05100193 CITY OF CUPER'I'INO " +° €. �'"� "�"� "--'`
BU
IL
nINc revision PERMIT �CQNTRACTnRANEORMATKION:k
BUILDING ADDRESS: LNJ3 . CONSTRUCTIUN, INC PERMITNO.05100193
CHRISTIN LAM
ID�S� &/;A PERMIT SUE DATE
581 BELLEVUE AVE 10 24 2005
p
PHONE: SANITARY NO. CONTROL NO.
(415) 585-3884
ARCHIIECT/ENGINEEH: BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
ux� LICENSED CONTRACTOR'S DECLARATION
w C I horeby affirm that 1 am licensed under provisions of Chapter 9(commencing lob Descyr�i o1n
<y wiNSmian 70fAl)af 'vision JLaf NC Busincssmd Profcssinmy ode.and my 0cmtx is INSTALL TEMP POWER POLE C pF�AL�y®
5�2In full Lore'a effec U
2 Liccnx Class Lie.
�Fo Da¢ Con
DELL a"l
ARCNITECTS DECLARATION MT�6 2005
1 understand a anJ my plans shall used public records
]yU
C, Licensed Prafemional
`C,� OWNER-BUILDER DECLARATION ■s) 1p® ax' 1 of
g I hereby affirm that I am exempt from she Contractors License law for dx �� it "��
q<$ 157 IIp' fUl C
po fallowing reason. 7071.5,Busirss and Raf¢sinm Code:Anycityrmunry
K m 9 which requires a permit to ennstrum,alter.improve,demolish nr repair any awcmm �-Q Q 0
y 2 Y 'nM w its iaNNM,ah.leCteres the appliCom for such permit to(Ie a aigned tl8lemenl
<
that he is licensed pursusnuothe penru ns of the Conuac.,.U...Law(Chain. 9 Sq. Ft. Floor Area Valuation
WW (commencing with Section 7000)of Division J of the Business and Professions Code)or
i
than be u exempt Nerefmm and Ne basis for be allcgcd exemption.Any violation of
Section 7071.5 by any applicant for a Permit subjects the applicant to a civil penalty of A er Occupancy Type
not more than Live hundred dollars(3500).
t as owner of and
pmpeny or my ,intended
wire wages r Mev role campema0on,
will dLaNewo2 and Nc swctureisnoti License Law
far at..S'c.un ano strucat
.of .-Re uired_Ins ections.. _.
i pand ropenressimu Coot:The roves cmr.and who iaw doesorkhimywanowrlhhis! .,"-' _ _ _ ._. _.. ..___.__... ..... ....._.._._..___
pran=ploy b;Lonvidtchor cdthaves Neimprovedwbo aressuchnotm minded
himxeorNroughhis: _
hwnva,.dvices:pri.,mr i prsuch
.,.ti..Id.ioino..yiaiorcoinfread thea side.lr.! iL_`'�;.� �.,I��j;.,.,1.'L.
however illux ldngorimprovc c trshaf d oneyear orimpamchon IbeposEo
p-dildo wdl have ilie burBm of proving Nat he dIE rant Wild or ImProv'7or puryox of I
sak.7.
i l
..,met
tht aL,1(See'ny,am exclusively contracting withli The C.O ctap, so....___.._....._.__._.._...._....-- .. ... ._....�_..___...,.__ .__... ......_......._...
come La d psdjen(Sec.n an Business and rty.h.PrefesiWild,
Code)The Conmcmri Lid
who Lawdoesnosapply mmowner
.m hony.wiLa Wildsorim on
Merton and I
who eanmcu for sato pmjeeu with a eonuacmr(s)licensed pursuam m Ne CLantrwreri
" Lk<me lbw:____.___. ":„P:::•\ �i':T•:iy,':r'..
j ❑lam exempt under Sec. .B&P C for this msson:
r. ... .. .Dox '._..__.,__ ..... __ .___ ....._.. ... .__.._._._. __. ... ..
df WORKER'S COMPENSATION DECLARATIONU _
I hcrtb ¢from,under peak f ane of the following delarations: i �'
Y Y PerN7 __. .....
d.... ro wJlmd,1byS h3100.f Grnxmm Cldc.rarefaf Workers Compen
mlLan;as p[ended forby Sttuon J700 oLNe IaWr Cade;Las N'pcRomnance of Nc :r%1
0'1 have and wll'maimem Workers Compensation Insurance,as required by S'eum
77W.fibc Labor Code,for the peRasniancu ofN-work forwh bNspermt is isdea)
I My WorkC Rsato I _-'./c�arrie-r end Policy number {
_.CERTIFICA 08NFROM WORKERS'.__.__..... I
CGMPENSATIATiN$URANGE, j
0 u rlON I
(tbnsccuon recd nothecomplrscJ if she perm0 13 rourone hundred dollars(3100)
Or kat) f. .nl if 5B tP Y '. - f Lv , _ .. ..... --. .. ..— .. ..
1'aiuf Nat Nc rurnrmantt or the Lark for which this perren is issued I shall not -__ - _ — __f.
e^IploY any p'sso I any manner an as wticcomes bpcuo 0e woher�Co 'pera0on' ' �s .'i i hs �, 'i'!£. t';]
s'I laws afC I! 5 Date 1
I� AOPbcat
' NOTICETOAPPLICANT If affe"roWng this Ccnfcaicur Exc pt nYnB should ._._.._. ..,_......... .........
b .....i._. ..__..._ . ._ . .... .._. _.........
eehme Subjeerm Nd Worke Compellsbt an pro sio s or Nc Labor Cdde you must ,i};d ,.lS I I
.J Z7LaJli N comply IN Nell p n n N s permit shall be dee cd revoked I
~CONS`TRUCT'ION LENDING AGENCY,,
Ik�ebYeffrmMssNcrtisarnmtrueuo krld ng a.) do,c Performance aro.
C: .>r �dicwwrk fur hxh this pcmut u issgca(s�J097 C C.) t t 1 no
W II Name
Lenders Atldress _ _.
U ''' Icurly that, v'm isa-PPlicsson .tree[Hit the hovel fomi5tlu .� ....._.. __...
U. c rico 1 agree to comply with all city and county onlnares and state laws relating to i
O U building Ire swcuon,and hemhy toothed.mpresc troves of this cricr poo IM _ _ _ _ .. ...__ ... ._. .
almv'mentron'd pioNrly fonaspecu n pugwe. o jr,
4 (We)agree of save rldcau fy and LORI,l armless the City of Cupertino against.'
y l4balu'sl gmenu.eosu and Cape.which sy In anyway attme against mid COy, _
U,Z'..in<onseq ntt NC Br i gof Ii permlf _ ._ .._ _. _ j�Flr(/'`�iyL(y/5I�////t 1—','.a _- — - -,I
^I APPLICA : DER STANDS- D, ILL COMPLY WITH A LNO O ISSUed by:
(/`•'_�/�i/A+ Date Gi-G kf _rJ fg'�
SOURCE GdL TIONS
r. ...Re-roofs..._ ...._... __.
Signature o(A c- DConvactor " -' Do,. - - II-
I b - HAZARDOUS ATERIAIS DISCLOSURE I i. Type Of Roof
w ;
_.. ll dxapples t L t rt ding more handle to m
dams axnah _. _ _._._____. _. .___ .. -
I u dcf)ned by the Cupertino Munro p 1 CLadc CT pk 912 and IW HedIN and Sdfmy
Seon 25532(ayl L�' t
< ,.L evGres+ ,. Not. I - j All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I agree to remove
ry Wlldx applicant or jiuh prey bolding pare-use cquP nt or JG sem; hch
emit ha d us Cortina L J f cJ by the B y Area Air Q al ty M race's'-' I .all new materials for inspection.
D., t ` I I:
DYcs u . i t ......"1
is
c ,. M1mumW es w,
rcquremc IsunJcr Clop¢ 6Y5 afIMCI(ori
i 25577 and 255741,toot Stan Nmlf N' ill g
Jms s n hasC t a at It ti my rapomM1 1 iy W smufY 6cc P of Nc
I hate aJ Nc h rvdnutmaxrmks
HeaIN&Safety Code$ttv 25505
ky` ineeor arlre mrymn Signature of Applicant Date
```��--�__---rrr _ .. _._ _._....
. ._ __..
sawn ufamNonzedagem -' Alllroof coLeririgs tobe Class 'B or better
Community Development
10300 Torte Avenue
tip
Cupertino CA 95014
Telephone(408)777-3228
�ncil C�T1N0 Fax(408)777-3333
rC 1 Building Department
JOB DP}�RESS: PERMIT #
O
0 CU b 64-o" 'J Osy 60 r3
OWNER'S NAME: 0215' I >JAM PHONE #
GENERAL CONTRACTOR: U O N )4C iohj ,l aJ c FAX # S -
I am not using any subcontractors: C 0
Si tune Date
Please check applicable subcontractors and complete the following ' ormatior-c
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 37536031.00
DATE ISSUED. : . . . . . : 10/24/2005
RECEIPT #. . . . . . . . . : 31723
REFERENCE ID # . . . : 05100193
SITE ADDRESS . : CHRISTIN LAM
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP CUPERTINO, CA 95014
RECEIVED FROM . . . . : BARRY LO
CONTRACTOR . . . . . . . : BARRY LO LIC # 25507
COMPANY . . . . . . . . . . : LNB CONSTRUCTION, INC
ADDRESS . . . . . . . . . . : 581 BELLEVUE AVE
CITY/STATE/ZIP . . . : DALY CITY, CA 94014
• TELEPHONE . . . . . . . . : (415) 585-3884
FEE 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 VISA
TOTAL RECEIPT 100.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
o5r co 9
CITY OF CUPERTINO
TEMPPOWER
CUPEIZTINO PERMIT APPLICATION FORM
APN # ^ ^ 1 Date: 0 /
Building Address: IOUG �f5KTS� vp
Owner's Name: (7 Phone #:
. 12} S IIS
Conlr torPhone: License #:
LV _ R^ 53 196W
Contact: �Ou LO Phone: }S Cupertino Business License #:
Building Permit Info: Q
Elect CY � �J T t\—lam PO�vaVZ
Job Description:
Residential EL Commercial ❑
Alik Cost of Project: 0170
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING