08090173 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTokltINFORMATION. '
BUILDING ADDRESS: PERMIT NO.
835 BETLIN AVE MANA .GENERAL CONTRACTOR 08090173
OWNER'S NAME: PERMIT ISSUE DATE
HUA JI 1839 TAMPA WAY 09/26/2008
NE: SANITARY NO. CONTROL NO.
(408) 375-4288
ARCHITECVENGINEER: BUMMING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
ups LICENSED CONTRACTORS DECLARATION IbDESCiI Iron
m F 1 bertby M.that 1 am li¢nand umkr provisions of Chapter 9(mm
mcnJob P
Z with,,,exon 7IXlU3 of Oivis�on .Inde,Buainev uM Prafcssiom Cade.and mylicenxu TEMP POWER
<< in roll farce and" L b
i Lice Lie.e
=p Da¢ Conlrsuor N
e 7W7W ARCHITECTS DECLARATION
U I undenund my It.still In end as public dxords
s.'or' Licensed Professional
^ 5 OWNER-BUILDER DECLARATION
2 I I Wreby affirm that I am exempt font the Contractors license Law for the
0 o follawing maaan.($ttdon 703IS.Business and Pmfessimen Code:Any city of county
which requite;a Permit to consmact,slier.improv,demolish,nr repair any sImcum,
prior to its issuance.alw requires the applicant for such permit to file a signed summem
Nat W is licensed purnrmt to the prnvisons of the Connectors License La.(Chap=9 Sq.Ft.Floor Area Valuation
it] (commencing with Section 700D)of Division 3 of date Business and Professions Code)or $600
y`< that he u exempt tWmfmm and the hands for On alleged exemption.Any violation of
Scedon 7031.5 by any applicam for a permit subjects IW applicant to a civil penalty of
.1... N Number Occupancy lm.m man fio huMrtd p,p
dollars ISM 36927021 : 61 P Y TYPe
L u ower .the Onsomeone my emntendedwith wagex ss Meir sole c.m.Bund
will do On work.andm The Com Ismor's intended Law
Tarsalepply an tan Business
and professions
ty.1h ons Cade:iM Css ince rs «..«law dace tot apply to m osier e. Required Inspections
Own
property w W Wilds«cd On,such imon,aM who m enouch wok nimme ed for ugh ria
awn emploYnex,ProWded NCl such impowmenu ole not intended or offered foraa4.lf. '
however.me Wiltl an uimpowmmtusold withinotoyw of impowe for de ose of
WIIW will have Je WNra of proving man K did not Wild m improve Int purpose a(
sale.).
0 1.a owtor of the popery am eaclusiwly contracting with licensed contractors to
construct the project(See.7044,Business add Professions Cade:)The Contractors U.
cense law does not apply to an owner of property who Wilds or impovex thereon,and
who contracts for such pojecu with a conuactor(s)licensed pursuant to dte Contractors
License Law.
0 lwcrunmunder5ce ,B&PClmmiamam.
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hemby afford Under peiulty or pedury oro of the following declauaons:
bath and will maintain a Certificate of Content to self-insum for WmImesCompen-
on,as provided for by Seeuan 3700 of On labor Code,for the perfarreer a of th
wort for which this penin is issued.
0 1 nave and will maintain WwMr's C.mpensauon Insurance,as hemired by S,cu.m
37M.1 to labor Code.for the peformance of the wort for which mu permit is issued. '
My Workers compeauded Insurance artiv and Policy num W ve��
Cartier. � U V fl Polity No.:'j2^'I_
ERTIFlZ� G'IE OF Policy
FROM WORKERS' -
COMPENSATION INSURANCE
(Thusectlon need nothecomplemd if tie permit is forms,hummed dollar($100)
or less.)
1 cgoiCY that in the Prfofmmcn of the work for which this Permit in issued.l shall not
employ any person in my manner re u m W,Oe,mbjecl to the W&kersCompensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL an,,making this Certificate a Exemption you,haulm
become subject In the Wohers C&npeeution provisions of me Labor Code,you most
., O forthwith camPIY with such povisians Or mu permiL mail W deemed rooked.
'z y CONSTRUCTION LENDING AGENCY
[-v Ihachy.M.that them ha conswcd..lendingagcne,for the perf.d.of
a > de wmk for which this Permit is issued(sec.3097.Civ.C.)
al Q Lenders Name
U z Lenders Address
U Q 1 sstify mu 1 haw rta l this apdiauan ded sum Or,On aWw Ordmtsuw is
D. P corm 1 Agee to comply with ail city aIM aunty eminences,and awe laws relating to
0U Wilding conswcdan,and hereby authonae mprtsentadv,s of this city to noun upon Be
a mm-mentioned pmpmny for impcNon purposes
.rFn y (We)agree to Saw,indemnify and keep harmless the City of Cupertino against
IV) liabilities,jedgmcaw costs and.1.which may in any way acmeagainss said City
U z mSURE
,Of me granting of thisA STANDS AND IL COMPLY WITH ALL NON-POINT Issuedby: Date //Z �'G.NS.
s.
Re-roofs C7
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will On applicantm Tutor,Wilding&,Chamr9.1store mhad the
Health and Safety
c de0ned by the 32(s)?nes Municipal Code,Chapter 9.1i,and the Health and Sa(ety
coda,scN.n zss3z(.)7 All roofs shall be inspected nor to an roofing material beim
❑Ya ON. P P � Y g g installed.
Will Oc applicant or(mum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ha menus air contaminants u defnncd by me Bay Arca Air Quality Management all new materials for inspection.
nct7
0Ya [aNo
1 haw:foul the hmallons mated[,cmd.rocas under Chapter 6.95 of the Caiifor.
nu Hnith&safety Code.Sadmu 2550125533 mil 534.1 uMersund that iflM Wilding'
dam ,moods haw a crani u my reryomihility to noufY the m,upml of de
m cn houslEcmet or ismanccmfaCcnificam Ocapr Signature of Applicant Date
on. D,to All roof coverings to be Class'JW'or better
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36927021 . 00
DATE ISSUED. . . . . . . : 09/26/2008
RECEIPT # . . . . . . . . . : BS000006195
REFERENCE ID # . . . : 08090173
SITE ADDRESS . . . . . : 835 BETLIN AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER HUA JI
ADDRESS . . . . . . . . . . : 835 BETLIN AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CARLOS ORELLANA
CONTRACTOR . . . . . . . : CARLOS ORELLANA LIC # 27468
COMPANY . . . . . . . . . . : MANA GENERAL CONTRACTOR
ADDRESS . . . . . . . . . . : 1839 TAMPA WAY
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (408) 375-4288
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 600 . 00 0. 50 0 . 00 0 . 50 0 . 00
1ERT<200 UNITS 1. 00 40 . 79 0 . 00 40 .79 0 . 00
1TRAVDOC FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 82 . 08 0 . 00 82 . 08 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 82 . 08 VISA
---------------
TOTAL RECEIPT 82 . 08
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER
•
CITY OF CUPERTINO
A TEMP POWER
CUPEf1iTIN0 PERMIT APPLICATION FORM
APN # - l&c?A 70� i• J °( 2� o
Building Address:
B 4?+J 1 n
Owner's Name: Phone #:
Contractor: Phone #: 4o g— 375 4 �
rv\C,hCt ✓ ,("V- I cc)v\ fYC C �0 V- Fax #: S 1 —] S 7
Contact: Phone #:
Ca,- 103 o (u,-,w
Contractor License #: D — 8 Zo) t o cl
Cupertino Business License #:
Job Description:
TLS
Residential Commercial ❑
Valuation (cost of project):
(o o C)
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>1K Res. Temp Power>IK E 1REAP14
Amps
( 1 ERT<200 Res. Temp Power<200 E
Amps
1 ERT2001 K Res. Temp Power 200-1 K E
Amps
1 EPERMITFE Electric Permit Issuance E
1 ELCPLNCK Electric Plan Check E
1BSEISMICR Seismic Residential B
r 1TRAVDOC Travel &-Documentation B
Fee
CITY OF CUPERTINO
TEMP POWER
COf
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
1 ECT<200 Commercial Temp Power E
<200 Amps
IECT>IK Commercial Temp Power E
>1KAm s
IECT2001K Commercial Temp Power E
100-1K Amps
1TRAVD0C Travel & Documentation . B
Fee
1BUSLIC Business License B
•
•
Community Development
h ✓ 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
qfUPEkTINO
Building De artment
JOB ADDRESS: PERMIT# n
E33,-5 ���� �� o� � 9 � i�3
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: YvYAv\k n.fa FAX #
I am not using any subcontractors: C1 ZG o
Signature Date
Please check applicable subcontractors and complete the followin 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
er/Contractor Signature Date