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08090125 CITY OF CUPERTINO BUILDING DIVISION PERMIT 7ONTRACT,,0RjNF,0RnR10N,. , BUn.QItaCIfT dREENLEAF DR WELKIN INTERNATIONAL IND INC P 08090125 NLERlS lN1AlM1E: _ PERMITL4UEDATE 'XIAOBAI GU 19925 STEVENS CREEK BLVD 09/19/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: TEMP POWER BLDG BUILDINGECTPERMLUINFO MB MECN 0 O p LICENSED CONTRACTOR'S DECLARATION O O O O rd F 1 hereby a?rm use,I am li¢vcd under provisions of Chapter 9(cmnmcncin6 Job Description with Soaion7")ofDiWcon3aflhe Business"Professions Code.and my license is =m in full form and effect. 5 q Z Lkenm Clan Us.0 t;:p Delo Conuanar qg 7W ARCHITECTS DECLARATION :thouI understood my plans slWu turn l be used public rereturn y 0'^ Lu.Cucd Pmfcvmael 3 OWNER,BUTIDER DECLARATION E 1 hereby.Ram that 1 am exempt from the Contructofa License U.for the COO following ration.(Section 7031.5.Business and Professions;Code:My city or county $ which Oxon.a permit to oon,trinL alter,improv,domaliNs m repair any stn crane _Z< prior W its issuance.also"or=theapplicatn forsuch permit o file a signed statement E O that he Islicensed pursuant to the pmrisiou of tie Committees lJmmc Law(chiptm9 Sq.Ft. Floor Area Valuation x�$ (commercial;win Section 90DO)of Division S of the Businessaral Prafcsdoas Codc)m - That he k exempt netefmm and The basis for the Hlegod exemption.Any. of Section 7051.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number iter mere nut five hundred dallars ISM Occupancy Type 01,uowneref Thepmpa y,mmyemployeeswinwagesuthetrsolecompewdon, - wlBda fie sions Co We ah Corera MtNW ause Law does era apply wrier of aro property who u las Tore Conmcmh Limine Law dam ret apply lf an owner is _ Required Inspections propertywho bisildrorireprows himp and whodmuuchwork himaelfartfwuL his two emPbym.proNded thatach improwmmta are wt inteMro moRered Ire aaln E. however Ne building ur impmwmcot 4 cold a did ane year of Improve a far the owned builder w10 have ee buNan of proWnR That K tlid ret dtis m improv far puryme of U,(t.as owner of The propenK am exclusively contracting with flamed conductors to construct dtc Mica(See.7044.Business sad Prafesdou Code:)The Conuaa n's U. come Law does ao,apply he an owner of property who wilds or improv theme.and who contracts for such pmjeas with a contractor(.)licensed pursuant w the Condactot's Liecome Law. 0 1 ser cactopt under Sec. B&P/C�far cids reason wnv 44 /� '"l l(9 7Th .C�x .r Dots �- K 5 CO BRITON DEC RATION 1 hereby alrtrm under pemlty of perjuryore of cite following declasstiom: 0 1 ham and will maintain a CertiOma ofComenuaself-sure fmworber sCo rfam- .It..as provided fm by Section 5](10 of The Labor Code.far The pedonnance Of the wart for which this permit is Wood- 0 1 have and will maintain Wretch CompemNon Imunna.u mquirtd by Section 57OOofa LdWr Code.far The pedarmanmafdm wart(mwbich nu permit isi...-a ' My Worlia s Compensation I ournarce carrier and Policy number are: Cartier. Policy No.: CEIInFICATE OF EKEMP ION FROM WORKERS' COMPENSATION INSURANCE rods section need Out W arnpktedUthe permit is rmoahuttdred dogars(SIM) m kis) I certify that a The perfmma no of the cork f���Opis permll u wco l�steel . Laws at nyperson in any mannersossm t.AV.W/7pkeri Com on Laws of California.Dam NOTICE TO ct 0 the Wad 's fur making t ' Cisi tate of Exemption,you shoos become subject y The sorter's inions or provision of The Ithm Coda you mut .,O forthwith comply with such Provisions m nu permit shall de deemrA rewkeQ ' .z.,v" CONSTRUCTION LENDING AGENCY (-t r I hereby affirm Out Nert is.comuuction knding.gene,for The performance of C > the wart fm which ts,Permit is Issued(Sec.3M.Co.C.) MW Q Lenders None ' z Lender,Address t)0 I mnify dust 1 have read this applieuion and state that The.bow information is (p,r eoOma.I storm m Comply with all city and century aNIrW4ea and some laws Rlat us .0 fr.�^ building construction.and hereby suthada representatives of this City W endrupnn The muml dep (Z) ahowdes.j d,..%. ort far inspection which as p, (We)agree W save,indemnify and keep harmlms the City of Cupertino against Thy Z hatein of th.cosuand carof this which may in any way acctu.gaitu mid City („)z A APPLICANT of The RSTAN of nu permit' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGUfATI S. �¢v c Re-roofs / t mea pp t ontrttcmr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII y t applicant or Imurt building ampant score or handle Had"'an material u defined by The 32(a)?no Munici Cade,aapdr 9.13,and The Holth and Safety odea Sailors zss5u,)t Tm All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,I agree to remove Will The applicant or res a bonded aceoB taw equipment or device which g P eDmiuha ardnm air cmuminanu u dcnmd by Loue Bay Area Air Quality Managcmrnt all new materials for inspection. Dyes Rrl I haw mal the ha:vdmamamdw rtquiracaux ceder CltspiO6.95 of theCalifor- niaHcalth&Safely Cada,Suadem 25505,15555 amt 25554.1undmaand thaifes:building dam trot currency hew a tm r,wt it is my mpomind'y to scary cite amupant of The requirements which met be met prior tobman¢of.Cadr.m or Occupancy fir Signature Of Applicant Date ownmm.a omi.d.Rcm Do All roof coverings to be Class'ni'or better CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32608056 . 00 DATE ISSUED. . . . . . . : 09/19/2008 RECEIPT # . . . . . . . . . : BS000006131 REFERENCE ID # . . . : 08090125 SITE ADDRESS . . . . . : 21011 GREENLEAF DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER XIAOBAI GU ADDRESS . . . . . . . . . . : 21011 GREENLEAF DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : XIABAI GU CONTRACTOR . . . . . . . : XIE, CAIXING LIC # 24081 COMPANY . . . . . . . . . . : WELKIN INTERNATIONAL IND INC ADDRESS . . . . . . . . . . : 19925 STEVENS CREEK BLVD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 • TELEPHONE . . . . . . . . : (408) 733-0188 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1ERT<200 UNITS 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 BSEISMICRE VALUATION 500 . 00 0. 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0. 00 TRAVDOC 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 ----------------- --------------- -------------------- CREDIT CARD 122 . 87 discover --------------- TOTAL RECEIPT 122 . 87 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- --------- ---------------------------- 402 TEMPORARY POWER • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 SCUPEkTINO Building Department JOB ADDRESS: Z/O// aR4EA!Z-z -{ ?t-' Dk> , PERMIT # CGS 75RT/�clO. CA 9SDJ;f-.) 0/ OWNER'SNAME: XrglJls�}/ PHONE # GENERAL CONTRACTOR: X/Q�� FAX # eFo� �c -�Z -33g6 I am not using any subcontractors: / ��/�--c--, (f 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 OLinoleum / 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 TEMP POWER CUPEI�TIN0 PERMIT APPLICATION FORM o 8'09 o APN # Date: ,32CD ©8' OSCp•C�0 S t lQj, Zoo Building Address: Z/o// C2Z-Z�N LF-A '4 D2 . C�cp�l2T�Jc�� C/-F 9SdfC�G Owner's Name: Phone #: Xi�D6�r c�i� 4lc) a' - 4/6 - 7;Ri$ Contractor: Phone #: 40 9- 8S' - 96 96 Fax #: �o�- z 2 -3 3 96 Contact: X � Phone #: Contractor License #: Z Cupertino Business License #: Job Description: Residential Commercial ❑ Valuation (cost of project): Quantity Fee ID Fee Description Fee Group Permit Type IERT>1K Res. Temp Power>1K E 1REAP14 Amps / 1 ERT<200 Res. Temp Power<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps 1 EPERMITFE Electric Permit Issuance E IELCPLNCK Electric Plan Check E IBSEISMICR Seismic Residential B 1TRAVDOC Travel & Documentation B Fee CITY OF CUPERTINO , cr TEMP POWER CUP ` CITY PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type 1BSEISMICO Seismic Commercial B 10EAP14 1 ECT<200 Commercial Temp Power E <200 Amps 1 ECT>1 K Commercial Temp Power E >1K Amps 1 ECT2001 K Commercial Temp Power E 100-1 K Amps 1TRAVDOC Travel & Documentation B Fee 1BUSLIC Business License B • •