06010019 es`
[8C"LDING
ITY OF CUPERTINO ^ 717M.77—WA,
BUILDING DIVISION PERMIT iaGUL TRA TORTNIH'<
ADDRESS: D & D CONSTRUCTION PpnMrr No.06010019
0584 FLORA
NER'SNAME: PERMIT ISSUE DATE
WENJUN TANG 1447 HAMPTON DR. 01/05/2006
JNE: SANITARY N0. CONTROL NO.
(408) 666-5298
ARCHI7ECTIENGINEER: BUILDING PERMIT INFO
a BLDG] ELECT ^PLUMB MECH
O
�oo LICENSED CONTRACTOR'S DECLARATION - `SII PA 4
1 Meloy,af1lrm tat 1 Am licensed under Provisions of CNplor 9(commencing Job DOSCriAid 3js)
wit Section 70(10)an3lyision 3 of Ole Business and Pmfrssium Code.uad my license is
nn inpull. "t.mdeae TEMP POWER POLE �- 2��6
jn� License Clue Lte.a JAN
Dau Contactor /'ll`I
ARCHITECCS DECLARATION
underhand undernd my plans shall he used As
public rtenrda
p 3 Licensed Professions Lpfv'ly}
^
OWNER-BUILDER DECLARATION
9 0 1 hereby reason.(Su an 1 am exempt from th)Contractors e:My c Law for ne
i.o O following messaPermit
t 7onstr.Business and omfeuium Cade:Any eiry or county
$ which rtquiru a permit to omaamet alar,ht for such
h Permit t fie a sig any aurment $500
poor Met he
slts censed pelso uantto eatMe Obvisdomoftemchpermr'laie )Law ttstemenl
< batheiscMSwi Sacci 07001)ofDivisnsnrNemaaracessindprYLAi(Ch.Plor9 Sq.Ft.Floor Area Valuation
Y $ (eammes,exemthec0on7a00)nddo Division nodeegedAssaadon.Any
Code)m
3.. hal he u exempt therefrom and We bub for Jc alleged esemptim.Any Nolatian of
Section 7031.5 by airy applicant far a permit subjects to applicant b a civil pemlry of
act mart than aw bundled doll.(M). r Occupancy Type
❑1,u owner of the property,m my employ=with wages As deur Able wmpemtion,
will do the work and the suumurs is not Intended of offered for sale(Sm.7044.Business Required Inspections
and Professimu Code:Tie CanucmfY License oa
e Law does; t apply b aw
an ns ns
f q P o
property who builds At improves thereon,and who d=sac h work himsel r m t Bough his
own employ=,provided thnsuch impmwmeo,ate notion nded aroRerW(resale.If,
however,the building or haprovemem Is Abid wlthin ane year olcompictiom,Ne owner.
builder M0 Ww lie burden of proving that he did not build ar improve far puryose of
Ale.).
O 1.As owner of the property,Am exclusively...motiMS with licensed commitment b
construct she project(Sec.7W.Businw and Profusions Cade:)The Contractors U.
cause law d=not apply As an owner of property.who builds or Improves tieman.and
who contacts for such p ejects with a contractor(G licensed pursuant b the Contractor,
License Law.
❑i am exempt under Sees B l P C fo this reason
Owner //-, Date. (
WORKER'S CO ON DECLARATION
I hereby alarm under p)nalty of perjury ane of be following dederaflou:
1 how and will msnuin aCeNfiuuaf Covent in self-Insure fm Woker'aConpem
137ODof
ion,u provided for by Scedon 3700 of the labor Cade.fm de performance of tie
k!or which this permit b Issued.
1 have and will maintain Worker's Compensation Insurance,u squired by Sudan
the laborCalm for she performance ofthe work far which this permit b issuedy Worker's Compensation Inursme Artier and Policynumber art:
rtier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tab section need hot be completed If the permil is foronohundmd dollars(SIM)
or less)
1 cenify Nal in the performance of b,work for which this permit is issued,I shall not
employ any person in any mangerAbubbccomesubiacw oewaf otcompcnsatiaa
Laws of California.Dam
Applicant wy
NOTICE TO APPLICANT:If.after MAIM&this Campsite of Exemption.you awuhl
beccom Subject he the Worker's Compensation provisions of the Lather Codc,you mut
.J O pal comply wit such provisions or this permit shall b:deemed malice.'b
,uy CONSTRUCTION LENDING AGENCY
[n l hereby alRrm that then is a construction lasing agency for doe Performance of
C> the work for which MIS permit Is issued(Sae.3097,Civ.Cd
WG Landers Nana
6.
.7 Z lander'.Address
U Q 1 e)nlfy that 1 have read bis application and mu Na the above information Is
Fcontest.1 agree In comply with all city Aad county oMinarces and suss lows totaling he -
OU building construction.and hereby author=representatives or this city to color upon Ons
[Il .hove-mentioned pmKrty for Inspection purposes.
(We)agree to saws Indemnify and keep harmless be City of Cupertino against
ati 4�jn liabilities,judgments,cam and expenses which may in Any way Acme aloin said City
f`)(y in consequence of the granting of this Permit.
G'•a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date j �-6
SOURCE REGULATIONS.
���/�' Re-roofs
re
SignatuofAppl' UCanwc DoT
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant am arhandle hazardous manorial
As defined by the Cupeniw Municipal Code.Chapter 9.13,and to Health and Safety
Code'Sees..25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu ❑No
Will the applicant or future building occupant use equipment or devl=which" If a roof is installed without first obtaining an inspection,I agree to remove
it havard0us air conuminsnts As defined by the Bay Arta Air Quality Mangemenl all new materials for inspection.
unlet?
[D Yet I_-]No
1 haw mad the hazarderi materials r equitemcnts under Chapter 6.95 of the Collor.
"is Heolth 6:Safety Code,Sections 25505,35533 anal 25534.1 undcaund ma if Irke building
d=not currently hews A Ienana del It is my cap refile ity b notify Me occupant of the
actlummem which man be at prior to ish.af.Cmallesm of atcupmty Signature of Applicant Date
a
Ownm or..O.H.1d.gent Date All roof coverings to be Class"B"or better
Community Development
4 10300 Torre Avenue
✓` Cupertino CA 95014
Telephone(408)777-3228
CI OF Fax(408)777-3333
�UPEIJTINO
Building Department
JOB ADDRESS: i orgq F(axt f s*i, vL PERMIT
io44f'oi 005 o DU .
OWNER'S NAME: W&AI AIVPHONE # V o8- 666- Cs
GENERAL CONTRACTOR D-P-D C°nSL`i-u bst FAX #
Z'NC&- WLIL
I am not using any subcontractors: t I—eZ ° b
ignature 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
er/Con 5, r Signature Date
I ,
CITY OF CUPERTINO g
(E, TEMP POWER b vl/
UPEPT
1 iNO PERMIT APPLICATION FORM
ME APN# 7 � 61� o� 6��_ Date: �! �^o
Building Address: 1o5-0 Roq i s-` Ave
!w0 ,rod
Owner's Name: Phone#:�08, Yl-7_rf-2
wsww/ TA k 6r
Contractor: Tot D C"fttuPhone: O 0 J g. X66 -rri90 License#: b 87 7 6/
Contact: 9;Kk Wk Phone: t�8 &j0. o87f Cupertino Business License#:
Building Permit Info: ?c'rop Pownf' d
Elect ❑
Job Description:
Residential x Commercial ❑
Cost of Project:
05-06
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
/ EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
z �s 6
177