06070206 CITY,OF CUPERTINO *pia r
BUILDING DIVISION PERMIT COIVT"CCTnR II�I'EORMATI'01��.
xRsfi.�•'�" .s u..'A�.3A SP%SSR'msNlxe�75ici +8" 3.ss,&
BUIL DING ADDRESS: s A TO Z GENERAL CONSTRUCTIO Bxmrr NO06070206
1138 HUNTERSTON PL
OWNER'S NAME: PERMIT ISSUE!DATE
JOICE WANG 3063 KING ESTATES 2006
NB: SANITARY NO. CONTROL NO.
(408) 926-5313
ARCHITEC IENGINBER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.06 LICENSED CONIAACIOR'S DECLARATION Job Description
i Lu 1 husby affirm that I mmaim, m
licensed uer provisions of Chapter 9(comMOIPc
ng
vim Section 7000)of Division 3 natie Business;aol Professions Code.and my license u
fl
InflifwuandnIT �7jp TEMPORARY POWER POLE
@4 Lleenma Lle.M
Dam Contractor
Iq- ARCHITECTS DECLARATION
i eZ 1 undereund my plana andl be used As public meads
se
G Licensed Professional
OWNER-BUILDER DECLARATION
I o I hereby aRrm that 11. exempt from Pr Cosions C s License law for the .
.o a which
muoa(Saito 70713•Business and Rofuaions Code:Any city or county
i:t� wbkh rtqussu•permit re rnnsuseL iron improv,de permit
t m mash any urunuro $369
Sn prior m it ceased pumm requires;don pro applicant farmuch Commune to cis a signed(Chapter
;gypthat rsieinswitpurawmrothcofDislouofthe
veBussm(endProessonCMptw9 Sq.Ft.Floor Area Valuation
(commencing with Section of Division 7 arrive Business and Professions Code)w
8 ohm he k asempt detefrom and the basis for the alleged uempdon.Any violation of
Section 7031.5 by any applicant far a permit subject the applicant m a civil peuRy of 9RA4%`8erU U Occupancy Type
not mom than five hundred down($50)1
0 I.ur ofthepmpwty.wmymploymwWwgnuthehmitmmpertadon,
willdothew rLandtheatroctumtwtmmMedwoReredfwuk(Sm.70N.Budau Required Inspections
And Poorest.Code:The ContrmTur,License law does roet apply be an owner of q P
propertywho lames,ldawimprovwtheroprove who dcenasehwmk himeelfwllussia his �� �+S � �
own ver.th eu•provided that ouch Improvements m net ear ofldampIcin.Russia.IL yflsJF7���,t
however.the building or Impmmnmtmsold within caw Set or mp—fa.theowner-
builder will haw the burden of proving massive did rot build a improve for pogo¢of
alk.). AUG
0 1.u owmr of the property m utludvely canuaning with licensed mnuacmn m F:�lG
construct the project(Sea 7044.Business and Professions Code)The Cmuacu's U.
ceva law does not apply As an owner of property who builds or improv Ihereen,rod.
wLkc.LAW.
ho mnrramsfor such pmkcs with a conuactons)licensed pomace to the ConummYs {{t'r��7TTO(ty5r[�{jy� y(tjJ atr��{' ,pry{1�.tp��t�/{ R[ttgt�4A��ttf{'((/t/�.���/y,`/�
0 lomaemptunder Sea ,Ba PCfw Nlamome
0. Dat
WORKPAS COMPENSATION DECLARATION
I herebyffuode
am sr peully of perjury we of the folio ng decal fl c
I haw and will min Wn a CcAEcaw ofComent m self-insure fw Workers Compen-
sation,u provided pan by Section 3700 of the Labor Code,far the performance of de
work for which this permit Is lamed.
0 I haw and will maintain Worker's Compensation Insurance,u enquired by Socotra
3700ef the Labor Code,fw the petarmaae arrive Werk fwwhich this permit t lamed '
My Wetter,Conpweramian Immsnm arrive aM Policy nmbv am:
Cartier. STATiT �IlIAI� Policy No.:
CERTIFl TE OF IXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(This section need ambecmpleed If the Peron Is fovea hundred drllm($10))
or leu)
I sonify dot in the performance of the web for which this permit k based.1 Nail not
employ my person in any observer mss to become subject be de Workers'Cmpensa lmo
Laws of Califomma.Dam
Applicant
NOTICE TO APPLICANT:If,afar making this Ceroincale of Eaemption.you should
berme subject m the Worleces compensation provisions of the labor Code,you mut
0 O forthwith comply with such provisions or this Permit chill be deemed revoked.
,z., rte.. CONSTRUCTION LENDING AGENCY
E" 1Iereb,.M.that there lea comuwdnn lending agmey rw the icrfuen.of
C the wont for whim this permit Is issued(Sec.3097,CW.C.)
QLanders Name
91. Lenders Address
U0 1 certify that I haw read this application and sum that the above information u
Dy f~ comet.I agree to comply with all city and county ordinances and state laws totaling to
pU building construction,and hereby Authorizerepressntmiva orthis city to enter upon the
�U shove-mentioned pmperty for inspection purposes.
(We)agree m save.indemnify and kap hamim the City of Cuper ino against
cA llabilitice.judgmem,eom and espenses which may in my way acus agalnst said City
V z A APPLICANT
of the panting crime permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S Date
SOURCE R��/{�j CATIONS. /
(�J�Ls's,/( 712}jRe-roofs
Signature of Airpitcm
rtuComtor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appllcant or fmm building wcupanttm or handle hamdea material
As dersed by tie CupMno Municipal Cade.Chapter 9.17.and the HuIN and Safety
Cade,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Oyu ❑Ne
Will the applicant or form building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haardna air cemmninam As dermal by the Bay Arca Air Quality Management all new materials for inspection.
District?
0Y. 0N
I haw revel the haardam
ssmriabrequiremnt underCbaper6.95 of de Glifary
nit H.10,SafetyCode,Sccdwo25505.25577md25534.luomutaM Wtifft building
dwarot cu ndy have
a sonans Nm it k my nesponsib111ty m ratify the occupant of the
uimmen mamuRbcp et - tuiuuanceofaCenifmma(Of"f',",e Signature of Applicant Date
d p 7, " ��dc All roof coverings to be Class"B"or better
OwarorauNrnrcdc cot �9¢'
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36222026 . 00
DATE ISSUED. . . . . . . : 07/28/2006
RECEIPT # . . . . . . . . . : 35436
REFERENCE ID # • . . : 06070206
SITE ADDRESS . . . . . : 1138 HUNTERSTON PL
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JOICE WANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : A TO Z GENERAL
CONTRACTOR . . . . . . . : DAVID LE LIC # 25458
COMPANY . . . . . . . . . . : A TO Z GENERAL CONSTRUCTION
ADDRESS . . . . . . . . . . : 3063 KING ESTATES
CITY/STATE/ZIP . . . : SAN JOSE, CA 95135
TELEPHONE . . . . . . . . : (408) 926-5313
41EE 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
----------------- ------------ --- ---------------
CHECK 100 . 47 758
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO
51(2�1 TEMPPOWER �0
OFUPERTINO PERMIT APPLICATION FORM
APN# Date:
Gz , - .a -
d26 7 e
Building Address:
1139 4LI N ascent
Owner's Name: Phone #:
DeU Cr
Contractor: _ Phone: License #:
LE (Act) 156 - 191-F 5 a
Contact: Phone: Cupertino Business License#:
Le- Sq o — V7 4 .zs �
Building Permit Info:
Elect ❑
Job Description: _
Residential Commercial ❑
Cost of Project: mo
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•