06060071 CITY OF CUPERTINO r , w
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BUILDING ADDRESS: NATIONAL CONSTRUCTION REN fiffNO'06060071
20846 GARDEN GATE
OWNER'S NAME: PERMIT ISSUE DATE
DR. YITON T. YAN 1355 FILIPE AVE
Eo SANITARY NO. CONTROL NO.
(818)221-6057
ARCHIT MNGINEER: BUILDING PERMIT INFO
BO EO PLUM MEOCH
�o p LICENSED CONTRACTORS DECLARATION Job)) aljNo
I U I hereby of ow that I am Imended main,provisional of Chap.9(commuting tlr,�[turrJf1{
,z1 wish Snctim 7000)ofDivislon 7 ofthe Business and Profeaduns Code,and my licenm le
I.full I.andelrcol. TEMPORARY POWER POLE
�N Z Licanm Cl s Lk.A _ 7f b'- �®
�.0 0.dl LIr-I,zYn r(��
1 �u ARCHITECTS DECLARATION
1 urderaw al my plw shall he used As public records
O �C Q
C
Licensed Pnrreaional 2000
1w
OWN -BUILDER in Me Comm ON
f a C I hereby olnm that 1 ort exempt form me Cssions o Ucense baa for tbo
O O fallowing reamn.(Section 7031.5.Buatia and Improve.
deaoli Cala:My m s manly
i$ which requires a permit re cousuucL aver.improve,dpermit. file
rep Nr any mumm m 3 8 9
-iy
poor in iuissuance.almnttorequires the provisions
far smhpcmmi'w Rkasigned mtemur
�
that he Is license)pursuant me pmvisione arthe Conuacwr'sixense law(Chapur9 Sq.Ft.Floor Area a" tion
;$ mAMA(commencing with Section 7000)of Division 3 on Business Doul P,nimmum Code)or
.. Awl he ts eanmps tM,efrom and the basis fm the alleged exemption.My violation or
SecUen 7031.5 by any applleant for a permit objects the aPplkanuo a civil penalty of 3 APNr Occupancy Type
not mart dun five hundred dollar(5.100).
❑I,..waftheporpmy,amympWyemw(thmgesssde4mie=pe Um.
will do theweell themuaurre bnotwunded oro(fmd rorsale(Sec.70th.Business Required Inspections
and Profession Cod=The a nusur,1 imtu law ul=cot apply u an Owner of q P
porosity who Wildear(mpmves meson,and ahodusauchworkhimselfor duuugh his
man employ=,Provided that such improvements uemainunded moRered(mala IL
however,she building m improvement Is Sold aloin arm year of complotion,the awner-
Wllhr .will have me Wrier of proving that An did not Wild m Improve for purpose of
ale.).
❑1,as Manor of the Property.am exclusively contracting aim UmosW contractors he
c=tura the project(see,70th,easiness wed Porress=code:)The Comhamars U-
ccnoe law d=misapply in an owner of property abo WIWs or improves mmwan,ad
who contracts for such projects with a conlracwr(0 licensed pursuant w the Contractors
License Law.
❑Iameasmptundm See .B&PCfothisreaon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby aVum under penalty of Perjury ane of me following declaotinne
I W ve ad will maintain•cedficeu acom wnaseir-A.rarwOhnesCompen-
ation,M provided for by Section 3700 of the labor Code,for the performance of the
work fic whim this permit I.issued.
❑1 have Lad will maintain Workers Compensation Imuramc,As mquirml by Semon
37M of Me labor Code,for the Performance of the work farahkh this Permit is Wood.
My Wm%kcYs Campemadan hommm anise and Policy number am:
SYAft(ice+,P O>'V CL '06
Curler. ��........��,, , No.:
�'�CERTIFI OF EXEMPTION FROM WORK S'
COMPENSATION INSURANCE
(lhu section tied not he completed U de permit is fa one hundred doom(SIM)
or lea.)
I cenify shat In me performance of me work for which thin permit is.Med.I mail not
employ any person to my maturer At,as in becaoo subject in the WaM1m'CompemNen
Laws of California.Dm
AppUaot
NOTICE TO APPLICANT:If.ofw,making this CeNfiau of Emmption,you mould
become"gem in me Workers Compensation provisions,of me labor Code.you mea
.,O fonbwim comply with such Provisions,in this permit"I be deemed reveled.
Z CONSTRUCTION LENDING AGENCY
t-r I hereby AM.that dam Is aconstructinn lending agency for we performance of
1zM e work for,which mice permit is issued(Sec.3097,Cos.C.)
IQQ Lenders Name
M Z Lenders Add=.,
U O 1 certify that I have read this application and mu this she above immennNon is
U, correct.I agree to comply with all city and watery andimnxe ape sum Ise missing in
C) building construction,and hereby authorise representatives of this city to cnwr upon she
a above-communed property for Impaction purposes
F (We)agree to ave,indemnify and keep harmless me City of Cupcnino against
y li.tril,m.judgmeriMcam and expenms whim may In 0,way accuse against Said City
U in coneegti=of the Swung of this permit � � O�
^ APPLICANT UNDERSTAND AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. 1 06/
/. GP iii La7uswt2R✓2.e-[NyP,a�J,ac. d.6 Re-roofs
Signature RAWlicanKoilibacter Dew
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future Wilding osvpantst=or handle hamrdom mawrul
As defined by Me Cupertino Municipal Cade.Chapter 9.13,and ted Health And SafetyCade,Section 35533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu
41 Will tiw applicadrm(mare Wilding Occupant um equipment in devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air comumoum,a defined by me Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea JS11u .
I have mad the haradom/ `maariaUmquiremans umlerChapW6.95 ofthe Caller.
nia Haim&SalwyCode,SOctiom 31505.25533 am131534.1 unutmand Mmifine Wilding
d=cot currently have a mount,Mut It a my responsibility in notify ted occupant of the
re IrememwahienmmlWmetPriarwissuancear.certifkawMrOc Signature of Applicant Date
06 oP o�
Owner m autbmircd agent Dow 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
4FUPEkTINO
Building Department
JOB aADDRESS: PERMIT #. eL� Pyr;n d o 6d
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR ��. �/ 1. FAX #
I am not using any subcontractors: �.�f�c� CrnZo�v��v a72
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
Owner Contractor Signature Date,
CITY OF CUPERTINO
.m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . 1 . : 32630035 . 00
DATE ISSUED. . . . . . . : 06/08/2006
RECEIPT # . . . . . . . . . : 34761
REFERENCE ID # . . . : 06060071
SITE ADDRESS . . . . . : 20846 GARDEN GATE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DR. YITON T. YAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : CHIUNGYING YAN
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 1355 FILIPE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (818) 221-6057
4tEE 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 MASTERCARD
TOTAL RECEIPT 100 .47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
CITE' OF CUPERTINO �1 �
` TEW :'O' ER
*CUPERTINO PERMIT APPLICATION FORM
APN# Date:
3 - 06 0 3/ 6
Building Address:
L> . erg wC>
Owner's Name: v Phone#:
Contractor: Q� Phone: License #:
Contact: Phone: Cupertino Business License#:
2
Building Permit Info:
Elect
Job Description:
Residential 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
•