00060195 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
I1Ull.DING ADDRESS: - PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
10354 IMPERIAL AVE G. T. CONSTRUCTION CG . 00060195
DONE: - SANITARY NO. CON't No,
YEN, JAMES 20711 FARGO DR 06/30/2000
O O ARCHITECT/ENGINEER: BUILDING PERMI'P INFO
< (408) 725-4499 Bl LDG ELECT PLUMB MECH
yzy
n Z LICENSED CONTsedund under
DECLARATION Job Description
O'G O (hereby affirm that Ian)licensed under previsions of Chapter coole9(rommenc.se
yt- wish Sect ion PMyd)of Dieision3ofthe l{usiness and Pm(csi meads,and my lir
ia Y ct< Lin full Class end effas. .y n
o i U G!o"q Class 1.10.1
Ilam! S DEC(,
3 al
a(-n JJ \ ! TIiCf'S D[Cft TIO
5 1andesiandmyplansvdallheusedt,ptroucrecord+ * .NO CONDITIONS
s ��
pLI<cn 1'mfcsdnnal
OWNERtBUILDIiIp DECLARATION
ce I hereby affirm that 13rd CHo,in fnr,the Contntafor x I.iseme law our Ibo
t$Q
followingre reason.(Section]d3Lr,It,Acir, and Ive.de io demolish,
Code:An,city oratanty
Y S 7 which res issuance,
n permit re construct,applicant
approntfor such
h or iit t file
repair ed strimpecom l '
duct eslhmsedpuruarequires Shenpplicunt for mchparmr LienseLwchapncm
maheendingwdpereon7000)ofnt to the Diisink n3 of theusinesLacemelawonsCoadylare) Sq. FLFloor Area Valuation
(commencing wird section 7000)oft e basis 3 t e a Business and Proion,An vi eMe,
or that he is exempt therefrom and the basis for she alleged exemption.Any l Pennon
of sermon than
n by any hundred
of for o 500). whjmt.She applicant to o civil pcnnBy
ornntmot<m3nBv<nunJrcJJuoarc(asal). APN Number Occupancy Type
ED 1,mownerofthePruM Y norm em to ees with wages as theirsolecnn,tensa Sion, $''
Y P Y g
will is a work,and ns ode:Ih is not ear's Li car c Law for snot(Sec.7144,
Btlsinms and Professions endo:The rept Stan,s Liceme Law does not apply m an Required Inspections
olr of papery Who hews or ov ded tat vtplu,and who does such woreaded r 3571.9049. IZIIZf
larenlyb his awn employees. I lkfiJ that such hnpmapis of are not mlelldar or
olrcr¢i fa sale.If,h.p,hdid ,the l have f a I,deripdof as n e than
within nae build or
ilnpleti for the owa of .It.)
will have the M1unleu of pnrving Wm he did not build or
i�„presetbrptlpsseofsal<.I .. 103 — UFER
Cl,as owner of the property,ampxeluslvely contacting with licensed commclo,In 304 — ROUGH ELECTRICAL
construct the x,det(See.7044,Business and Profe.+sionc Codd:)The Commctor's
License law docs not apply to an owner of property who builds or improves thereon.
and who contracts for such pmjecd with a comrvcmrts)licensed pursuant to She
Cnmraanfs License law.
❑1 am exempt under Sec. .B&P C for this naso
Owner Dae
WORKERS COMPENSIG[ON DECLARATION - a•® '
I hereby affirm under penalty if perjury one of the following declamdonsl ♦V\ �`1/
J I have and will maintain a Certificate of Consent m self-insure lot Wader's
C, pcmotinn, its provided for by Scctinn 3700 of the Labor Coda, for the
Pei linnt3nac of She work for which mis permit is ismed.
❑1 have cad will maintain Wader's Canpensntion Insurance,m rcquircd by Section
3700 of the Labor Code,for the pprfojaancc of She work for which this Permit is _
issue..AlyJ�y�� n+atiJ,n Sourer a d Policy n TZrt-3
Currier.�N!! //LLII �rLsl�.Aq, lIIIIIPIIIIIInIiry No.: . //LL1I-- YY
CERTIFICATION OF EXEMPTION FROM WORKERS' s
COMPENSATION INSURANCE
(This section need not he completnl if,.ha Permit is Board hundred dollar
(SHXBar lass)
1 certify that in the pert Inane of the work for which this permit is'dsual,I s
shall not employ any parson in any dai rr so as In became subject It,the Worker.'
Con,cromion Laws of Ct IToMll.Dine
ApPlic:nu -
NURCE TO APPLICANT.If,oiler making this Ceriltcme of Exemption,you hold
hect,lne mbjec to the WmImes Compensation provisions of the Labor Calc,you lost
Q 0 Ilmhwin comply with such pno Won,or this pem,it shall he deemed revoked
FZ) CONSTRUCT ION LENDING AGENCY _
IX 1 hereby affirm that there is a consumption lending agency fa the peHamance
of the work far which this permit is i...d(Site.3037,Civ.C.)
IlQ Ixnder's Name
Dz Lender's Address
I parity that l have read this uppikedli m and nam that he above intonation is
kw F. correct.I agree to comply with all city and rnumy ordinances and state laws,skiing
Q Vto building tonmruction,and hoaby authorlm reptaxertativcs afthis city to enter upoid
> r,T4 the ubov-darlioncd property for impection put goes. .,
26, (We)agree ms3ro,indenmil'yunJ keep harmless the City of Cupeninn againt
Z liabilities,judgments,coq,and expenses which ma in any way accrue against.said
G r� City in consequence of She gaming of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT IDate
Issued O
SOURCE REGULATIONS. y'
Signature of ApplicanlComuctor Data Re roofs
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant orftere building occupant arc nr handle hazaNam material Type of Roof
as defined by the Cupeninn Municipal Code,Chapter 9.12,and the Health and Safety
'Code,Section 25532(a)^
El Yes El No All roofs shall be inspected prior to any roofing material being installed.
Will the apphcamadname mildilgoccu,nnseequipmemord,we,Much If a roof is installed without first obtaining an inspection, I agree to remove
• N hrocid sircontaminant aedefined by thv Boy Arca Air Qunl.y'M:mngemm�l
Zulld, ❑N all new materials for inspection. Applicant Understands and will comply'with
all non-point source regulations.
I have read She hatadous maRsiul+ugolrcmea,coup,Chapter 695 of the '
Caliti,mia Health&Safety CMe,Sectinna2551)5.25533and2534.1 inderatandihm -
if the building does not currently have a tenant.that it is my responsibility to nonfy the
occupant of the requirements which must be met prior to issuance of a Certificate of
°"°Pan`s' - Signature of Applicant Date
Ownermanhaired agent Data All roof coverings to be Class tB" or better
OFFICE
CITY OF CUPERTINO
I� 1 of 2 BUILDING PERMIT RECEIPT OPERATOR: yvonnek
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:35705035.00
DATE ISSUED... ....: 06/30/2000
RECEIPT #....... . .: 12674
REFERENCE ID # ...: 00060194
SITE ADDRESS .....: 22360 SANTA PAULA AV
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .... . . .
OWNER ALLEN HSU
ADDRESS
CITY/STATE/ZIP ...: SAN JOSE CA, CA 95129-39{6
RECEIVED FROM ....: TIM
CONTRACTOR .......: TU, GEORGE LIC # 21401
COMPANY G.T. CONSTRUCTION CO
ADDRESS .........": 20711 FARGO DR
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
TELEPHONE ...... ... (408)725-1499
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- --- ---------- ----------- ---------- - _-____:- _----___--
BTEMP FLAT RATE 1,00 157.50 0.00 57.50 0.00
---------- ---------- -------111--- ----------
ERMIT : 57.50 0.00 57.50 0.00
1
VOICE ID DESCRIPTION VOICE ID (DESCRIPTION
........ ............................ .......................
304 ROUGH ELECTRICAL 501 ' FINAL ELECTRICALENERGY
505 FINAL ELECTRICAL