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06060203CITY OF CUPERTINO A9'R"I1UiAO BUILDING DIVISION PEM , .STIN Bu1L0ING ADDRESS: S ILDER INC PERMITN0.06060203 10066 JUDY AVE NER'S NAME: PERMIT ISSUE DATE WALTER VAN HOOF & MIKE CHEIT 18240 PURDUE DR 06/23/2006 PHONE: SANITARY NO. CONTROL NO. (408)718-6673 ARCHTIECf/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 R IF LICENSED CONTRACTOR'S DECLARATION Job Dei I hereby affirm Nu I am licamed under provisions of Cham' 9 (commencing FINALEU with Section 70(11) of Division Sulam Business and PmRssium Cade. and my license u infull force and effect. INSTALL TEMP POWER POLE License Class Lk, w Date Contractor JUL 1'6 2006 ARCHITECTS DECLARATION 1 understand my plana shall he used u public records �� NOW Licensed Pmfcssimml OWNER -BUILDER DECLARATION e Conuoufa LicmLaw far ft I hereby affirm that 1 am empt from Nsem e fallowing memo. (Section 7(D 1.5, Business and Prohssiom Code: Any city m =only which mquhe, a permit in construct, alto. haprove. demolish. or repair my structure $500 prior m its issuance. also requires the applicant farsuch permit to file a signed statement Ft. Floor Area Valuation that he is licensed purmmt to dm Provisions of the Conuamafs Licanse Law (chaptu9 Sq. (commencing wi Section7") of Division 3 of the Business and Profwions Code)w Nat he b exempt therefrom and the bub for the alleged exemption. Any violation of er Occupancy Type Section 1031.5 by any applicant for a permit subjects the applicant m a civil penally of nmt more Than Rw hundred dollar ❑ 1, u owms m(tle property. a my wpbyces with ages u the'v role compcntation, Required Inspections will dm the work and the swmsre is mtimmrded araffued raraale(Sm. 7061. Bossiness and Prefesamon Code: The Comsactafs License Law does amt apply m an Owner .f q P properlywho buildsterimprosn dv con, and who doessuch murk loamifuthrough his Own employees, provided thatmch Improvement; arc not intended aroBemd fmsaln. IL however, the building Or improwement is mid within arc year ofcomplemn. rite matter - builder wl0 have the burden of pouring that he did amt build or improve for purpose of ark.). L as manor of the property mat ucludvely comm cting with licemmd comrauor to truct the poukm (Sec. 7016. Business and Poufesslans Cade:) T o Coommafs U. law dura not apply m an owner of property who wilds, or Improv thereon, and whocontracts(m such projects with acantranorp) licensed pursnam m mho Conuanmh Law. ;LkUm lam ptoMuaceB d PCformhisleason DamWORKER'SCOMPENSATIONDECLARATIONi hereby afnma under penalty a(pe jury am. of the following declarWonsl have and will maintain a Ceniacuu of Consent in self -insure for WarlaWs Compen. mi., u provided for by Sce dao 3700 of the labor Cade, far the perfarmsma Of the mark for which this pemlh is issued. ❑ I have and will maintain Worker's Compensation Inhuman, an required by Section 3700.1' the labor Code. for the puformaded of the wads far which Nb permit is hard. ' My Worker's Compensation Insurance carrier arta Polity number ma: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Thbsection sed notbecampleted if the permit Is I.. hundncddellns ($100) or less.) I unify Out In the performance of the work fm which this pump is issued, I shall not employ anymnan in my mannerm u in become mbjut in the Warkere Computation Laws of ifnmia.lam91 . NOTICE 70 APPU ANT. iL after making this Cerdflcaw—orlIcemption, you should become subject in the Worker's Compeuatim provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall he dcemed naked. CONSTRUCTION.Is.cLENDINCAOENCY 1 hereby affirm that thew 6 • lending agency far dm performance of ed (Sm. 0 ' the work for which this permit b issued (Sm. 7097, Civ. CJ Lender's Name landefi Add. i1 ova ll, that I have and this application and sues that the above infomatiu. b ' comm. I agree to comply with all clay and county ordinances and sum laws reladng m Wilding comm etioo. and hereby authorise MinalUmives or this city to enter upon the ser impection 1 above-mentioned properly purposes. (We) agree a ave, indemnify and keep harmless the City of Cupertino gainst i liabilities, juigmemes, case and eapenus which may in my way amuse against said City T in consequence of the granting of this permit. APPLICANT UNDERSTANDS A WILL COMPLY WITH ALL NON -POINT Issued by: Date SOUR REGU T N5. Re -roofs Type of Roof SilmolfidafApplicanDmmmar Data HAZARDOUS MATERIALS DISCLOSURE Will the applicant or forum building Occupant sort or handle hawdous material defined by tie Cupertino Municipal Code. Chapter 9. 12. and the Health and Safety Seetio.25531(a)71 ❑ Yu I N- All roofs shall be inspected prior to any roofing material being installed. If a roof is Installed Without first obtaining an inspection, I agree to remove WBI the applicant or future building.ccupant use equipment or devices which emit ha amlous air cmum lanta u defined by the Bay Area Air Quality MAUJIVO nt all new materials for inspection. Dialnct7 ❑Yes PNO I bow: nod the haundrs materials requlmmmus under Chapter 6.95 or the hlifm- Ohl HUI" Safety Code, Seetiom 25505,25533 and 25531.1 understand esu iflhe Wilding does am c. rely haw a lanme dot it is my Onimadmily at mdfy, W occupant of the nalommcnu which muubemel M manes of.Ccraifmama(It Signature of Applicant Date All roof coverings to be Class "B" or better Owner Ihady d em Dau 17, C` MY OF UPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: 60(6.b PERMIT # 6466U-zd 3 OWNER'S NAME: PHONE # — GENERAL CONTRACTOR T r FAX # I am not using any subcontractors: 4d Ie n —21 S 6 �Zgnature—� Date Please check applicable subcontractors and complete the following information: Wk Own /Contractor Signature Date 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 Wk Own /Contractor Signature Date 0 Item 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37511012.00 DATE ISSUED.......: 06/23/2006 RECEIPT.#.........: 35000 REFERENCE ID # ...: 06060203 OPERATOR: amyw COPY # : 2 SITE ADDRESS .....: 10066 JUDY AVE SUBDIVISION ...... CITYCUPERTINO .............. IMPACT AREA ...... OWNER ............: WALTER VAN HOOF & MIKE CHEN ADDRESS ..........: CITY/STATE/ZIP ...: , RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY/STATE/ZIP • TELEPHONE .... FEE ID UNIT QUANTITY --------------------------------- BTEMP FLAT RATE 1.00 EPERMITFEE FLAT RATE 1.00 TOTAL PERMIT METHOD OF PAYMENT AMOUNT ----------------- ------------ CHECK 100.47 ___--------- TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION -------- ------------------------ -------- ------------------------ 103 UFER 0 MIKE CHEN HSIU YING CHAN LIC # 27738 SSK BUILDER INC 18240 PURDUE DR SARATOGA, CA 95070 (408)718-6673 AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 62.10 ---------- 0.00 ---------- 62.10 ---------- 0.00 38.37 0.00 38.37 0.00 ---------- 100.47 ---------- 0.00 ---------- 100.47 ---------- 0.00 NUMBER ------------------ 137 VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL CITY OF CUPEIZTINO CITY OF CUPERTINO TEMPPOWER PERMIT APPLICATION FORM OOMOON'3 APN # 3 7;— 1 k l I I Date: Building Address` := Elect. Permit Issuance ELECTRICAL DD ,e BUILDING Owner's Name ,, Phone #: 4_�- dt� Contractor: Phone: License #: < - eY(406) �; -114 -2- Contact: Contact: Phone: Cupertino Business License #: .2h !Nt t� D - % OD Building Permit Info: V Elect Job Description: ...�" k.5 UL►'� Residential Commer ial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Grou BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING 1-1 L