08090144 CITY PF CUPERTINO ?5' y4
BUILDING DIVISION PERMIT CONTRATEIR INI''URM�ATIO',N,
d4rt, rr, xa RyY
BUIL INGADDRESS: PERMITNO.
X11919 CORTE MADERA LN SUM' S CONSTRUCTION 08090144
OWNER'S NAME: PERMIT ISSUE DATE
ALEX UMINO 347 ESTHER AVE 09/22/2008
NE: (408) 202-6501 SANITARY NO. CONTROL NO.
ARCHI'MCT7ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C 0 0
upQ LICENSED CONTRACTOR'S DECLARATION Z Job Description
C 1 hemby affirm Nat I am limnaed under pmviAons of CMpmr 9(rommcneing p
<U viNgecdon]B(IU)ofDiviuon3ofNeBusircvWAofetioruCode.Wmylkensu TEMP POWER FOR ADDTN TO RES
in full forte and efleeL.
j ZO Lim.Class-La.R
=q Dim Curtness,
7W ARCHITECTS DECLARATION
V I understand my plans shall ho used an public remN,
g Lictumd Profeansnsl
'0 1 OWNER-BUILDER DECLARATION
j�I 1 bench, fr,.that
I am exempt from the Communes License Law for the -
i e O following mason.(Section 703 1.5.Busima snit Pofcanions Code:Any city or county
which requirce•Permit to construct,eller.improve,d...luh or repair any snetum
_iy pnt a
Or us issuance.alW requires the applicant far NKh permit to file a signed statement
�< met Ise is licensed pursoant m the provisions of the Contractor',Licemc Law(Chapter 9 Sq.Ft.Floor Area Valuation
y Gcom
(commencing with S.ens.7")Of DivisionJofdieBusiness and PmfessumsCod $e)ser 500
Q 3
that h is excmpt intentm and the tants for the alleged eacmpt on.Any violation of
Section 7031.5 by ary applicant for a permit subjects the applicant to a civil penalty of
not..thanfive hundred dollars(S Number Occupancy P Y Type
I,u owner of the property,m DIY mnPloyca with wages u Ne'vhak compensation,
andda tiawons Cod the atmnum a rot kanens maRetdo freak(Sec.us an Owners,
and Professions Code:The Cnntramem,uid vease Law acts ort apply m,n owner or Required Inspections
Own enyvho Wild,oeimpmvea Nerrprerve who dansauchwmkh offered Waugh his
ownemployees.provided provemimprovementsatenot ear ofsmolreted for sale If,
however,the Wilding the orimpmvemmtuhathwithin rev:year or c provefrNeoww-
builder NB haw the tuNm or proving that he did rot Wild m improve for purpoa of
mk.
V.owns of the property,Cm exclusively contracting with licensed contamoss in
constmet the project(Sec.7044,Business and Professions Code:)The Cuntracmr's U.
cove Law does not yply to an owner of property who builds or improves demon,anot.
who contracts far such pmjccts with a contrxmr(s)limina d pursuant in on Contractor,
Lieeve law.
❑lam escm nm see .B R P C for this mason
Ow Date JIZ40q
0R1g 'S COMPENSATION DECLARATION
I tete um under Penalty of perjury oor the folkwing doclaradmu:
1 have and will manual..CertiOmm ofConsma in self-imam for Weemes Compen.
satian.as provided for by section 37M a the labor Code.for the Performance of use
wort for which Nin permit in issued.
1 how and will maintain Wisner,Compensation Insurance,as resulted by Section
377 of Ne Labor Cade,for Ne performance of the wort for which Nu permit Is Lssmd.
My wo l eh Campensaien Inmrance amu and Policy number,m:
Carrier. policy No.:
CERTIFICATE OF EXEMPTION FROM WOR(ERS•
COMPENSATION INSURANCE
This aNme reed nmtbecampkied if the permit Is foranc hundred dollars(SIOD)
or la4)
I certify that in on Performance onnyff the wart for which Nu is permit issued,l shall not
employ any inion in an 'lIm bacome habjmt m Ute Wohers'Compensation
Laws o(C,lifoml Date
I o
App scant �Mr!
NOnCE TO APPLICANT.If,after making this Certificate of Eaempdon,you should
become subject m Ne Worriers Com smitation provisions of We Lata Cade,you most
Q z forowith comply with such provisions or this permit shall be deemed revoked.
,z.," CONSTRUCTION LENDING AGENCY
[-+� IImeby affirm that Nem u acownactimt lending agency for the performance of
a the work for which Nis permit is issued(sec.7)9]•Civ,C.)
QLenders Name
z fielders Adders
U O i minify that I have mad thin application and suer:Nat the,bow krorm,tm I,
U.- memet.1 agree In comply with all city and county oNim,mes and state laws muting in
-C) building convection,and hereby authasia mpmscnmives of this city in anmrupnnW
ahove-nes mtiooed property for uspemion purposes.
(We)agree to ave•indemnify and burp harmless Ne City of Cupenino against
C.to liabilities.judgments.erose and estimate which may In any way accrue against=it City .-
.)z in musegoeoee of thc gran g of Nu permit. Issued b
^ APPLICA UNDER NDS AND WILL COMPLY WITH ALL NON-POINT
souReE£eu`uuT s s. _ Y� Date
4 zzaw Q
stgeawmof sir cmnramr / �k Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wi11 the a CuNm vefuture Wilding Conic,Chapt stme or laddie Hadoud Sg.,,
C honed by tie 32(a)?w Municipal Chapter 9.13,roti Ne Ha1N and Safety
cmk.Semon us72(,n All roofs shall be inspected nor to an roofing material bei,
❑Yes rJ+� � P P Y g g installed.
Will the, Rant sir future Wilding oma m woe If a roof is installed without first obtainingan inspection,I agree to remove
PP 6 W ea Air u or devices which P g
it hn>ANous air contaminants u honed by the Bay Area Air Quality Management all new materials for inspection.
.AWlcl1
Yes ON.
I have mad W hvaNms maenatsmquitemmuundcrChpar695 ofd¢Calife,
nia Heohhhsafcty Code,Sections 25505.25533 and 25534.1undesund NmifNe Wilding
dma rotcu ly he
, a Nu it u my responsibility m ratify de oaopant of use
mqu' ens which mmet poor m issuwee of a Ccnircam of Occupancy.
Z oq Signature of Applicant Date
owner sir rot ri> Dow All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32645036 . 00
DATE ISSUED. . . . . . . : 09/22/2008
RECEIPT # . . . . . . . . . : BS000006151
REFERENCE ID # . . . : 08090144
SITE ADDRESS . . . . . : 21919 CORTE MADERA LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : 'ALEX UMINO
ADDRESS . . . . . . . . . . : 21919 CORTE MADERA LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1128
RECEIVED FROM . . . . : EMY TAN
CONTRACTOR . . . . . . . : YAT LEUNG SUM LIC # 25867
COMPANY . . . . . . . . . . : SUM' S CONSTRUCTION
ADDRESS . . . . . . . . . . : 347 ESTHER AVE
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 202-6501
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ----------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1ERT2001K UNITS 1 . 00 61. 19 0 . 00 61 . 19 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 61 . 69 0 . 00 61 . 69 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 61 . 69 MC
---------------
TOTAL RECEIPT 61 . 69
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER
•
OSD� Dlyy
CITY OF CUPERTINO
TEMP POWER
CITY OF
CUPEkTINO PERMIT APPLICATION FORM
APN # 3 9- (,Ll S 0-3 (p , O 0 Date: q'�2 a`(DS
Building Address:
a 191 c� CO P-i E NA4)69A
Owner's Name: Phone #:
4L.(,--)( LAMItoC) ZKC))sI /ya
Contractor: �7>n v rd— Su Phone #:C¢o -1
Fax #:
Contact: n C Phone #: g
Contractor License #:
Cupertino Business License #:
Job Description:
Residential K Commercial ❑
Valuation (cost of project): 6-O O
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>1K Res. Temp Power>1K E 1REAP14
Amps
IERT<200 Res. Temp Power<200 E
Amps
/ 1 ERT2001 K Res. Temp Power 200-1 K E
/
Amps
IEPERMITFE Electric Permit Issuance E
1 ELCPLNCK Electric Plan Check E
IBSEISMICR Seismic Residential B
ITRAVDOC Travel & Documentation B
Fee
CITY OF CUPERTINO
e TEMP POWER
CITY OF
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
IECT<200 Commercial Temp Power E
<200 Amps
IECT>1K Commercial Temp Power E
>1KAm s
IECT2001K Commercial Temp Power E
100-1 K Amps
ITRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
•
•
Community Development
, 10300 Torre Avenue
F'% Cupertino CA 95014
I i _
Telephone(408)777-3228
CITY OF Fax(408)777-3333
I, f6UPEI�TINO
Building De artment
JOB ADDRESS: 21417 Co27-C- Yf1MC-kA PERMIT #
OWNER'S NAME: --C LLMIN O PHONE # 6 Y 0 9)517-I/`-F'
GENERAL CONTRACTOR: 54 n j tit n (,, FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
66 1 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical 13
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