06010154CITY OFCUPERTINO
BUILDING DIVISION PERMIT,13ONT-,",019RAiNFOIYMA'1�lON
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eUILDmGADDRESS:
C & D FREITAS CONSTRUCTIO
[PERMIT NO. 06010154
10390 MALVERN CT
OW NER'S NAME:
PM UT ISSUE DATE
RICHARD MILLER
23610 MORREL CUT-OFF RD
01/27/2006
NE:
SANITARY NO. CONTROL NO.
(408)353-1228
ARCHITEGTENGINEER:7
BUILDING PERMIT INFO
f SBL PLUMB
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LICENSED CONTRACTOR'S DECLARATION
Job Descri d00 �p
al 1 am licensed under provisions of Chapter 9 (comncing
I hereby arlirm Nme
P
withScodon 7010) oolvision 3 of the limineemand Profcssioos Code, and my licmue is
I. full
a 51'7
TEMP POWER POLE JAN 3b 2006
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Date 1-7-r'—nG Comncwr ]nrerve� r i
ARCHITECT'S DECLARATION
f�•�s ��rtt1
I unrol sand my plain shall be used u public neemds
Licensed Pmfcssiunel
OWNER -BUILDER DECLARATION
1 hereby .(Sect that 1 Law for lite
exempt from the Conion
Co e; Any c
num 1. Code: Any city s county
following neuon. 703 s,2 Business and Proave,
t dmuos
Permit Improve, deemitt er repair any e
which myus permit to cunm+uct
.$200 $ 2 0 0
plicIW.
poor u n ratcre ,
also requires the applicant much permit to ffiee a, Law
its Tensed
Sq. Ft. Floor Area
Valuation
(atsumem
that , p of the
licensed pusuao wth)of
BuscwfaLttnaclaw(C Code)
(commencing with Section Ilio) of Division J of the Business and Profrsaious Cnde) m
(comms Division
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that be 13 exampr Nmefrom antl the basis for the alleged memptl)n. Any 1.1Wun of
r
Occupancy Type
Sectun 7031.5 by any applicant for. permit wbjmu the mplicant w a civil penalty of
not come dun five hundred doles (2500).
0I,nowerofthepmpwy.mmyemploycuwiNwageuthekwe,compe on,
'
Required Inspections
will do Newoh• and thestrcwm Is not intended maRcred feature (Sec. TE A. Business
and Professions Code: The Otarma ues Liccres, law does net apply in an owner or
property who builds m improves themon, and who does such work himself m Uumugb his
own employers, provided that such Improvements an, natinunded moQered persalt. if.
however, the Wilding or improvement is sold within one year of complemm. the owner.
bulldu MB have do burden of proving that W did net build or improve for purpose or
.I.J.
0 T. as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business cad Professions Code:)The Con acmes U.
mus law dm not apply to an owner of propene who Wilds or improv thereon. and,
who contracts for such project with a eemmortaT s) licensed forward in the Comrmor'a
License law.
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0 Icon tempt under Sea . B k P C for this moron
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby afro) under penalty of perjury aro of Ote following declwiona:
I M. ad will malntsin aCanlfimuaf Consent he self -insure for Worker'.Compen-
Milan, u provided for by Section 3700 of the labor Code, for to pedom moue of the
wart for which this Permit is issued.
0 1 have and will maintain Winter's Compensation Insurance, as retained by Section
3700 ordw labor Code. for the peRamance rtf the work for which tht permit is issued.
My Worker's Compensation Wunme camter and Policy number art:
carrier: is PolicyN., I a_reyiG;
CERTIPIC OF EXEMPIONFROMWORKERS'
COMPENSATION INSURANCE
(Thr, auction reed nottecompleted If lbe permit Is forum hundsoddollm (5100)
or less.)
,
I certify that in the performance of the work Ser which this permit is luted, I shalt not
employ any person In any mannerw Is in become subject to the Worker' Cooperation
Laws of Cellfoml.. Dow
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Applicant
NOTICE TO APPLICANT: If. after making this Certiricae, of Exemption, you should
become subject M the Workeh Compensation provisions of IW LaWr Code, you most
.
foMwith comply with such Prevision or this permit shall N rimmed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a convection lending agency for the performance of
tho work for which this perch I. issued (Sec. 3097. Cn. C.)
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Lender's Nurse
1<nder's Add.
1 certify that I low read this application and me, that the show infomNon is
tomo. I aper w comply with all city and county on inames and sue, laws mladng to
Wilding construction, and hereby authorize representatives of this city to enter upon tho
above,mention x! properly for inspection purposes
(Wc) agree w save, indemnify and keep humleM the City of Cupertino against
liabilities, Judgment, costs and expeosm which may in any very wrow against sod City
in APPPL CANTenc` UNDEOf the RSTANDS Aof IND WILL COMPLY WITH ALL NON -POINT
Issued by: Date/ LC'df'
SOUR REGULATIONS.
Re -roofs S .L
Type of Roof
Zoe. `—
Slime um a� VCwtwwr We,
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding occupant Mme unbundle hastdoos material
sa de0ned DY the CupeNno Municipal Code. Chapter 9.12, mo the Health and Safety
cot. snetirn sss3z(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yin �fo
'If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or Stewre building =open, use equipment or devices which
colt harardum cit cinumimnu u defree by the gay Arta Air Quality Management
all new materials for inspection.
Dmir."?
OYU g o
I have mad the hasaNcos malertah requirements under Cltspter 6.95 of rite Califor.
nta HcSW Je Safely Coda SecoonsZW5,25573 md25534.1 undesmnd Ihmifthc Wilding
dm not currently hoc a unam, the, it is my responsibility in really list omupsnt of the
requirements which meet W=Ipoor to insurance ofacmlrteaworaapanry.
Signature of Applicant Date
Z.- �/ "27 -or-
All roof coverings to be Class "B" or better
Owner or authorirsd agent Date
a
CITY OF
�UPEkTINO
Buildinz D
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
t
JOB ADDRESS: 10, 90 halvcrvt (Lk. PERMIT #��/�
OWNER'S NAME: D1 n \ 1 H 1 I I. r PHONE
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
Owner/Contractor Signature
Date
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
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SCITY OF
CUPEkTINO
CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
6 G6(0/S-�
APN #
Temporary Power
ELECTRICAL
Date:
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
Building Address:
LIC20
CA
Owner's Name:
Phone #:
</4r -3o -
Contractor:
Phone:
License #:
CSO 1
_
S
Contact:
Phone:
Cupertino Business License #:
Ta C '
C/off - / -
1I
Building Permit Info:
_
Elect
Job Description:
Residential 4 UCommercial
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Cost of Project:
•
Qty. if
Applicable Fee ID
Fee Description
Fee Group
BTEMP
Temporary Power
ELECTRICAL
EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
•