08070124 CITY OF CUPERTINO � �?+kc .c " rr>
BUnAINCmvlslOr? PERMIT CONTRA(::4TGIRANFORMATION
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BUILDING ADDRESS: PERMIT NO.
20819 GARDEN GATE DR NATIONAL CONSTRUCTION 08070124
OWNER'S NAME: K t PERMIT f55UB DATE
DAISY LO 15319 CHATSWORTH ST 07/17/2008
NE: (818) 221-6057 SANITARY NO. CONTROL NO.
ARCHfTECTYEaGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
fop LICENSED CONTRACTOR'S DECLARATION
F 1 Mrchy Y)of that 1 un ftheBd under ad
of Chapter 9(mmmenesi is Job Description
n� inwith full
ldarmDlVblon3efthC Business and Profrssiuna Code.eMmylicensa is ONE TEMP POWER POLE
_mow in con m la s arwL
�qz Damm Class Lk.L
Dam.Conuoscims,
i l047 AbeCPS DECLARATION
u I undersunJ my plats"WIIbe veld u public rerorde
A.
LG Licensed Pmfcsumml
OWNER-BUILDER DECLARATION
I faulty allium that 1 am uempt from the Contractors Licence I.A.far the
O following mann.SucciTID 1.5,Business and Professions Cafe:Any city er coaly
$ which rtquima a pcumil m convma.,Iter•on,m o.demolish.or repair my structure
blwmiuissunceussu mquitu provision of for emnpormit toftlea,Law(Ch ncr9
pp ' m,tori{ummedpurmmtmtkofDi,kverdieeBBanter•, dProfssiosCodw9 Sq.Ft.Floor Area Valuation
Y 3 (comma.cinL will,Sutim 70 00)the Division r of the Business, prion,A., iol Code)w $350
y Na h u exempt Newsom and de bub for tti allegro eaemPrkm Any l Porosm of
Sudor 70313 by any hers Applicant s(a panni,mbjew the applicant m a civil Porosity a Number - Occupancy
rot mart duv five bmtlmd orlon(L500F 32630046 . TYPe
❑I,u coerce of th property,w my wplaym with mgr u Mev rote eompensadon,
adProfessions
r fe wort,C d d-The Con Ia me's Laded,Law d s at Apply so in,HYywy
ma enty who W Cede:The ce mencem,Licenser dew dor,ml apply m an ct gh is Required Inspections
propertywhobuild,viireprove,Merton,andwho doe,suchcork..fffertfrough deb
awnemr.the Wiprovidedthat,uchimprovement{amnot Intendedm ledoo.forsake.If.
bowewr.it building aimprovement4 mid within one year ofcomowcforNeuwrcr-
builder WH low the burden of moving dot he did at bald w improve for PURem of
sok.).
1.
as awrer a the property,as collusively conuutin[wish Ik<nied mnhictws to _
the project(Sec.1044.Business and Professions Coda:)The Cmeaeor,U.
ce LAw does oro apply m m owwr of property wbo builds or impsovu Wermn,rod. .
who cmtncta for swh fenjeces WN a eonaactor(s)licensed punuam in No Cantraetols
Lice.Law.
❑lam exempt under Se ,BA PCfru Nis num.
Owner Dae
WORKER'S CO PENSATION DECLARATION
1 hereby aPura under penalty of perjury,not,of de following dalarationx
hart and wdl msintsin a Caudate ofCottxmb mlf-invert foe Wohufa Comprn
same.As provided for by Section 3100 of the Labor Code,I.tk Perform.of the
work for which his permit is issud
❑I hoe And WII maintain Worlds Compensuim Insurance.u mgamd by Section
3100 of Nr Labor Code,for No performance ofthe vert for which thus permit teased' '
My Workers Compemauon Wunwe carrier and Policy number am:
Cartier. Policy No.:
CEKrIFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TILAAccim mad Aorto cwnpkwd iffie permit is foronce hundred dollars(310)) '
orkx)
I cuufv Na,k Na perfmnuee a the work w vers' Nis_amen b isaed.I WII trot
amPloymyperm.in any mmrcrm jfftp Ne Warin'Cernprnsadon
Laws or Califomis.Dam p
Applicmt— �+(�
NOTICE TO APPLICANT.Feffter making Nb Cer ificam of Exemption.You should
become subjut m the Worlri Compensation provisions of No labor Code,you am
.J z forthwith comply with each Provisions or Nb Permit mail be dunned mold
zNl CONmucnoN LENDING AGENCY
I lercbr alfum NU Vert b a comuctm IcmRrZaprrcY for one potmo lea
6i the werk foe which Nb Permit b issued(Sm.3091,Civ.Q
Q Ladet's N.
z Lenders Address
U C) I tvtify that 1 have mad this application and sure Nu the above inromadm b
n. cortin 1 agree 0 comply with all city and county ordinances and state law,rtladng to
building construction,and hereby mNori a mpreienudves of Ni,city or cow upon use �[\��t(t.(/�/////fit
W ahove-menuened ro,copro,serty for inspection which may
LL (We)agree to an,indemnify and keep holies the City of Cupertino stain,
t..r Z d,bdiuequedg,orthe eaamdeapemurmit, in.nymy.tvaeaEafmssidcuy
U z in comequerce of Ire ErantinL of Nb pamiL
^ APPLICANT UNDERSTANDS AND WILL COMPLY WRH ALLLUUU N. TNT Issued by: Date
SOURCE REG�It3S
/tom(
SignatureSignatureer mmucanwx r Re-roofs
HAZAR US MATERIALS DISCLOSURE Yaw Type of Roof
Will rhe applicant or future building occupant von or handle hwNous material
As dedrcd by the Cupertino Municipal Code.Chapter 9.1;arta de Healtn and Safety
late.O es 25532(x)? t1Na All roofs shall be inspected prior to any roofing material being installed.
wn Ne, Ream err comm Wilding era If a roof is installed without first obtaining an inspection,I agree to remove
w e panty A wmpnten, i deism which 8 Pe
navaNnns air amumirunta dedrca by tie e,y Ala Air Gwny MmaLmmrm all new materials for inspection.
❑YaNe
I haw mad be harzrdwamateriabmquhcmenu under Clop erd.95 oftheCalifor-
outHealdt A SafmyCodc,Sermons 25505.25533 md25534.1 and varod thuifthe building
does net cunendy have a moll Nat i,B my nipemiollty no nndfy the 0.eup5rt of Nr
mgsirtmenta which_ met Prior m Lumrceofa Cartifeawer cepa" Signature of Applicant Date
e5
OwrcrwmNamrd agcnr �D,w All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . 1 . : 32630046 . 00
. DATE ISSUED. . . . . . . : 07/17/2008
RECEIPT # . . . . . . . . . : BS000005499
REFERENCE ID # . . . : 08070124
SITE ADDRESS . . 20819 GARDEN GATE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER DAISY LO
ADDRESS . . . . . . . . . . : 20819 GARDEN GATE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : NCLTR WORKSHOP INC
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS 15319 CHATSWORTH ST
CITY/STATE/ZIP . . . : MISSION HILLS, CA 91345
TELEPHONE . . . . . . . . : (818) 221-6057
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 350 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
7.ERT<200 UNITS 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- -------- -----
TOTAL PERMIT 122 . 87 0 . 00 122 . 87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 122 . 87 #1314
---------------
TOTAL RECEIPT 122-, 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER
•
OG o7 o�� y
CITY OF CUPERTINO
TEMP POWER
CUPERTINO PERMIT APPLICATION FORM
APN # 3 �!-Ib ;� Q -- �d� � � � Date: y ( -7D
_l 10 G
Building Address:
z;�Aq*
Owner's Name: Phone #:
S �—q 4ag L4L73 2
Contractor: Phone #�
Fax
Contact: Phone #:
Contractor License #:
Cupertino Business License #: o?D 5;
Job Description: llI
Residential Commercial ❑
Valuation (cost of project): f O o 0
Quantity Fee ID Fee Description Fee Group Permit Type
I ERT>1 K Res. Temp Power>I K E 1REAP14
Am s
IERT<200 Res. Temp Power<200 E
Amps
IERT2001K Res. Temp Power 200-1K E
Amps
/ IEPERMITFE Electric Permit Issuance E
1 ELCPLNCK Electric Plan Check E
1BSEISMICR Seismic Residential B
/ 1TRAVDOC Travel & Documentation B
Fee
✓ CITY OF CUPERTINO
TEMP POWER
CUPEkTiNO PERMIT APPLICATION FORM
Quantity `Fee ID. Fee Description Fee Group Permit Type
IBSEISMICO Seismic Commercial B JCEAP14
IECT<200 Commercial Temp Power E
<200 Amps
IECT>1K Commercial Temp Power E
>1KAm s
IECT2001K Commercial Temp Power E
100-1K Aiii`s
1TRAVDOC Travel & Documentation B "
Fee
1BUSLIC Business License B
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
OUPERTINO
Building Department
JOB ADDRESS-.7,.S ^ ^ ^ PERMI 6D 0 .7 C)
OWNER'S NAME:D1 ( C> PHONE #
GENERAL CONTRACTOR a C Q t FAX # o . E7 3 ,-77 3
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 0
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
• � 6
Owner/Contrctor Signature Date