08040020 CITY OF CUPERTINO �a,�
BUILDING DIVISION" PERNIITCot\;`Y°1�1'>C Wil:!♦N.vlQ. Ml �A v$
Bu1Lo11h6G�3('Tf'aOHNSON AVE NATIONAL CONSTRUCTION P08040020
OWNER'S NAME: PERMTr ISSUE DATE
JIAYI LI 15319 CHATSWORTH ST 04/03/2008
ONE: SANITARY NO. CONTROL NO.
(818) 221-6057
ARCHRECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
3Qa LICENSED CONTRACTORS DECLARATION Job Description
usF 1 la allirm ush 1 am licensed under provisions of Chapter 9(commencing
az1,y with Section 7")ofDivinon3ofthe BusinessAnd Professions Code.And!myRccowis 1-100 AMP OVERHEAD POWER POLE
E, in full fame and Affect.
j Z Llanse Clan Lk.0
Dau: Coins , Y\
ARCHITECTS DECLARATION
I undenunl my plus Nall be used a public msords
J U
5 C Licensed Profeaiaul
OWNER-BUILDER DECLARATION
i 1 hereby affirm Not I am exempt from duct Contractors License Law far the
ZOO following reason.(Section V3 1-5,Business and Profeauoa Cade:My city a,county _
3$V which mquires A permit to consuuc4 ate,,hnprove,demolish,nr repair any Made
ZSa prior an its hisium.also mmdoeS the applieut for such permit on file a signed ststemem
FFq< that he is licensed pursuant o the provisions of the Consumer's Uccnsc Law(Chapter 9 Sq:Ft. Floor Area $500 Valuation
3$ (commencing with Section 7000)of Division 3 of the Business and Professions Coco)or
3 tits,he Ica exempt therefrom And the basis for the alleged exemption.Any vE.l.U,.of
Section 7031.5 by any applicant for a permit mbjcca the applicant to a civil penalty of yp7s,T Number Occupancy Type
rot mom dose few hundred dollars ISM 37518035 :tl lY'
❑1,u owner of ice pmperty,m my mployeex with wgu u their mk compensadon.
willde thawmk,udtheswmum tsnotintendedoraQered for.I. Sec.70N,Businw Required Insr�actions
Nd PrefeVlOa CadC
Carlo:Tax Comumra LIRMG m LAW it=set apply an owner of q p
properly, he buildsorimprovu theman.and whodoessuch w AlAhimself or through his
own mployw,provided list such improvements Are rot inuMed maRerd fesaa If,
however,the building or impmvemmt is to within one)ear of completion.the owner.
builder will haw tied burden of proving that he did not bulk or Improve for purpose of
Asia.)1..
I.as owner of de property am exclusively contracting with Iicemed romram,s lo
muco the p.jem(Sea 70,14.Business;ad Professions Cods)The Convect .LT-
come Taw does not apply to As owner of pmpcny wha builds of ImprovAs thereon,and.
who eomaeta for such projects with a contractor(s)licensed puissant in Iia ConusOds
License Taw.
❑tem exempt 7p,Be —/yam Bk PC forth n
Owner V4, Z;i/. Data mo
JV WORKERS ENSATION DECLARATION
I hereby since under penally of perjury arc of fled following declaradans:
ham and will maintain•Cerflfiuste of Conxenit.self-imam fm WmicesCompen-
n,As provided fm by Section 3700 of the labor Code,for ft perfomanm of ice
ria for which this permit is issued.
❑1 bast and will maintain Workers Compensation fnNMm.As nurtured by Section
3700.1'use labor Code,fm the perf.mAme of the work for which this permit is Issued
My Workers CompenAsuom lm in ce cartior end Policy number ser:
Cartier. Polly No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(lltissecuan reed not be cmplemd If the permit is for one hundred dollen($1010
or less.)
I cenify that in the perfomanco of the work for which this pemlt Is issued.l shat am t '
employ any Person in any manera a lo became wbjech mice Worke,s'cempc.aflon
Lawsof Califord Deed -
ApPlicat V
NOTICE rO A CANYrIf,after makingAd Clurtiricau,of Exemption,you should
become subject mut.Workers Compensation provisions of the labor Cie.you most
.J O forthwith comply with such provisions or this permit shall be darned ended.
?► CONSTRUCTION LENDING AGENCY
(—t (hereby slim dost then is a comotoman lending agency far the perfamanm of
D:> the work fur which this perms,is issued(Sec.3097.Civ.C.)
Q Lender,Name ,
lenders Address
U Q I comfy that 1 haw read this application and sued that the Above kfomadm is
li comm[At=to comP1Y with all dry and county ordinances Ad state laws relating an
(] building commucti.n,and herebyaoNmire repmsenuuvu ofthis city to enter upon the -
W above-mcnuaned progeny for Inspection purposes
(We)agree to taw,indemnify and keep harmless ice City of Cupertino against
v,c N liabiliuesjudgments.cusuad eapenw whichmayln arywaysmnd agilmtuid City
U.Z in consequence of the swung of this permit.
^-� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by: Date
SOURCEEGULATION
�-+a-� � Re-roofs
Sign mofA IanuC.Mran.rDate
HAZARDOUS MATERIALS DI CLosuRE Type of Roof
Will the apple=,or future building occupatstme or bail,harardous material
u dellnd by de Cupertino Municipal Codc.Chapter 9.11.And the Health and Safety
Colic,Section 25531(.)?
[:]Y. All roofs shall be inspected prior to any roofing material being installed.
WIII the applicant or fuV.ture building aampam me equipment m devious which If a roof is installed without firs[obtaining an inspection,I agree to remove
't haurdude air contaminants a derind by the Bay Area Air Ouslity Management all new materials for inspection.
nc9
❑Yca
I ban mad Lite haadmomaterialsmquimmmus under Chapter6.95 of the Califor-
nia Heal"SafmyCode,Sections ZoM5.25533 And 15534.1 understood LiwifNc building
once not cum lly have A mat.ter it u my responsibility to nilly the oauput of the
requimmcnu whit unbcmdp,iomiaumm.ftccru am Occupancy. Signature of Applicant Date
Owner ora rvede t D,m' All roof coverings to be Class'W'or better
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37518035 . 00
DATE ISSUED. . . . . . . : 04/03/2008
RECEIPT # . . . . . . . . . : BS000004346
REFERENCE ID # . . . : 08040020
SITE ADDRESS . . . . . : 10321 JOHNSON AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JIAYI LI
ADDRESS . . . . . . . . . . : 10321 JOHNSON AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JIAYI LI
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 15319 CHATSWORTH ST
CITY/STATE/ZIP . . . : MISSION HILLS, CA 91345
TELEPHONE . . . . . . . . : (818) 221-6057
• FEE ID - UNIT----- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------- --------- ---------- ---------- ---------- ---------
1BSEISMICR VALUATION 500. 00 0.50 0. 00 0.50 0. 00
1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
1ERT<200 UNITS 1 . 00 40.79 0. 00 40.79 0. 00
ITRAVDOC 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 #1406
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER
WoLl00020
CITY OF .CUPERTINO
�� TEMP POWER
CUPERTINO PERMIT APPLICATION FORM
•
' APN # Date:
2751 ?03.5-
Building Address: 1032 To n.Sc,-7, A 02
cA 93-0 i
Owner's Name: Yl Q� r L Phone #: 7
4/- 09-
Contractor: ft�c�
Phone #: 0
Fax #: D --42o —2.7-051
Contact: 6' Phone #:
Contractor License #: 7/ o
Cupertino Business License #: 2 2 /j 3
Job Description: ._ U 0 A
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
/ IEPERMITFE Electric Permit Issuance E
IELCPLNCK Electric Plan Check E
1BSEISMICR Seismic Residential B
CITY OF CUPERTINO
.eva TEMP POWER
OF
CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMIC0 Seismic Commercial B 10EAP14
IECT<200 Commercial Temp Power E
<200 Amps
IECT>1K Commercial Temp Power E
>IK Amps
IECT2001K Commercial Temp Power E
100-1K Am s
1TRAVD0C Travel & Documentation B
Fee
1BUSLIC Business License B
•
•
Community Development
e 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: U,32 ,rv1cµSoy, Ve PERMIT #
G -ei�f, rLo -o/ Q
OWNER'S NAME: ;& ; ; PHONE # 46 OLY 3 a &(1-t
GENERAL CONTRACTOR: J.Yk L FAX #
I am not using any subcontractors:
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
Linoleum/ Wood
• Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
i Z)
�bwner Contractor Signature ate