08080087 CITY OF CUPERTINO •s.=-ter�' " ::« "�` '"* � ' a"
BUILDING nIVISION PERN T CU1�IT1L4C"TORINt`U$MATIf7!N .
BUILDING ADDRESS: PERMIT NO.
2065'7 CRAIG CT TBD - TO BE DETERMINED 08080087
OWNER'S NAME: PERM ISSUE DATE
I,IANG-HUT YANG 08/12/2008
IrE. SANRARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMfr INFO
BLDG ELECT PLUMB MECH
I�
20, LICENSED CONTRACTOR'S DECLARATION Job Description
06 1 bemby aRm that I am d'uenad under pmvidow of Chapter 9(t o didemaing p
ZjT with Suction?000)of Division 3ofthe Businestmad Professions Code.and mylieenais TEMP POWER
^<�H in full tone and effect
ash z License Clan Lic.a
a—q Dow Contractorunderstand'- ARCHITECT'S DECLARATION
WU 1 understand my Plans shall Po used u public records
Cd
LLo Licewe0 Professional
5 oat I am exempt
from
DECLARATION
COO l reme a(Em that 11. exempt from Bte Canon,;Co License Law for the
COO O fallawwhich
swan.Fermi i I onsiam5.Business,LW Prom.demolish.
Cade:Any city or county
$ which its issuance.
n Permit re ennwue, sir.improve,m permit i sere a airsig any awmuro
prior uslimm na,suantto to the applicant for such permit infileLaw statement
$<
that heulittvcdpurwamloNeprmisimuofNeConuactariLi¢ttsel�w(Cnapin9 Sq.Ft.Floor Area Valuation
y (COmm
F- eneing WlN Sttti0o 10003 of DIVulOo 3nINC BYL11wf Ltd PNfC{Slans Cade)ar $'1000
k5$_ that he u uampt Ihmmrmm and Ne pasts fm the alleged exemption.My violation of
Section 7031.5 by any appHcmi for a permit subjects the applicant to a civil penalty of
K �pLI Number Occupancy Type
t mart than five becomes dollus ISM 3 5 915 016 U(1
❑L ot awmr .the P struct re my employees ora wren as Nei(sole compensation,
will dothe wmk.ands-no lumeanot Intended o L wdoffered scut a(Sea.70 x1,ow.,
arW Prrywh obu Cade:The ContracNts Liccwe law does a reply b rt aWKr or Required Inspections
ownem lobo Wildamimpmses Ncrepn,Lod who stem eucn orded umxlfmlAmaen bas
awnemplayw,provimd Net wenimPmse widasenot intendedmaRctud fpr Sala If.
hawder,the building or impden of pmuret lased within aK yet or Improve for the owner.
builder will law tits burden of pmvinB that k did rot still m improve Ire purpose of
ale.).
E�1,u owner of the Progeny.am exclusively contracting with Iicemed coraCNa to
construct the project(See.IWC.Business and Professions;Cade:)The Con4rnors Li-
cense law docs act apply to an owner of propany who builds or improves Ounces.and. '
who cunmctsfon such Projects with a conuacter(s)lianas personal to the Conan ten
Lice.Law.
❑l ore eaempt undo See/ B&P C fm Nu reason
Owed LJ emN�N'///n � /U/1/ll Daae IZ
WO 'S COMPEKSATIN DE RATION
I hereby&Mm under peoahy of KdM nuc of the following declambac,
ham and will mainuin a Certificate ofConsenI to self-insum fm WorkehComper-
sation,as provided for by Section 3'100 of um Labor Code,for the pcAomana of the
wmk for which this permit is issued.
1 have and will mYnuln Wmbe's Compensation IM1NILIa.as madded by Seco
3700of the Labor Coon.fm the Xrfomance^f0u woss("which ads perm,is lasucd '
My Workers Compensation Imaraa carrier and Policy number are:
Cartier. Polley No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITU Mellon sad wtWcwplcmd if tie permit is faone hundred domes($100)
or less)
1 cenify that In due perfomamt a Ne wart for which this permit Is issued 1 shall rot
employ any person in any mmrorso as to become subject is the WorkersCampettades
laws of California-Dau
Applicant
NC'TICE TO APPUCAW.tr4Wr maWS its N ate f ption,you should
became abject m the W^rter's Comp:wtion provisions oT Ne m Code you mtw
0,7, foMwith comply with such provitinm or this pemit shall W deemed revoked,
?O CONSTRUCTION LENDING AGENCY
[--� I hereby Onm that Nen is a construction lending aaenry for the performance of
a Om work for which Nis pemit is issued(Sex.3097,Civ.C.)
G Q
Leader's Nam:
z lasagna Address
U0 1 unify that 1 haw sad this application and sate Nu 0m show inforeaticn is
is, r'� correct.I ague It Comply with all Chy Nd County mdlaLlw and state laws relating to
0(��^ building commuction,and hereby"don=rtpmaeoatiw of Nu city to cater upon lM -
Dd show-m.1migm property for inspection purposes
(We)ague to ave,indemnify and keep bermlw the City of Cupertino against
Z Habincorded scan err the gran and expevawhich may in MY Way eccrve aaswl.uid City
V z in eoneequentt of the gantint of the penmis
'-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date - .Z -GSI
SO CEREGULATIONS.-
�/44 SVtP44' Re-roofs
Sgsu 0TApphcm btdwa -----Da-te —
HAZARDOUS MATERIA DISCLOSURE URE Type of Roof
Will the applicant or forum building necopanr nom orhadle baardow material
u defined by the Cupenina Murmipal Code.Chapter 9.13,and!the Halth and Safety
Code.o«sss3z(a)7 En No All roofs shall be inspected prior to any roofing material being installed.
Will thea cram or future Wilding oar ant a If a roof is installed without first obtainingan inspection,I agree to remove
ren d p M Air Qu ret Mane which Pe
.nstric 7w Lr cmuminau u mnKd by the Bay Ama Air Quality Mavgcmcnl all new materials for inspection.
t]Y. Ell.
I hawmad the hsardwa materials misiree gids under Ch.pur6.95 of the Cattle,
ia H
realth&Safctycode,Samns 25505.25533 and25534.1unmmmnd thadthe Wilding
dao not covertly have a team that it o my respamiMiity m notify tie occupant or the
mpuim ts which mut be t pier w issumwe of•Certifcale of Occuparuy.
W1 1t Signature of Applicant Date
owreg ora dagent DateAll roof coverings to be Class'%q."or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:-
APN . . . . . . . . . 35915016 . 00
DATE ISSUED. . . . . . . : 08/12/2008
RECEIPT # . . . . . . . . . : BS000005769
REFERENCE ID # . . . : 08080087
SITE ADDRESS . . . . . : 20657 CRAIG CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LIANG-HUI YANG
ADDRESS . . . . . . . . . . : 20657 CRAIG CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : LIANG-HUI YANG
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . .
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---- ---- - ---------- ---------- ---------- ---------- ----------
IBSEISMICR VALUATION 1, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 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 122 . 87 0 . 00 122 . 87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 122 . 87 MC
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER
•
� L) 297
CITY OF CUPERTINO
TEMP POWER
• CUPEkl INO PERMIT APPLICATION FORM
APN #�� / Co ' U d Date: O� 12 p 8
Building Address: D
20657 Cra C Cu, t C 950! 4-
Owner's Name: UPhone #:
kt- 4-0(k- 749-212 3
Contractor: Phone #:
` (1�rn ��• C`1 Fax
Contact: d, Phone #:
Contractor License #:
Cupertino Business License #:
Job Description:
Residential Commercial ❑
Valuation (cost of project):
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>1K Res. Temp Power>1K E 1REAP14
Am s
I 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
IELCPLNCK Electric Plan Check E
1BSEISMICR Seismic Residential B
I' 1TRAVDOC Travel & Documentation B
Fee
CITY OF CUPERTINO
a TEMP POWER
COF
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
1 ECT>1 K Commercial Temp Power E
>lK Amps
IECT2001K Commercial Temp Power E
100-1K Amps
1TRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
•
•
Community Development
i 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
46UPEI�TINO
Building Department
JOB ADDRESS: PERMIT # U U Y U 0
D 4Tr-/) t Cf a
OWNER'S NAME: - Mn _ u" PHONE # —2 2
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: L a.,a 12/a�
Signature Date
Please check applicable subcontractors and complete the following 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
Owner/Contractor Signature Date