06030019 CITY OF CUPERTINO ^' *;V'�-%LAW
FO
BUII,DING DIVISION PERMITwill
, CU1TRC*T�(1R'INATIO
BUILDING ADDRESS: PERMIT NO.0 6 0 3 0 019
20897 ELENDA DRIVE
'VET'S NAME: PERMIT ISSUE DAIS
SU, KATIE 03/06/2006
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
Sap LICENSED CONTRACTOR'S DECLARATION Job DCSC
r�ri 1 Imreby&from Nal l Am licensed under provision of Chapter 9 teommencing
with Secda 70!10)of Division 3.f the Business and Proicealun Cade,and my license is
In failforoe And At TEMP POWER POLE g�
jgz U...Claa Lic.0 Nr NEEDS CONTRACTOR INFO MAR Ifp 2006
all
ARCHITECTS DECLARATION
Q I urduarrad my plan shall be used As public mexa ds
krg BUIW IN
h Licensed Professional r v
OWNET-BUILDER DECLARATION l��J��
1 hereby.(firm that 11. exempt from the fa OM ar'a License 4w far mo
e o O following wan.laatiun 703 L5,c usher.and Profession Cad:MY city Of county
$Pi which its ants a pemi,te c res Me,alcor.improve,dmrall1 m,Asir Any ummuro
Pommiuisswa0.asuantto im thovisio offor eachwtor'sLOleaaLw(ned Chap em
�< Net(commencing
pursuant In tiro Invision of the License Prom onsCopmr9 Sq.FL Floor Area Valuati 150
than a is arm wlm Sepia Mur ad A Division r of Al aged esa and on.My
of
Se t Section
ta esembt 0mrtfrom And the beer it me silAthe nemant in Any violation of
Section 7031.5 by any appliall for•Funis inbjecta tiro Applicant m•rival penny of 1YP
nor am thus raw n.rdrea anion(f500). 32630016 r00 Occupancye
❑I,u owner of me property,or my employee with wga u Neo mle mmpenulon,
will do the work and Neauucume is nal Wended molrem!fursam(Sec,70/4,Business Required Inspections
And Profession Cade:The Connoisseur's LlcenY Law doses at apply N an owner of q P
property who build or Improves thereon,and who dao such wad himself ar through his
.wnemployees,provided that such improwmmu see at intended croQerW facials If.
however,Ne building or improvement is mid within ane you of completion,Me.war.
Wilder will have the burden of proving Nm he did mi build or Improve for Foram of
.in L
Ji I.is&war of the property,am eminively contracting with licensed amncmrs to
&nursed Um project(Sec.7044,Business and Professions Code)The Contractor's U.
eerie yaw does not apply m An owner of propeny.who builds or improver them.n.rod,
who Convects for inch pmjecu with a conmacLor(s)licensed Panamint An the Contractor's
License Law.
0 am aempr and Bac. .B kPCfm Nia no
ACT Dim 0
1 OM'E! A CLARATION
I hereby ala¢under penally of perjury Am of the following declarations:
1 have And will maintain a CeNBnte of Conem in self-ininm far Worker'sCmnpem
min,as provided far by Section 3700 of the labor Code,fa the performance of the
work far which mu permit is issued
❑1 have and will maintain Workers Compewdan TnulAnce,As required by Sudan
3700 of Ne labor Codc,for On perfomunn of the wok fawhich this Form,l&issued.
My Workers Campersadon Insurance artier And Policy number am:
Carman. Policy N..:
CERTIFICATE OF MEN P770N FROM WORKERS'
COMPENSATION INSURANCE
(Ibis aculnn need not hocomplemd If me permit Is foram hundreddollan($100)
or less.)
I certify that in the porfoonaae of the work for which Nis permit u Issued.l Ntll not
employ AnYPanYn µID� �6Nelect mtM Waken'CanAenvdw
Law n of California.ssan res-- !/J .
Applicant
NOTICE TO A�P� I ANTftIf.I¢r making ffiTrCni4CZLC of Exemption,you should
become subject an the Worker's Compensation provision of me labor Cade.you most
O forthwith amply with such provision or NN
is Permit all M doomed rooked.
Z CONSTRUCTION LENDING AGENCY
F IMmby eRmm that Nem I..c.nuuctinn lending agency for the perruronna of
the work fur which this permit is Issued(Sec.3097,Civ.C.)
Q Landers Name
=Z Lendr'a Address
U0 I easily that I haw read this appliculon and sum that on,above infamWa Is
U.E correct.I agree to comply with JI city aul county oglinames and suer lawn relating N
C) rVbuilding convection,and hereby auNodne representatives of suis city to carer upon me
W shove-mentioned Property for Inspection purposes.
(We)&gra to save.Indemnify and keep harmleai the CITY of Cupertino against
rrA Ilabilims.judgmcnu.coau and expense which may in Anyway smut Against Wa City
APPLICANT
T of Ne granting or-A p Trot(. y
GULA an
APPLICANT UNDERSTANOS•ANO WILL COMPLY WITH ALL NON-POINT Issued b Date
SOURCE RE/� /La
signs or p -:::: .n!/asonor � -z- Dam
U Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam w furan building uccupantuam or handle huardon memo.]
As defined by the Cupea no Municipal Code,Chapter 9,11.and the Health and Safety
Boston 15531(a)7 `' All roofs shall be inspected prior to any roofing material being installed.
Oyu QFI.
wB the applicant or comm building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hararcinus air conuminAnu As defined by the Bay Aro Air Quality Management all new materials for inspection,
District
❑You
I havereal the haurdmlassmav:rialuequiremems under Chapmr695 of the Califor.
nu HealthAt SafetyCode,Secvau 25505,25533 ux1255M.I undcrsmm!muifNo bolding
dila at eurtonity he veno this my msponlhiliry b notify die occupant n!Ne
.Mba 0 met prmr cc.r a Conlficam of Occupancy. Signature of Applicant Date -
owr(era umansdeg-,dri � Dim All roof coverings to be Class "B"or better
CITY OF CUPERTINO
I 1 of 1 PERMIT RECEIPT OPERATOR: bethe
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32630026.00
DATE ISSUED. . . . . . . : 03/06/2006
RECEIPT #. . . . . . . . . : 33451
REFERENCE ID # - - . : 06030019
SITE ADDRESS . . . . . : 20897 ELENDA DRIVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SU, KATIE
ADDRESS . . . . . . . . . . : 20897
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : VEY TZE SU
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
• TELEPHONE . . . . . . . . :
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
----------------- ------------ ------------------
CHECK 100.47 2639
TOTAL RECEIPT 100.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO
���" TEMP POWER
E
RjT
ecUPINO PERMIT APPLICATION FORM D6o3oai�
APN# 3� ` �� ^D� Date:
Building Address:
2Q0 G� PM G{ '� �a— • i vt
Owner's Name: \ Phone#:
ontractor: _VC74 Phone: / License #:
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Elect ❑
Job Description: T
Residential 4
Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•