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06090004 CITY OF CUPERTINOIR BUILDINC•DIVISION PERMIT S'C0112A.CT.QRIIY)+jUMA'I'IOt BUILDING ADDRESS: NATIONAL CONSTRUCTION REN AMTNO06090004 21135 HAZELBROOK D OWNER'S NAME: PERMIT ISSUEDATE EDITH ONG 1355 FILIPE AVE 09/01/2006 NE: - SANITARY NO. CONTROL NO. (818) 221-6057 ARCHI ECTIENGINEER: BUILDING PERMIT INFO BLDGO ELECTO PLUMBO MECHO o p LICENSED CONTRACTOR'S DECLARATION F 1 hereby am.Nat 1 am Ikns ecm d ukr pmvisiens of Chapter 9(commencing Job Description IZn with ScedOn 700(1)of DNW a d of the Boldness and ProfaaSlOm Lade,and my liccrem is !Sy inmBfa,anameffem. INSTALL TEMPORARY POWER POLE p z DOW ❑oa Lk.a Dam Gen pp ARCHITECTS DECLARATION i a< i understand my PlaDECLARATION .,.hall he used u public mcaNs iyU va Licensed Professional OWNER-BUILDER DECLARATION 1 a C I hereby,(Tum on 1 t. exempt Tum the Contractors :Any c Law for the ,a o (allowing rete,..Permit t 703 t.5,mount, Business and Pmtesdnns Code:Any city or ceomy $g which mqulnv•permit m admathe Blur.improve.deantigh permit a or repair any ilemcm $1000 Z!~^ prior he I, trend purse requires thanisio,o for such permit mfile al Laedauumt9 a dsetheulicrostcdpumion7 cpmvisloiuocauseBuacmrandPin w(Chepur9 Sq.F[.Floor Area Valuation th (comm he sig with Sen1on7000)of Divbion Sof tier Business and Prafestions Cade)01 .�.- Nn he u exempt therefrom and the baso for the alleged clamplim.My violation of Section 7071.5 by airy applicant for a permit ubjeeu the aPPikanl m a doll Pendry of r Occupancy Type not mom Ilan fiw hundred dollars ISM 0 I,u owner of the pmpmy m my empla)eea with wag,u Heb mm wmpmW-. will do Newark,and the suumum is ootimungded oroffered forsele(Soc.7044,Burineu Required Inspections and PmfeSllOm Cade:The ConYibA Lm2M1¢ does,da -1 apply m N W'ne'r of 9 P property who build,or imptows Leonean,and whodoessuch work biaudfma m igh his ^ owncmployces.provided Nu such impmwmmta erg Out Intended maligned Russia.IL Y' bwm 'bmvtatedinga Z.of emoatkhathe did Out Sear or mpasto frthe buildw MO hew Ne burden of proving that he did ml dtiW m improve for Purpose of ale b}1,u owls,of Ne miserly,am eaelnsiwly conuacling with licensed cenuantoea or e6mmocl Ne pmjen(Sec.7044.Business W Pretensions Code:)The Contractors U. cava Law duct not apply in an owner of property who builds or antennas Leeman.and who connote fors h Pmjecu with a ennumtor(s)accused persmm in he Conuacmr's Lkcae Law. 0 14 exempts en, ,BkPCfur isit W Dam 1 0 ORKER'S COM , DON D LARATION 1 hereby affl.under pcndlY of perJmy one a following declarmons: ❑I hew and will mainainaCendncas a(Consemm If-iuu ,forworker,Compen- ation,u pmvidad for hY Section 5700 a(dm lalari ode.(or Ne perfmmanm of age work fm which this permit is iaucd. ❑1 Mw and will maintain Workers Compensation Inuranu,as required by Section 3700 of he Iabm Code,for Ne performance native work,for which this permit is issued. My Worker's Compensation Inurma carrier and Policy number are: camer, Policy Nm: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE - rlTu section need ant he completed it the permit is fororo hundred dellani(SIM) car leu) I cenify the perfmmance of the work for which this permit te i m j l I rwt amploy any n in my mm rs rbc omc ubje lidl W tion Laws o(Ca Appllam NOTIC PPLIC e u c incase of Exemption,you should become a Jon m Nc Wehera Compen,atun Pmv ions of Nc labor Cade.yeti muss C)O forthwith comply with such pmvtdom or this perm' shall be deemed revoked. 'Z-, CONSTRUCTION LENDIN AGENCY H Ihn,rehy eRlmt that Nem is a conswction lc Ing agency for(1u Performance of the work for which this permit is issued(Sec.3097, iv.C.) QI<ndmh Name Z Lselers Adducts I)Q 1 certify Nat I Mw read this application and sus Nu an,above information k fL E•' contact I agree in comply with all city and county aNinauces and eras laws mlatiag in C)U building conuuclion.and hemby guillotine represcnmtivas of this city m enter upon the Q Gil ahovcmcntiuncd pmpeny for inspection purposes. (We)agme to ave,indemnify and trop hamdess the City of Cupertino against rFi y Iiabiliup,judgmenb,eosU and eapenw which may in my way sexton,against aid City z APa -a' lSfun MIL SNu D WILL COMPLY WITH ALL NON- INT Issued by: Date SOUR E SLA 0 I D Re-roofs salmawbrApplicanUC HAZARDOUS MA Ars DISCLOSURE Type of Roof Wil by the Cuperan fMariciAi ampmt Romor haMkhsvrdaumasrid u defined by Ilea Cupertino Munlci ,Chapter 9.13.and he HcaiN and Safety Cmm,S y.11531(,)7 All roofs shall be inspected prior to any roofing material being installed. Ya u Will the applicant or future loading occupant tau equipment or dcvkn,,which If a roof is installed without first obtaining an inspection,I agree to remove emit Ignitions air conuminmau fined by the Bay Ama Air Quality Management all new materials for inspection. DisWct7 ❑Yea u 1 hew mad the hcaaNnm materials requirements under Chapmr6.95 of the Califor. jw �otly tyc a.Soclon 3150, 511and13534.1 unamused Lemif Nchuildus haw a sena (,that it ism respomlPllitymnotify du accts rotf Nc ehman..i priarmiaa m Cenirteame(Ocel)dtr. Signature of Applicant Date iredegenl - All roof coverings to be Class nBn or better ' CITY OF CUPERTINO em 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32628051 . 00 DATE ISSUED. . . . . . . : 09/01/2006 RECEIPT # . . . . . . . . . : 35874 REFERENCE ID # . . . : 06090004 SITE ADDRESS . . . . . : 21135 HAZELBROOK DR SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . : CUPERTINO . IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : EDITH ONG ADDRESS . . . . . . . . . . : 19902 VIA ESCUELA DR CITY/STATE/ZIP . . . : SARATOGA, CA 95070 RECEIVED FROM . . . . : EDITH ONG 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 •FEE 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 VISA TOTAL RECEIPT 100 . 47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL Community Development _ 10300 Torre Avenue aClOF Cupertino CA 95014 Telephone(408)777-3228 Fam(408)777-3333 IWUPERTINO Building Department JOB ADDRESS: PERMIT Ni9��L levo TPO OWNER'S NAME: 17W 01167 JPHONE # GENERAL CONTRACTOR FAX # I am not using any subcontractors: j c/' / D,6 Signature Date Please check applicable subcontractors and complete the followL information: 60 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 Til Owner/Contractor Si ture Date CITY OF CUPERTINO o(p coo 4 SRI- TEMPPOWER •CUPERTINO PERMIT APPLICATION FORM APN # Date: / /l /0b Building Address: ;I113 �- Owner's Name: - '46- ��171� O �n6bw6��d . Contractor: Gow hone: License #: Contact: Phone: Cupertino Business License#: Building� nfo it I : Elect Job Description: Residential Commercial ❑ Cost of Project: 16� Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING