05110081A
CITY OF CUPERTINO
INFU.RMATIQN
BUILDING DIVISION PERMIT
�zCON TRACTOR
BUILDING ADDRESS:
NUNES ELECTRIC CORP
PERMIT NO. 05110081
20128 STEVENS CREEK B
OWNER'S NAME:
PERMIT ISSUE DATE
PINN BROS CONSTRUCTION
10486 DOUGHTERTY AVE
11/1S/200S
NE:
SANITARY NO. CONTROL NO.
(408)776-0599
ARCHRECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
bercby affirmNat 1 are licensed under pmvisiwu of Chap er 9 (commencing
with Scetion 7000) of Division 7 of the Buineuwd Professions Code, and my license e
ieBrum.mil �i-,7/o�1 3
License tsss Lic. x
TEMP POWER POLE
Dam Corbusier
RCHITECI-S DECLARATION
! I undersand my plans shall be recd as public records
Ps
4
LiamcO Pmfccdonel
OWNER -BUILDER DECLARATIONfollo
I hanky affirm the 1 from the Committees n Lyon for de
c
Code: Any city or
i 1.. Business: A
mason. 7 1.4 Business and
akr[If{�
LCO
ws.Pre.Manns
t e improve. dcmulW, or repair any uctury
which requires a permit re cores e,
which re permit
4 0 0
pWhet.plic
+ ommum
lensed be Neappin far suchpermilm0uratle a e Lnedmemem
Sq. Ft. Floor Area 1�
Valuation
��
thiormis
purimmgo
o
throw aw,witpurswnrmNcOfDiviomofOf e,BuwmrindProrli.Guprcr9
t (evmmencinx"^N Suvan7000)of Diveion7or be, Business and Proessiw Guile) or
is fy Rrt`
�1.h II
2006
that he a exempt s u efmm and Ne bum for the alleged exemption. Any violation e(
r
Type
Section 7071.5 by any applicant fora n sub' Ne a luonuu a civil penaltyof
)eCL1 °0
not more Nen five hundred doBus(M00
ttt
,Occupancy
❑T,uowrer of tiro paperty, or mywplaym web wagesuthevwlecompewtian,
w—
Required ectioni`i.J'
wiBdathework. and lhemisctemefast intended wonecilfarxale(Sec.70",Business
and pronations Coda: The Contractor's Liar Law it. wt apply m an mwoer of
9 P ,
prope ny who builds cr im proves Neeson. and who does such wort himself m through he
awn employcu. Provided that such improvements are not intended or offered! formic. If.
'
however. Ne building or improvement is sold within o. Year ofmmpleuw, Ne owner -
builder will have the barren of proving Nat he did nos ntiu or improve for purpose of
sale.).
1, as owner of the property, am eeluivelY conuaztitS with bosomed tern mors in
cumwct are project (Sec. 7066, Business and Professund Code:) The Conuames's Li -
ewe Law does ms apply as an owner of property who builds or improves daemon, and,
,
who contrieus for such projects with a canllYlar(s) licensed pY@Ilanr to the Connector's
Lux""
Law.❑
I am exempt under Set . B d P C for this maven
wner Dae
WORKERS COMPENSATION DECLARATION
1 hereby .Bim under penally of perjury arm of Ne following d.leratiom:
T have and will maintain a Cenifica s of Cr ment m self --ileum fon WancxfsCrmpcn-
ma, u provided for by Section 7700 of the Labor Code. for the peruniss. of the
-
rk for which this permit is issued.
I
'
1 have aM will mafmuin Worhefs Compensation Imuran., u oxime d by Section
00 of the Labor Code, for Ne performance of the work for which the permit a iuued
y Wa here Compensations l_n/Came.. Cartier and Policy number are: w
rtier.--@ft in Poliry Noll 6 �Ofe T 3 /10Z
CERTIFlGTE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Elbe vection need rot becompked ifft permit Is fa one hundred dMm(SIW)
or icss)
I c uify thus in the peifamana of the wok for which Nis pcman is issad, I mall not
employ any person in My roomer an in in become subject to Its Worker3 Compereation
Laws of Califmmia. Dae
Applicant
NOTICE TO APPLICANT: TL after making this Certificate of Exemption, you should
become Subject m the Worker'1 Corropenamon provlYom of NC Labour Codi'. you most
rorNwiN comply with such provisions in this permit shall be deemed reveled.
j CONSIRUCION LENDING AGENCY
T hereby affirm TNI them is a Construction under{ agency for Ne Nor.... of
' Ne wort for which this permit a issuW (Sec. 709'1, Civ. C)
Lenders Name
Lenderx Add.
I CeNfy that 1 have and this application and sue dead the above information is
' COMM I agree to comply with all city and county Continues and sum laws relating to
Wilding convutetion, and hereby su bonne mp+uenutives or the city in veer upon Ne
Shave -mentioned property rot inspection purposes.
'
(We) agRe la save, Indemnify and h.p hadereh as the City of Cupertino agahW
j luddlitie; judgmcniscros and expenses which may in any way amuse against said Oily
' inconsequence of the granting of his IRMIL
APPLICANT UNDERSTANDS AND LL COMPLY WITH ALL NON -POINT
Issued by:S4tQ�( Date
SOU{ REGULATI0
M-15-) S
Re -roofs G7
)ifirmitureofApliciardContratter DateHAZARDOUS
MATERIALS MATERIALS DISCLOSURE
Type of Roof
Will Ne applicant or forum building a.upwt store or handle hauNou material
waLu dcRncd by [1e Cupertino Municipal Cade. Chapter 9.12. and dm Heald and Safety
stere Scotian ss37ua)? ON.
❑Yes
All roofs shall be inspected prior to any roofing material being installed.
Will To
If a roof is installed without first obtaininginspection, I agree to remove
an ection
P $
or
the applicant on¢ building occupant use equip or devise which
mit hitoodnus it corsminane u defined by Nc Bay Area Air Quality Management
all new materials for inspection.
Distil.?
❑Yes ONO
Ne Califon
1 haw;mad dse,.&,it
V5505mmquimmem5underterman6.93of
nice HeaIN&Safely Code. Section 23303, 25577 wd2337d.1 wJCrsunA dutifNe building
docs ons umnrlY have a enanl Wt eves city m mtify the occupus of the
requi towhich mut a prior veeofa CmuOcae oroc cu wry.
"1 0
Signature of Applicant Date
0�
All roof coverings to be Class "B" or better
g
caner '
Lir auearired agcm Oeste
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building De artment
JOB ADDRESS:
o f -857 IS
PERMIT #
6 S// pv�
OWNER'S NAME:
PHONE # ;2 S�Z
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
//—/fir v
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
L,--
Electrical
N 12 O G h—
/
5 41
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
//—/fir v
Date
nu,c ,.
OCITY OF
CUPERTINO
CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
0S -I <�Y-06,I
APN #
3Cv�C)3C�D(
Date:
Building Address:
EPERMITFEE
Owner's Name: 7�
Phone #:
0 %O — 4-6%6o 5-I
Contractor: Phone: `7710License
#:
o S g-1
4�
o to 4� S
Contact: Phone:
_77G -77
Cupertino Business License #:
4-.0% OS
a
Building Permit Info:
Elect
Job Description:
Residential ❑ Commercial ❑
Cost of Project:
Qty. if
ADDlicable Fee ID
Fee Descrintion
Fee nrnnn
BTEMP
Temporary Power
ELECTRICAL
EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
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