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05080002 CITY OF CUPERTINO ',« aT BUILDING DIVISION PERMIT 9C0i riUO`�TORINFO.RMATION BUILDING ADDRESS: SANFORD ELECT PERMITNO.05080002 20902 GARDEN GATE DR OWNER'S NAME: PERMIT LSUE DATE VINCENT LIU 20888 PROSEECT RD 08/01/200S NE: SANITARY NO. CONTROL NO. (408) 996-9797 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 10, LICENSED CONTRACTOR'S DECLARATION f u� I hereby afrrm mm at 1 am licensed under pumnsnf of chapter 9(commencing Job Description with Section 70Xq of Division 3 of the Business and Profession,Code.and my license is ? „ in full fame and effect. TEMP POWER SERVICE y z License Class sec.0 1h,, Dam Cumnsmr ARCHITECTS DECLARATION ¢i I understand my plans shall be used as public records w rrF�� spy Licensed Pnrfcssional ' `F 1'1-11 \l 3 OWNER-BUILDER DECLARATION �(f. tN�m"a'LWR 1 hereby air.moi I am exempt form the Commctor's License Law for the p o following mason.(Serum.7031.5,Business and Professions Code:Any city or county 3 m which requite a permit m em.suum,alms.iropmvc,demolish,of rep,any snet.. - ,,,, 3 O O _ice prior m its ismanm.alsu rcquimame applicant forsuch permiuo file asignW sutemcm Ezp thathculicenwdpuwanuomeprovisionsuftheCanuxwr'slittnwlsw(Chaper9 Sq. Ft. Floor Area artw. Vahialion iH$ (commemcingwith Scnion7000)of DivWon3 mfthc Businessand Pmfcssions Code)ur — that he Is exempt therefrom and the basis for the alleged exerrtplow.Any violation of P--'.te nn eapp Section 7031.5 by any applicant for a permit subjects me applicant m a civil penalty of F � �U pg2n�cy' Type re m not more five hundred dollar(5500). t ' Vt lJ li �g ❑1,as owner of she property,or my employees with wages a their sole compensation, will do me work.and me sWclum in;not Intended or oRCmd BMW.(See 7054,Business Required Inspections and Professions Cade:The Contractees License Law d.rant apply m e an owner of q P pmpeny who builds or impmsss thereon,and who docs such work himself or through his own employees,provided that such improsemenu arc net intended croffamd forsake.If, however.me building or improvement is sold within one year of complcuon.the owner. builder will have the burden of proving that be did not build or improve for purpose of salt.). �%owner of the pmpcny,am exclusively connecting with licensed convectors to construct me project(Sec.7004.Business and Professions Code:)The Conmcmrs Li- cense Law does not apply to an owner of property who builds or improves Jtcmon.and who comment for such projects with a eonoaemr(s)licensed pursuant to the Gonlraelor's License Law. ❑1 am exempt under Sec. B&P C for this mason Owner Dam W KFR'S COMPENSATION DECLARATION 1 hereby turn.under pcnahy of perjury nW of dw fallowing declamtians: J Ihs.tandwillmainuina CenrLawof Consentmmlf-insumfm Wor esCompcn- sation,m provided for by Section 37W of the Labor Code.for the performance of me .,it for which this permit is issued. 1 have and will mainmin Worker's Compensation Insomnce,as required by Section 37W of the Labor Code.for the peformarom of the work far which this permit is issued, My Worket's Compensation Insurance carrier and Policy number art: Carrier: Policy No.: _ CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE (Ibis auction need not be completed Ede permit is for one hundred dollars(SI W) or less.) 1 certify than in the performance of the work for which this permit is issued.I shall not employ any person in any manner u become ym)enmlMWorkers'Compauo cnsn Laws of Calf D '— —0 1 Applicant NOTICE TO APPLICANT:If,after making this Ceni6cate of Exemption,you should becomes subject to the Worker's Compensation provisions of the Labor Cods,you must ,J 2 forthwith comply with such provisions or this permit shall W deemed revoked. Z'O CONSTRUCTION LENDING AGENCY [r T hereby affirm that mem is a commucsimn lending agency for me performance of ".� the work for which this panni,is issued(Su.3097.Co,C.) OU. 0 Unders Namc a Z Lenders Address U O I certify that 1 have mad this applieatian and sate mat Jou above information is It, F c(Mmel.I agree to comply with all city and county on inarmes and sow laws missing to C)U building conswnion,and hereby authonrt representatives of this city m cow upon the above-mentioned properly for inspection puryuses. FM. (We)agme on sem,indemnify and trop harmless the City of Cupertino against Iq liabilities,judgments,costs and expense which may in any way ucmc against ssid City U z APPLICANTeUNDERSTANDS AND SWILL COMPLY WITH ALL C7NON-POINT Issued by: Date �-6/—61` SOURCEREGUL�TI NS. A y`—('--0-f__ Re-roofs Signamm of AA,loodu Cc mart., Dow HAZARDOUS MATERIALS DISCLOSURE Type of Roof , Will due applicant a future building occupant store or haddic hanrdous material Mdefined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safely oJc, el'.y.25532(a)? ``// All roofs shall be inspected prior to any roofing material being installed. ❑Yes l]YNIS' J Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hsysfdous air contaminants as defiWJ by me Bay Area Air Quality Management all new materials for inspection. ✓ District? / 0Yes dryo 1 have mad the hvarthmsmaerials requirements under Chap er6.95 of the Califor. nia Hushh&Safely Cake.Seconds 259)5.25533 and 25534.1 understand thatifthc building Jas not cunmmly have a tenant that it is my responsibility to notify the Wcupant of the myuimmcmawhich sit mapnor .ssaonce ofaCentficamofOcapancy. Signature of Applicant Date Owner or aushorisd agcm All roof coverings to be Class"B"or better Dam Community Development '.. 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 GTY Of Fax(408)777-3333 �UPEI�TINO Building De artment JOB ADDRESS: PERMIT # pg p Z a den 66le p �o�ooaz OWNER'S NAME: WeU5wooct VeVe, f c PHONE # (5}-2og—o 8 GENERAL CONTRACTOR: G 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 ��(�E CITY OlV1P POWER �CUPEkTINO PERMIT APPLICATION FORM APN # ,3 Z / _ � O � 07 Date: Building Address: 20 oz Garden Coati DY• CL ev+i1D Owner's Name: i JPhone #: ellswoo8 Vevelo ment, Inc 650-20g o $6 Contracto : Phone: License #: S mord e�ectrlG 40E-g66-g7g7 Contact: Phone: Cupertino Business License #: /; L t , It --z -o$ Building Permit Info: Elect L7/ Job Description: Temp. ower -dor a new S FD Conskruc f-f 0 n Residential Commercial ❑ Cost of Project: *600,000 Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING �oo , Z�7