05060101CITY OF CUPERTINO
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CONTR
BUILDING DIVISION PERMIT
A.C�,U iI�It.�R�N.Y.Itl�41�1`I �"�g`
BUILDING ADDRESS:
PERMIT NO05060101
0 5 0 6 010 1
OWNER'S NAME:
PERMIT ISSUE DATE
ONE:
SANITARY NO./19,12 CONTROL NO.
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLO
0 O
LICENSED CONTRACTORS DECLARATION
lob Description
I Witty affirm that am licensed! under pmviaians of Chapter 9 (mmmeOcing
wish Section 70111) of Division 3af me Buil. and Professions Code, and my license is
mm11 f dart«I Z
HEMP POWER POOL
Lkense CI s Lk. g
..CIA
- -
Damle�l—cr. Camraewr
�`'O NTRACTOR: Z.M. GENERAL CONTRACTOR, INC
ARCHITECTS DECLARATION
I understand my plana &hall W used At public records
Lucnsed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from We Conuacror's License Law for tW
following Mean. (Section 703 1.5, Business and Professions Cade: Any city or county
which inquires a Permit m construct, alter, impraw, demolish. or mpair any structure
prior m its issuance, also requires Ute Applicant forsuch permit to rile a signed Aluminum,
that he Is licensed pursuant to she provisions of me Comoicmri License Law (Chapter 9
Sq. Ft. Floor Area
Valuatio$150
(canmencing with Section 7000) of Division 3 of the Business and Professions Cade) or
mat he is exempt therefrom and the hues for me alleged exemption. Any violation of
APN Number q
Occu ane
P y�YPe
Section 7031.5 by any applicant for a permit subjec s the applicant m a civil pemlty of
an, mare than live hundred dollars(M),
32645048.00(/
❑ 1, u owner of ties property, or my employes with wagm a Uelr sole compenseadan,
1'..
Ir�rr
s
Pfudd. Code; The cnuanYicL oapply
anddooehnumsi�ssowdosnmroa
doea Owner of
property who build&orimgoKa thereon, and whodaes such wink himselfor through his
�Required3rispecTio
ownemployem.pmidedtMi mhimpfov uamm,imusdedorortemdforsau.n.
however, the Wilding or improvement Is sold within one year ofcomplelion. me owner.
Wilder will have ties When of praying that he did na Wild or improve far purpose of
C
p 2005
sok.).
co 1. as awrcr of Un Sm. 704. Business euand contracting wire liaised mmr tia's i-
construe Ues (Sec. 7014,
who u Code:) The C
U�U�
not thereon. and
Prater,y who Wildsrs improves Normo.and
not pr wnrfand property
clawdamr
whoLi-
etsownerof
who sofa such projects with acontncser(s)licensed punuantmde ConvanmYs
La
License ase.
an
❑ I em mcmP, under Sec. . 9 h P C fa thio reason
0
Owner Data
WORKER'S COMPENSATION DECORATION
I hereby affirm under penalty of perjury ore of me following declaruiou:
1 haw and will maintain • CenlOcam of Consent to self -insure for Wakees Compen-
smlan, As provided for by Sudan 3700 of me Lmor Code. for the performance attire
work for which this Permit is !tared.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Sermon
3900 of the Labor Code, for be peKormance of the work fa which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartler.�PION N�.: �
CERTI ATEOFEA71ONI NFROM DIGGERS'
COMPENSATION INSURANCE
rlbk section need not becompleted If the permil Is formic hundred dollar (SIM)
or kis)
1 sonify that In the performame of the work for which mix Permit is blued. l shall not
employ anyperson In my manner an As in bomme subject to the Workers' Compenndon
LAWS of GaBfrodd. DAM
Applicant
NOTICE TO APPLICANT: IL after making this CmiOcate of FacmPtian, you should
become subject m me Worker's CompensNan provisions of tie labor Cade, you main
foMaith comply with such prevWmns Or this Permit shall be clamed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that dors is. commumMn knding.getey, for the performanm of
the wish for which this permit a ismed (5..1.57, Civ. C.)
Lamloea Name
Leader'sAddress
I codify that I haw read this applicid.. and sum that the aWve InfoanNan Is
cannot. I agree m comply with all city and county ordinances and sum laws relating to
building construction, and hereby amhodse representatives of Nis city in emus upon me
Above-mentioned property for Impaction purposes.
(We) agree On taw, indemnify and keep harmless the City of Cupertino against
62
Ilabilides, judgencnta, costs and expenses which may in my way aOcroe against Wit City
of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
A PLICA T UNDERf the STANDS
Issued by: Dale _�,J"—
SOURCE REGULATIQNS. _
-✓
�a*d�`�—y
Re -roofs
Type of Roof
Signu rt of ApplicmVComncmr Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupanusere Or handle hazardous material
As defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
um, en 25532(.)7 .
All roofs shall be inspected prior to any roofing material being installed.
0Yin ON.
If a roof is installed without first obtaining an inspection, I agree to remove
Will Oe applicant or future building Occupant use equipment or dcvi et which
It haurdanu u
ous air conumindefined by me Bay Arta Air Quality Management
all new materials for inspection.
ElYea [➢its1
lM.ot
have read the lusamau materials reqimenseu munderChapter,5 95 ofUe Califor.
H0II& Sa@tYCode.Socuou 25505,25533 soul 25534.1 undcmmil that ifUe Wilding
a rot currently ham A tenant, mat I, u my MaKmfibiliLY m nmtifY tie compenl of me
mugocmetpriormiwanmofaccnnmmofOcmpso-y.
Signature of Applicant Date
� � _
All roof coverings to be Class "B" or better
er or momflimil rent , Date
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: p-( ?g5 Ob o d,btn r+ V e.,
PERMIT #
0 Iry 60/O
OWNER'S NAME:w,)*i —TA (2.144i
PHONE # S- 391-33 9 3
GENERAL CONTRACTOR . s.A. & --w r
FAX # eK6) F6-7 - oq & S
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information
(o t Ci 1 017
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
(� t o o
Date
CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
APN# 326 5- oqg
Date:J-UK2 14 X006,
Building Address:
EPERMITFEE
l885 Ir)000Cbur l�riv�
ELECTRICAL
Owner's Name:
Phone #:
,5ivsqA A . Cal
4109- 3 -1 -17 -
Contractor:
License #:
-c . M .
�2j00
Contact:
Cupertino Business License #:
Mkkc-LLLA
Building Permit Info:
Elect a
Job Description:
Residential Commercial ❑
Cost of Project:
i
Qty. if
Annlicable Fee ID
FPB Decrrintinn
FPP (:rnnn
BTEMP
Temporary Power
ELECTRICAL
EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
UV I
•