06120051 CITY npEsoNo
vnPERMIT £CONTR°A GTCTR,INFORMATION ,
BUILDING ADDRESS:- CANAAN INVESTMENT INC PERMTTNO.06120051
20846 GARDE
OWNER'S NAME: PERMIT MUE DATE
Alk MR & MRS Y. T. YAN20902 FARGO DR 006
14 NE: ,
SANITARY NO. CONTROL NO.
(408) 873-7575
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�Oa LICENSED CONTRACTOR'S DECLARATION Ib Description
W affirm I hemby arm Nat 1 am Ol licensed under P"sirens of Chapter 9(commencing P
;i� with Scction70f10)of Division3oflhe Bustin WdProfessions CM,iMmylkc=is
« Nfull mmendaffect
g 7739GS CONNECT MAIN SEWER LINE
; _ Llemseclea Lea
Fp Das Cando( t•�.y_,gP,,.a 2n.,/ 7at,e•
ARCHITECTS DECLARATION
i 1 understand my plans shall W used as public mchal,
tOr
Licensed Prefassianal
s S OWNER-BUILDER DECLARATION
1 hcrehy sRrm that I am exempt from the Camranar's!cense law for Ne
'00 fallowing moan.(Section 7031.5,Busincu said Professions Com:Any city or county
$ which requires a permit W consumer.aloes,improve,demols i,or repair any commie $2800
-ieprior to is issuance.also requires lW applicant for such permiva Glc a signed statement
Nat W s licensed pursuant W the provisions of the Common's hone law(cTupir 9 Sq. Ft. Floor Area Valuation
[�n (commencing with Section 70W)of Division 3 of the Busineu and Professions Code)or
3
that k is exempt therefrom and the bass fm the a11Red exemption.Any violation of
Section 7031.5 by any applicant for a permit aubiccu the applicant W a civil Penalty of
net ream Nan five hundred dollars(5500). r Occupancy Type
1.u owner of the property,or my employcex with wagon an their selc compensation.
Pr thcwmk,andc7 eCmesmey Limdm asemdTarsalepply in x4,Business
and property
wh mu Coe:The Canthermn, fid License law aces ant apply lf an manor of Required Inspections
Own cou who builds i thasssch i mn and wM am
himxlforNrough his
Own employes,provided Wilding
oWl such imProsemmu tie ms ear caked moRcnW(ms owner-
build., U1
Nebui th,bunmpf .inumldwiiinorte year or cap.fr tlteow,of
builder wiB have Ne buadm of proving that W did nor build or improve for purysse of
sat.).
❑I.as awns,of the property am exclusively contracting with licensed mnaacmrs W
construct the project(Sec.7W.Business and Profes roes CMeJ The Conuacier's Li. -
cense law dun not apply W an owner of property who Wilds or improves unread.and.
who contracts for such projects with a mnuacwn(s)licensed pursuant W Nc Conmctare
License Law.
❑I am exempt under Sec B d P C far this rescan
ownerOain
WORICER'S COMPENSATION DECLARATION
1 hereby affirm under peasty or perjuay ane of de following declarations: t
I haw and will maimain aCeNfieuW of Camara W selNinsm a for WarkclsCompen-
scion.as Provided for by Section 37M of dte Labor code,for the performance of tW J Nt4ll
work far which this Parini,is issued.
❑1 have and will maintain Wmters Compersauon Inver .as acquired by Section
37M of the labor Code,fm the performance alone work far which this permit is issued
My Worker's Compensation Insmsna carrier and Polity number am:
Carrie'. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need fiat becompkWJ if(be pencil is foranc hundred dollars(SIM)
or los.)
1 ccatify Nm in the Performance of the wart for which this permit is issued.I shall not
employ any person in any mannerx an in became subject o On Wmkeri'CampCmadan
Laws of Califomia.Dat
Applicant
NOTICE TO APPLICANT:If,afier making this CenireaW of Esempuaa.you should - -
become subject m the Workers Campcoution previsions of Nc Labor Code,you must
.JO forthwith comply with such provisions mths Permit shall W decmed revoked.
zF7 CONSTRUCTION LENDING AGENCY
[•+ Thereby affirm that Nem is a construction lending agency for the Performance of
CL the work for which dust permit is issued(Sec.1097,Civ.C.)
W lender's Name
.a7 z Lender's Address
U Q 1 certify that 1 have mad this apPlica,ion and sus that Ne above information is
U. v- correct.1 agree W comply with all city and county onlinames and sae laws relating to
QU Wilding consmetion,and hcmby authorise represemauws of Nis city W enter upon the
ra ahovc-es judgcdpropcst for inspection pid,weswhichm.
(We)agree W sant,indemnify and keep harmless the City of Cupertino against
F'Z lncmitimuaric. ens,granind cspcnmamit. may in anyway acttuc against saidCity
U z A APPLICANT
of NC UNDERSTANDS
of this permit. _
^' APPLICANT UNDERSTANDS ANO WILL COMPLY WITH ALL NONPOIN/T Issued by: Dale
SOURCE REGULATIONS. /2/1 3/cab
LP�T` fid^ A Re-roofs
sit ear App ran Ont DO
Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(mumipal Code.
Chapan9.1of handle Health ad
u comma io de Cupertino Municipal Cade.Chapter 9.13,and are Health and Safety
Coca.section 25532001
All roofs shall be inspected prior to any roofing material being installed.
Yu
Will Na, Goan,ar Tamm ordain ossa int cox equipment If a roof is installed without firs[obtainingan inspection,I agree to remove
applicant i p q it Qu or Manna which P
emit harardons air contxninants u Jcfincd by Nc Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yesu
I have mad tic h icard,/ws\matcrials requirements under Chapter 6.95 of the Califor.
ns H Ikh 4 Safety Cam,Sadwu Z5505,25533 uW 73534.1 uMcrnand thad dose Wilding
does not currently have a icamnr.Nur i,is my responsibility on ally the mCap.,of the
riquirem nyq n n tau W m t prix W ua n ar.cen r a ar�j panty. Signature of Applicant Date
(/w , LP 1 A 12 rIp6
Owner oraumorindagent D,W All roof coverings to be Class "B"or better
Community Development
120 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPERTINO
Building De artment
JOB A� O � � GaA PERMIT #
L zoo-s /
OWNER'S NAME: c, PHONE # C-2-1 - -2-
GENERAL
GENERAL CONTRACTOR CC v FAX # /
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
•
Owner/Contractor Signature Date
CITY OF CUPERTINO
m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32630035 . 00
DATE ISSUED. . . . . . . : 12/12/2006
RECEIPT 4 . . . . . . . . . : 37024
REFERENCE ID # . . . : 06120051
SITE ADDRESS . . . . . : 20846 GARDEN GATE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MR & MRS Y. T. YAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CHIUNGYING YAN
CONTRACTOR . . . . . . . : ROSE. KER-DI MA LIC # 27800
COMPANY CANAAN INVESTMENT INC
ADDRESS . . . . . . . . . . : 20902 FARGO DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 873-7575
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- --------- ------------- ------- --- ---------- --- - - ---- - - --------- ---- ------
BPSEWER SEWER SYSTEM 1 . 00 21 . 58 0 . 00 21 . 58 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 59 . 95 0 . 00 59 . 95 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ - - ----------------
OTHER 59 . 95 MASTERCARD
TOTAL RECEIPT 59 . 95
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
__ ____________________________ ________ ____________________________
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 507 FINAL PLUMBING
•
Ssq, CITY OF CUPERTINO �)a�0REPIPE/SEWERS/MAIN SERVICE
41 CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
Oy er's Nam(�e: / / Phone#:
Contractor: / Phone: License #:
Contact: Phone: Cupertino Business License#:
v° g "873-�s�r a�
Building Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential �, Commercial ❑
Cost of Project:
-�Joo
•
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 Repipe of Fixtures PLUMBING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
•