06030001 CITY OF CUPERTINO sew 7.� a1 i7th�vs a e
BUILDING DIVISIONPERMIT ` EONTRGTTtTNik'U1tMAT.I�Q
rax
BUILDING ADDRESS: PERMIT NO.0 6 0 3 0 0 01
21524 CONRADIA CT
OWNER'S NAME: PERMSSUE DATE
Ahk CHUNG MING LI 03/01/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BURRING PERMIT INFO
BLDG ELECT PWMB MECH
0 LICENSED CONTRACrOR'S DECLARATION lob Descrip 'on
i� 1 hereby&farm that I am Iimued under provisions of Chapter 9(commencing
a� with Section 7000)ofDiviuon 3 of re BuurvessW Prefesuou Code,and my license is
in full form and ellen. POOL DEMO
j License Class Lic.p
9 Dau G'S DELL 3
ARCHITECTS DECLARATION /D�Oy� /
dj I underwnJ my latsu shall m used u public record LSA\
J
5u. Licensed Professional
^O Oat I am exempt
from
m Ce Connector's
9 a I mrehy,,farm on 1 1 exempt from the Canine Co License city
a for tise
o O fallowing muga Permian]rola Business and improve.
demolish.
Calc:My city os minty
$
which acquires n permit re mnatmeL eller,mprow,de ermit t are sig any is unarm $3000
�^ rdnrmiu issuance,also mquime prevision of for sort permittoLaw(Charter
g <
that hemncinS ihSectantmthcpmviu ion3of Contractor'sLicenseiarChapur9 Sq.F[. Floor Area Valuation
(commencing with Secrlon7000)af Oivuion7af the Buinesamd Prouealona Cwk)w
BB
that hating exempt Ikmfrom and Na hub fa On alleged ewnpt on.Any violation of
Section 70715 by any applicant for a permit subjects the applicant to a civil penalty of r Occupancy Type
.or move than arm hundred dollars($500).
0 1,u owner of W pmpeny,or my employees wlr wage u rteb mie mmpenudon,
and Prrework,anddm he Committees
License
oscredforu Apply 70M,B Of
and Pmfewau Cage:The C thenen,Lmmue Vw does net Apply lf rt awror of Required IHSpeCl10HS
property lobo bollw vi improves Neuron,&M wm doe&arms world himself ser through his
own employees,provided rarueh Improvements tie rot ear of d oroReree forOn,tela If.
however,the building or Improvement ts hold within oar year of mprow ore pur owron
bander will h&w On mdm of proving that m did Out build or Improve for purpose of
tete.).
0 1.as owner of the property,am exclusively contracting with licensee contractors in
construct the pmjen(Sec.7044,Business and Prorcuiau Cade:)The Conmeam's Li.
cense Law dean not apply 0 in owner of propeny who build&or Improv theme.rod,
who contracts for such projects with a contrenor(U licensed pu mint an the Conuutoh
License Law.
❑I am exempt under Sac. ,B h PC far this
Owner B r
Data
3 / O
hereby
S 0 ENSATION DECLARATION
I hey dnmunder p ty of perjury arc of the following declanionse
1 haw and will maimeln a CeNOc&m of Couart to sel6i mum for Wormfs Compere
Saban,in provided for by Secdon 7700 of On Labor Cade.for the performance of that
was for which this permit is lox.&
0 1 have and will maintain Workers Compensation Inunace,as required by Section
3700af the Iabw Code,for the performance cribs wort for which this permits leaned,
My Wertefa Compensation Inaunmm..is,and Policy nummr are:
Carrier: Policy No, '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSA77ON INSURANCE
(This sectim road ambecompleted firm permlt b forane hundred dollw(51(0)
or kis)
1 certify that in to perfwmanm of Ne wort for which this permit is issued,I shall not
employ any person In my manner set as m become subject in the Worteri Compensation
I. arCAltromia,Dya
APPlltant ,
NOTICE TO APPLJCAN7:II er ski g this Ceniaeere of Exemption.you should
become subject m the Wort amp tion provisions of the tabor Code,you mm
.JO AnOwith comply with such pmvialwu or ria permit shall W deemed ranted.
z'-' CONSTRUCTION LENDING AGENCY
�-..y. I hereby a1Tom drat ren h a construction lending agency forthe perfurmmce of
G'? the wort for which%ins permit is iuucd(Sac NN7,Civ.C.)
Q Lender'&Name
.7 z Lender's Address
U O 1 certify rat 1 haw read this Application and state that the above Information Is
is, cancer.I agree m comply with all city ted county ordinances and cum laws relating in
O building construction.and hereby authorise epruenwives of this city to corm upon the
t2j
above-menliond laterally for IMpedion purposes
O. (Wc)agree to sew,indemnify and keep harmless the City of Cupertino against
W liabilities.judgments,cow and expenses which may In my my atom again,said City n�
U in COnteal-A e
APPLICANT UNDERSTANDS IPermit.
DS ANWILL COMPLY WITH ALL NON-POINT Issued by: Date C
SOURCERE U TIONS. /-A r / 6 e Re-roofs _
SmgnaturcofAppl' n taru
H OUS MATERIALS DISCLOSURE Type of Roof
Will the applicant future building aceupantsmre or handle haeardous material
u defined by Ne Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
atic,Section sss7z(.)7
DYes 0 N All roofs shall be inspected prior to any roofing material being installed.
i
Will the applicant or future builJing occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
4 It haurdaus air contaminants u refined by re Bay Area Air Quality Management all new materials for inspection.
Diulo]
0Yes ❑No
I haw rad the husdou.materials requirements under Chapter 6,95 of the Califor.
nia Heal"Safety Cade,Sections 25505,25577 and 25334.1 understand that ifthe building
does not currently have a tenant that It ts my responsibility m nodfy re occupant of dor
mgairements ' maxi reetpdorm' ofaCmifcateaf Si gnature of Applicant Date
3 / 6
owror ser uimda cru ate All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
i ✓s Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: 275-24/ ctD?AVI- , PERMIT #0/
CLLg
OWNER'S NAME: PHONE #14eg Q
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 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
OwKer/ ontractor Signature Date
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35623054.00
DATE ISSUED. . . . . . . : 03/01/2006
RECEIPT #. . . . . . . . . : 33402
REFERENCE ID # . . . : 06030001
SITE ADDRESS . : 21524 CONRADIA CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHUNG MING LI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4801
RECEIVED FROM . . . . : CHUNG SONG CHEN
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
WE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
______ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 3, 000.00 83.16 0.00 83.16 0.00
BSEISMICRE VALUATION 3, 000.00 0.50 0.00 0.50 0.00
__________ __________ __________ ----------
TOTAL PERMIT 83.66 0.00 83.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_____ ____________ ____________ ------------------
CHECK 83.66 613
TOTAL RECEIPT 83.66
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
704 DEMO DEMO
CITY OF CUPERTINO
ODEMO
CUPEkTINO PERMIT APPLICATION FORM
APN# 3"56 OS�/ Date:
Building Address: ,7 l 52 L) /KG(;�. ems, rf
r Ix r i
Owner's Name: Phone#: (4-1,) d df-/8t a
X6 6
Contractor: License#
Contact: Phone#:
Applicant/Contractor:
BuIl ing Permit Info:
]d Elect lamb ech
o escription: ,
Residential: . °F ' Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupant Group:
��.
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG