENDING AGENCY
combination0 lending agency for the Performance of
I herby aRirm dao dern is ta a aed(Six.
the dark for which this permit en issad (Stt. 3077, Civ. CI
'
j Landels Name
lander'+ Address
1 certify that I ban read this application and suite the the aban information en
t
concert. 1 gree to comply with all ally am county ordinances and state laws relating R
building arswction. and hereby m non. mpmmnutive of this city team, upon the
abun-encntiumd propc0y for impccum purposes
(We) agree to save, indemnify and keep harmless Me City of Cupertino against
I IimilWm,judgmcntsFmts and eapasm which may in any my mane against mid City
in consegance of doe granting of this permit.
Z
UNDERSTAND D WILL COMPLY WITH A L NON -POINT
Issued by: Date
Re -roofs
of Roof
en ,HAZARDOUS MA DISCLOSURE aType
;AP'LICANT
de applicant ar futmc building oaupsnt store m lunme haardom mammal
flunIpp
y tfe Cuperm. Municipal Code.Chaper9.1; and the Health and Safety
,Serrtim25532(a)7
Yes (MA o
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
Will the applicant or fu_turre building mai use equipmmn or device which
h4"Ardnus It cmtaminmui as defined by the Bay AMA Air Quality Management
all new materials for inspection.
D s4icG
❑Yes --We
I Nn mal the haardoua materials requirements under Chapter 6.95 of the Califor-
Am Hato & Safety Cao, Sectiones 255M. 25533 and 25534.1 undcrsund mat dam building
does wt currently have a count, that It Is my responsibility in notify the caupant of the
require ntawhkhMMI bcmetpnor ma nneea9re.eafOcwY.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owauthor agent Dam
a 1 o 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37511008.00
DATE ISSUED.......: 07/26/2006
RECEIPT #.........: 35397
REFERENCE ID # ...: 06070182
SITE ADDRESS .....: 10122 JUDY AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: LUIS ROA
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: JORGE BARRIGA
CONTRACTOR .......: JORGE BARRIGA LIC # 28131
COMPANY ..........: J B CONSTRUCTION
ADDRESS ..........: 4532 MORNING BROOK LN
CITY/STATE/ZIP ...: TRACY, CA 95377
TELEPHONE ........: (408)595-5471
4EE
NEW BAL
ID UNIT
QUANTITY
AMOUNT,
PD -TO -DT
THIS REC
----------
----------
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
-----------------
OTHER
------------
100.47
------------------
VISA
TOTAL
RECEIPT
100.47
VOICE
ID DESCRIPTION
VOICE
ID
DESCRIPTION
103
UFER
304
_____-----_--_--------------
ROUGH
ELECTRICAL
CITY OF
�UPEI,TINO
CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
0WM2.
APN # :3-75-11
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V
ELECTRICAL
Date:
Elect. Permit Issuance
ELECTRICAL
BUSLIC
O
Building Address:
Z
wner's Name:
Phone #:
65z���4�-l8�/
Contractor:
Phone:
t
License #:
Contact:
Phone:
Cupertino Business License #:
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2
Building 116rmit Info:
Elect ❑
Job Descrip 'on:
Q
O�
Residential 69�,
CommerciM ❑
Cost of Project:
O G
d
Qty. if
ADolicable Fee ID
Fee Description
Fee Group
BTEMP
Temporary Power
ELECTRICAL
EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING