06060073 CITY OF CUPERTINO
BUILDIPjC DIVISION PERNIIT , +DNT - , 1 I OTIpN
n'# vfa s£, "`arc .a,'.r.,, pFydp�lah.7
BUILDING ADDRESS: NATIONAL CONSTRUCTION REN HN0'06060073
10540 CULBERTSON DR
OWNER'S NAME: PERM T ISUEDATE
DONG & THANHHAI NGUYEN 1355 FILIP
Eo SANITARY NO. CONTROL NO.
(818) 221-6057
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� 0
p c LICENSED CONTRACTOR'S DECLARATION lb Description
I I heroby affirm Net 1provision, olsCilp licensed under provision,of Chapter 9(commencing
.=g innm
iisxauroan�on iv3.f&an 3ofBusiran and Profeasaa Cade.andmyneets
licenseINSTALL TEMPORARY POWER POLE
!n 2:. License Clue Lk.as
iDote Cataracts,
t$ ARCHITECTS DECLARATION
y I undcnund my plena shall W need as public moment
'0 Licensed Profession) � �
t 5 OWNER-BUILDER DECLARATION
I hereby a1Rrm Not I em exempt from Bac Conuecmrs License Low for the
FI
a O following tenon.(Became 703 LS,Business acme Prefectures Code:Any city at county
iUT which McMinc l a permit to construct slmr.Montane,eameh'uh4 a motor my mamum - . $389
-xi prior an its issuance.also requires the applicant research permit to file a signed smemant
< Net be is licensed personal to the provisions of the Contractor's Lkesat law(Chapm 9 Sq.Ft.Floor AQW t V 20rs Valuation
9
(commencing with Became 7000)at Division 3 of are Bathroom and Profeaiont Code)or V
9 that he is exempt thaefrom and Bus bash for the alleged exemption.Any violnfan or
Secdon 7031.3 by arty applicant f"a permit subjects the appiwnt an a civil penalty of Occupancy Type
tet mom dun nus hundred authors(111500). SOL
❑I.u ower of du property,or my emplayeos with w{ea u their sok cmmpewdon,
will do Nework.and ahestrucam le tet lnteadelm ffrrd fonale(Sm.7061.Business Required Ins eCtlonS
and Professional Code;The Cmdamme's L.kvnee Law does not apply a an ower of q p
property who builds ori mprmes Boman.aha aha duostush work himself orthmugb his
ewe employee,provided Net such impromeats art not inaaNme aoRered for nit Ir.
however.the building or Improvement Is sold within one year of comptedon,the om"-
buila"will have the burden of proving that M did rot build a improve for purpose of
ark.)
u Manor of ate property.son emlusively cmuaNng with account comranas to
comm ct aha project(Sec.7044.Business and Profraslom Code:)The CMuxam's U.
muse Law does not apply to a ewer of property who builds a Improves thereon.and,
who comment for such projects with a eonumto,(s)licensed pursuant ve the Comractsrs
Lkena Law.
❑tom },.B k P C fa the rcasot
Owner WORKERS COMPENSATION F R
MPENSATi N 0 A ON
1 bemby aBim under penalty of perjury ata of the fallowing declaadom:
1 he.and will mairtsit•CardOots of Consulate he self-mouse,fee Workefa Camper,
satin,u Provided for by Sudan 3700 of the Lab"Code,fa the performanx of the
work for which this peach is issued.
❑1 have and will mtiamin Workers Compensation Insurance,as rcmimd by Schon
37M of the Labs Cade.far me perfameacc ftho work for which the permit at
My Workers Conpeuulon luutuce tai"and Policy numb"am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
ribtseection some an,be completed tribes permit Isfaanchundmdao0an($100)
or lea.)
1 certify thm in the ptalle ata of the ark far which this permit Is Weed.I shall am
employ any per^oe iy any manor ss a Penult
Compenmaan
Um of CalNEE Dean ]. `K 1 P-b _
Applieam 1 It Sze If r' o..n
NOTICE TO AP Kira".If,orf¢making this Coalfield of Esimpulon.you should
become subject to the Workers Cosnpcusation previsions of than Labor Coda you team
.,O forthwith comply with such provisions or this permit shall Ise dcemed revalued.
Z► CONSTRUCTION LENDING AGENCY
(r I harcby.arum met there isacmousseline lending agency for dee performame of
Chi> Be work for which this permit Is load(Sac.3097.Civ,C)
CQ Lenders Name
z Ludisea Address
U O 1 ceni(y that I haw real this applicada aha mk aha the show Infamada h
L4 F correct.l agree a comply with all city and county ordinances and stats lam relating to
OU building construction,and hereby authorise repreacmaaives crude city to enter upon the
[21 above mentioned pmperty for inspection purposes.
(We)agree to save•indemnify and keep barmksr the City of CupcNno against
F"y Iiabilidu,judgmenu.eomandeapnues which may In anymyacnue agtlnasaid City
in consequence of the grating of this permit. DG
POINT Issued by: Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON•
SOUR CULATI S.
I QA 9f 0 Re-roofs /L
Signstatal,dT ApprolullOoMmuccor Dia
HAZARDOUS MA ALS DISCLOSURE Type of Roof
Will do applicant or future building occupcot tam or handle haurdous material
M,defined by oro Caperton Municipal Code,Chapter 9.13.and the Health aha Safety
Cole.Semen 29532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yet tufa
Will the applicant o,ruam building=up.(use equipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
mft hanrdna air conuminna u defied by the Bay Arca Air Quality Management all new materials for inspection.
Duukt7
D Yes kd�°
I haw mal Ne hvardmss maorhls rcquimments underGapter6.93 of theGlifon
ni.H ]"SafelyCode,Smdom27503,23333md27334.lwdcr dthmifdee building
Means et comenlly have a tenm4 that it is my responsibility ts Mary do ottvp",of oro
coq which re be met par a issuance of aOcrulkete0Decuptmy.crK Signature of Applicant Date
own r,ntha raga em Darts All roof coverings to be Class "B"or better
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37533039 . 00
DATE ISSUED. . . . . . . : 06/08/2006
RECEIPT # . . . . . . . . . : 34763
REFERENCE ID # . . . : 06060073
SITE ADDRESS . . . . . : 10540 CULBERTSON DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DONG & THANHHAI NGUYEN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : THANHHAI NGUYEN
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 1355 FILIPE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (818) 221-6057
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BTEMP FLAT RATE 1 . 00 62 . 10 0 .00 62 . 10 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 100 . 47 0 . 00 100 . 47 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 100 .47 AMEX
TOTAL RECEIPT 100 .47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
•
Community Development
1300 Torte Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Y Cl OF Fax(408)777-3333
'WUPEkTINO
Building Department
JOB ADDRESS: 105 0 C01.$6RTMON Dr,PERMIT #
D e 73
OWNER'S NAME: DW4% id C*uyE PHONE # 420q6S/
GENERAL CONTRACTOR: MroiCq FAX #
I am not using any subcontractors:
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 ,���-�l JAM - I co
Owner/Contra46r Sqnature Date
JM CITY OF CUPERTINO
TEMPTOWER
�UPEIkTINO PERMIT APPLICATION FORM
APN# �(�� I �n Date: 6 It 8 Ob
Building Address: W54,o C J L KATS CW Pr C:U PEgTi/40 qST 19
Owner's Name: jq ,./En( DONG f 7 _t oto+ 14.41 Phone M. 777 _ 86
o14+� MMA 41 40,?V Phone:^�_ 30 - S6 cense #:
Contact: bofAC, 1ea Phone: or 920q - Cupertino Business License#:
� NSa,6 ;ZG46 3679
Building Permit Info: - j.y�.tA
Elect ❑
Job Description:
Residential Commercial ❑
Cost of Project:
7 2 Fri. d�
ri.
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING