06120044 CITY,OF CUPERTINOa
BUILDING DIVISION PERMIT CONTRACTCiR INFQRMATION ••:
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BUILDING ADCRESS: WELKIN INTERNATIONAL IND ITND06120044
20711 FARGO DR
OWNER'S NAME: PERMIT ISSUE DATE
WEN HAU CHEN 19925 STEVENS CREEK BLYD 12 /12 /2006
NE:
SANITARY NO. CONTROL NO.
(408).733-0188
ARCHITEC (ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i0, LICENSED CONTRACTOR'S DECLARATION
od 1 hereby affirm that I am licensed under previsions Of Cooper 9(Commencing Job Description
:z with Section 70110).f Division Sof Chad Budnea and Professions COdc.md my It.,.iii
!oH infall rorce.neerra REPAIRING THE EXISTING GAS LINE OUTSIDE THE HOU
s'a? Lkcnse Class 1lc.11
:.c Dam Cmdracwr
ARCHITECTS DECLARATION
i¢< I undnitand my plans shall be used u public records ,-
aaV
o In Licensed Professional
i 5
OWNER-BUILDERexempt riders
2 c c I hereby.. .firm on 11. cxcmpd from the Contractor's Lkcnx Law for de
p o which re mina(Section]IDIS,Bualtess and PoaRstimn Code:Any cityos County
which require a permit re eonswe,air,impmm,h crailA,or repair any azmnem $500
-iy pAoroialiensedp purathsuant
nttreqo the dhappl,.r0.urt in,sucCandidates
okadd dLaw(chxmem
< dhmhis licensed punuanuo the provisiansafthcfonmcwrY llttnsc law(CM1apwr9 Sq.F[.Floor Area Valuation
Rt- (Commercial;with Section 7(00)af Mould.Sof Ne Busimodmd Profusimu Cnde)m
$ Nn h is eacrept thoufmm and the basis for the alleged uemption.Any violation of
Section 7031.5 by any ipplfum for a permit subjects the applicant to a civil penalty of
not mare than five hundred dollars(x500). r Occupancy Type
❑1,as owner of the property.Or my employees wish wages as Nei to compeasedon,
will acidic work and the structure is not intended or offered for age(Sec.701 Baal^.<.
and Prefessiou Conrad:The Contaacwes Limsx ts Law donot apply to an miner of Required Inspections
property who builds orimprovu Hereon,and whmdoessuchwark himself orthmugh his
own employees,provided that such impmvemeou am,tot intended arofrehd furale.If,
bow r,br,the Wilding or hnprovemmt it seld within one year of complains,theowner.
Guilder will have the burden of proving Hat he did not Wild or improve for purpose of
rale.).
,kAy 1,as Owner of He property.am exclusively contracting with licensed mountains to
wdsuuct He project.(Sec.7)14.Buiunt and Profecdau Cade:)The Comracwh U.
cave Law dots not apply to an owner of property who builds.,improvas Ihemon,and
who contracts for such pmjeeu with a mnoacor(s)licensed pursunt to tho Conuanoh -
LkenxLaw.
❑1 ma uc pend Scc �,B A P C for His moon
Owner -
R 'S COMPENSATION DECLARATION
1 hmbY affirm under pcvaltY o(perjury Oha of the fdlbwing declaration: "
Q 1 ham and will for by
a tion 37 m of Co Labor selFiuum Ter Warlrm sComf the
scion, r provided far mi Section 3700 of Ute l,Wr Code,fm He performsorx of He - era
work for which His permit is issued.
0 1 ban and will maintain Workers Compensation inmumm,as required by Section
37W.1'the Labor Code,far Ne performance of Newark for which this permit is issued.
My Wrrkeh Compewlim Insurance cortin and Polity number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMMON FROM WOMERS'
COMPENSATION INSURANCE
Oho second hand sat W completed if the pandit is for ane hundred dollars ail(G)
m leas.)
1 ccnifv that in did performance of Ih work far whi h His permit u iauN,I dtall dot
empl4mypersaninany dmmcrmum oma emtodm Warkeri Compenatio
Lows of California.Drew.
Applicant
NOTICE TO APPLICANT:If.after making this Catific xempdion,you should
become subject to the Workori Compensation provisions of the Isbor Cade,you mass
.J aZ forthwith comply with such provisions a this permit shall h deemed rooked.
Z O CONSTRUCTION LENDING AGENCY
r_ ELI. I hmby alfrm load there is a construction lending agency,for Oc performance of
[L > de work for which tha permit is issmd(Sec.3097,Civ,C.)
G tondo's Nam
0.z Lenders Address
U Q 1 anify that I Asha read Otis application and sum On the mow information is
U. f" coma.I agree to comply with all city and county oNioandes and sum laws relating to
pU building Construction.and hereby authorize rcprcacnudims of His city to enter upon the
G aWm-menddneif ents.a yfor t epcetida por,bwhich m:.
(Wad)agree la save,indemnify and keep harmless the City o(Cuperdiou against
ti N in Cloiues,judgmcnu,totaling upmuu which may in any way attroc against said City
U,'Z AcPLICANce of the RSTAtotalingot His permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR ERECyUI,AJIONS. /
A Re-roofs
az
StgnurForAppn tr Dau ad d.�
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will Ih up rat or(Muni Wilding occupant store w handle haallou material
u defined by theo CCupertinM
o Municipal Code.Chapter 9.13,and the,Health and Safety
Code,Section 23532(a)?
❑Yu
Will the applicant `QNaant or future building occupant tax equipment or devices which All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining P an inspection,I agree to remove
-
trall
tr itn..mid. it concomitants as defined by the Say Area Air Quality Management all new materials for inspection.
❑Yes 9ft
I have real the haanrms materials requirements under Chapwr 6.95 ofthe Califor.
nia(kalccooddh Code,Scotianshat it Myrosnd25534lyto mull
did Marren off
Joel nod eutrcndy hose s Conant,that it u my reapansihilidy m testily the meupmd of He o
rtyuircmnms which mise he met poor tuissumteofa Ce r..Of Occupmd,. nature of Applicant Date
owdera authori=d agent D,m All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
( /' Cupertino CA 95014
,.
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPEkTINO
Building De artment
JOB ADDRESS: -7o711 .t?o pi". PERMIT #/
W
ONER'S NAME: t 2 — oral PHONE C'cfo� o
GENERAL CONTRACTOR c FAX # ell
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
bwngr7lfontractor Signature Date
CITY OF CUPERTINO
lam 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32633032 . 00
DATE ISSUED. . . . . . . : 12/12/2006
RECEIPT # . . . . . . . . . : 37017
REFERENCE ID # . . . : 06120044
SITE ADDRESS . . . . . : 20711 FARGO DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : WEN HAU CHEN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : WENHAU CHEN
CONTRACTOR . . . . . . . : XIE, CAIXING LIC # 24081
COMPANY . . . . . . . . . . : WELKIN INTERNATIONAL IND INC
ADDRESS 19925 STEVENS CREEK BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 733-0188
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW DAL
---------- ------------- ---------- ---------- ---------- ---------- ----- -----
BPGAS OULETS 1 . 00 5 . 40 0 . 00 5 .40 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 43 . 77 0 . 00 43 . 77 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - --------------- --- - -------- ---- --------------
OTHER 43 . 77 DISCOVER
TOTAL RECEIPT 43 . 77
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
•CUPERT`INO . PERMIT APPLICATION FORM
APN# 52(p _33- O3n Date:
�7 ���r c
Building Address:�07 / / "4L/' 0,
/P —,
Owner's Name: ( TL // Phone#:
Contractor, Phone: License M p
oe �� 8? 17096 LeO I -)-
Contact: Phone: Cupertino Business License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑
Job Description: r t4-r-,fix (N gt2 CW.4_ L e e e «C e �/„n e—
Residential &r ( Commercial ❑
Cost of Project:
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPFIXTURE Pblg. Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•