08060046 CITY OF CUPERTINOss
BUILDING DIVISION- PERTCO�PTRACORIIO TIQN
MI
BUl 1 G FSS: PERMIT NO.
HANNA DR UNITED SITE SERVICES 08070046
OWNER'S NAME: PERMIT ISSUE DATE
St,HENA CHOU 3408 HILLCAP AVE 07/07/2008
NE:
(408) 295-2263 SANITARY NO. CONTROL NO.
ARCHITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
�Oa LICENSED CONTRACTOR'S DECLARATION Job Description
toC I hmby anon that 1 am liocnacd ummr provisions of Chapmr 9 mommoxing p
<U with Scction'/O(XI)ofDivivan3ofNe Butinev aiM ProfeatiumCade,aM myliccaau TEMP POWER POLE
j = in full fora and cRcn. G $'} 3 S 3
Licca.Class 0 Lm.as
F p Dam Contractor
7W ARCHITECTS DECLARATION
I undcmund my plans Nall he hand As public omm is
J.0
It LL H Lice.ved Professional
503 OWNER-BUILDER DECLARATION
1 hreby 31711101 that I am eAcmgt from that COnhaclors Uccnw Law for Ih
i
00 following mason.(Section 7(31.S,Businm and Profesvna Coda:Any city of county
which.,.I.A permit to construct.elm.impmw,dcmnlW,or¢Pair any stmclum
Prim As is issuance.als°mcluims lh'Plicant for such permit m file A signed amemcnt
�o
that hcisliccnudpusuantmN Provisions of too,Conha tuYSLica..Law(Chapmr9 Sq.Ft. Floor AreaValuation
(commencing with Secdon 7000)of Division 3 of dos, m ro2tsi
BusinAnd Pont $800 Cads)or 8 0 0
$ that h u.,t thmfmm and the basis fm the alleged.0.my violation of
Section 7031.5 by any Applicant for A permit subjecu the applicant to a civil penalty Of
nOeeu ane Type distant fw hhdmd dollan(s ). 35729044 . Number
1,As owner of the pmpany,or my employ¢with wages As thir Able c.mperuadon,
will do the work.and th structum u an[intended m°frered for sale(Sac.7044,Business Required Inspections
and Proletflmu Code The Ca nschcYs Lion¢Law does not apply An An owener of q p
progeny who build,orimprows that¢..,and who dneaamh w.ohimsalfor Waugh his
°wnemplaym.pmvidedlhuwchimpravem U=notinmMN moRefrd fmak.IL
however,that Wilding Or hnprovemat 4 sold wiWn aro year ofmmPkton.the owner.
builder will haw the burden of proving that he did rot Wild or improve for pure.of
Ask.).
❑1,As Owner of the property am exclusively comossing with licensed conwctars to
construct the pmjm(Sec.7064.Business and Professions Code:)The Canmcur's U.
ceone Law does not apply to an owns of prvprny who builds or impr°ws thertoe.and
who contracts for such projects with a conhael.r(a)licensed pursuant to WC Comacmes
LICA."
law.
❑lamesemaum Sec ,BhPCforthismaon
Owner Dam
WORKERS COMPENSATION DECLARATION
40T h 'um mm of aBunder Penalty of perjury mof the folkywing detlanthm..
I haw and will maintain a Cenifram ofConam In alr4asum for W°rF°fa C.mpen-
sedan,as provided for by Section 3700 of the labor Cade,fm the performance a the
work for which thea permk is bound.
❑i haw end will mainuin Wo laces Comms.. hon Inwrance,as oninecd by Savor
3700 of tat labor Code.far don ped.man.Of dm work for which this permit is issned.
My Workefs Ompewtionlwtnna cart iv and Policy numban
Game lA t,
llryNa.: 3 Y33�
C IFl TEOFEKEMPr10N FROM WORKER ' D '
OEO'MEM INSURANCE
(Thu Aectm nand not On complemd 9th permit I,for ons,hundrtd dollen($100)
or less)
I certify that in th Pcrfom uss,of the woo for which this Permit is banned.I Nail not
employ any Penan in any manncran As m become subject m the Wortcn'Compevadon
Iowa of California.Dam
APplignt
NOTICE TO APPLICANT.If,afmr making this 0molmam of Eaemryion,you should
become subject u use,W.rksls Compcma ion pf°vuioru of ane Labor Code you raw
.,O forthwith h
with comPlY with such pr°visimor m than pit shall deemed rowked.
,E.t(n CONSI'RucnoN LENDING AGENCY
[-+ I hmby alRrm than dirt is a construction loading apra,fmthe perfovmaece of
E
the woo fm which than gamut is issued(Sts.309'1,Civ C.)
Ica 0 Lcn&es Name
z L.Afte,Add.
V O I cmify that I haw mad this apPlloadmt and stsm that dm show infomnton is
c.naCL 1 agma m comply wall city and county mJnanaf and sale laws mlating to
C) building<onsuuctian,and starchy audurim mpoomma ims°f this city to color upon Ne
E
above-ms,ntaned progeny for inspection Purprsms
F y
CWC)Mmm to saw,indemnify ad keep harmless the City of Cupertino Agvmt
r h Iiabilibes judgmoou,cmis and exxAsums which may in any way amt¢agaim said Cly
U Z in consequence of the granting of than it.
^ APPLICANT U ER NDS AN WILL Y WITH ALL NO POINT Issued by: Date
SOURCE R y
`7 Re-roofs
Signvwrt A ntracmr Dal a
HAZXRDOUs ATERIALS DISCLOSURE Type of Roof
Will thapplicant or future Wilding cal-Part momofhandle As mamrial
as defined by the Cu,AM.c Muai"(al Cade.Chapmr 9.13,a the HNth and Safmy
cAde.Sa3ss31(a>7
Y. All roofs shall be inspected prior to any roofing material being installed.
applicant or rmAm Wading aavpam um e9apmat m daunt which
a
If a roof is installed without first obtaining an inin inspection,I agree to remove
ora tat P
itsaw Aa nor.ubbma°u a{dclund by N°Bay ArraAir Quality Management all new materials for inspection.
Diburic
❑YaLJ+/Nu
L haw mad W hicaNam mamriaumquimmc r0apmr6.95ofWCalifor.
nits HCAIth ASafctyCadc,Soctoiu 25 5,25533 d .1AMciwane thatutm lwudbg
data not cmmnthy haw l t u my 'lit tormaxydo, t of
mquimonc.a mat 11c to �v ok Signature of Applicant Date
Owncranuth fv.dagrnl D. All roof coverings to be Classor better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: B1k: . Lot :
APN . . . . . . . . : 35729044 . 00
DATE ISSUED. . . . . . . : 07/07/2008
RECEIPT # . . . . . . . . . : BS000005359
REFERENCE ID # . . . : 08070046
SITE ADDRESS . . . . . : 18800 HANNA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SERENA CHOU
ADDRESS . . . . . . . . . . : 18800 HANNA DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : MANDY CHOU
CONTRACTOR . . . . . . . : KEVIN MELLIFONT LIC # 742
COMPANY . . . . . . . . . . : UNITED SITE SERVICES
ADDRESS 3408 HILLCAP AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95136
TELEPHONE . . . . . . . . : (408) 295-2263
•
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 800 . 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
----------------- --------------- --------------------
CHECK 122 . 87 227
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER
CITY OF CUPERTINO
5 TEMP POWER
• CUPEkTINO PERMIT APPLICATION FORM
APN # Date: o g
T b
Building Address:
19800 1-1o.11nA Dr . CApertt'no ,
Owner's Name: I Phone #:
Se re ho, C�°H 4ok_
Contractor: Phone #:
Li �A I
SI,kq S ovv( ce Fax #:
Contact: Cho Phone #:
and �
�0�473 - 70 3 6
Contractor License #:
Cupertino Business License #:
Job Description: n
lei
PbW��/
ResidentialV❑ Commercial ❑
Valuation (cost of project):
800
Quantity Fee ID Fee Description Fee Group Permit Type
�/h 1 ERT>1 K Res. Temp Power>I K E 1REAP14
J�� J A Amps
1 ERT<200 Res. Temp Power<200 E
Amps
IERT2001K Res. Temp Power 200-1K E
Amps
1 EPERMITFE Electric Permit Issuance E
I ELCPLNCK Electric Plan Check E
1 IBSEISMICR 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 10EAP14
1 ECT<200 Commercial Temp Power E
<200 Amps
1 ECT>I K Commercial Temp Power E
>1KAm s
IECT2001K Commercial Temp Power E
100-1K Amps
1TRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
•