06060024 CITY OF CUPERTINO �y�a,gi
BUILDING DIVISION PERMIT
BUILDING ADDRESS: CHUNG YIN WONG• P"""No'06060024
10255 LOCKWOOD D
PEItMT[LSUEDATfi
OWNER'S NAME: ,a
RAVI RAO DAVALA 1049 SITKA TERRACE 06/OS/2006
SANITARY NO. CONTROL NO.
E:
(408) 985-9269
INFO
ARCHITELT/ENGINEER: MB 'ECH
0
o o LICENSED CONTRACTOR'S DECLARATION Job ms WDescription
1 FFy 1
by dOt I sen licensed under Prons vidaof Cbaper 9(wm
meming 1 IN 2006
with Section IOW)of0ividon 3 ofhe Business and Professions Code.snd my license is
y In mu fares adafrm TEMPORARY POWER POLE
�Z License Clan TS a
Dam Caddhom
Qg J[LJyL'(j1l)�t(+}v�.9 t']JC'cyBrtf(.\�f\f
ARCHITECTS DECLARATION
i� I undersand my piens shall he used as public records '
LL
Licensed PNrGelaOal
ty
OWNER-BUILDER.DECe ContrON
1 hesehy ism hen I em sump,s an the Comms Co License taw far the
p o fallowing Hawn.(Sceuan 70313,Badness and Professions Cade:Any city or=only $250
3 which requires a parent,M monad,,alp,Wiment demalW,or repair my sanctum
-ZSr
Oar at its issuance.sho denims the-PPlicanal in'such Permit an it"'Signed anducaucanFt, Floor Area Valuation
a
that he u licensed foreman,to the provislans of the Commcmrs License law(CNpmr 9 Sq•
�F$ (commencing with Section 100()of DMshm 3 of the Business and Professions Code)or
dm k is catnap therefrom ands the bull for Ute alleged eumpuon.My violation of Occupancy P y TyPe
Section 7031.5 by any applicant for a permit subkws the applkmt to a dvil penalty of {
not mom than Rw hundred dollars($700).
❑1,u owmt"af Ide property,w mY eraDlaYvT+wW segs u he'll wlccmnpenatior, -
w0ldoNewarkandU¢swnutebrotin¢nGAwatfelW fonsk(Sa.1IW.Budnev Required Inspections
and p apholons Cade:The Contractoh License Law docs call apply m an owner of
pmpeny who builds ar im prove demand,and who dominants work hlmsel("hmugh his
Me m playeea,progdeA that such imptowmenu are ort intended woffered fm ads R,
however,he building or im ruwmem iswld wiNteam year o(campleUm.Neawem-
builder will haw the burden of proving Nn he did not Wild or impose for purpose of
ark
1.a M.of the property.w uelodwly contracting with[focused eantrumrs M
contract he pmjen(See 7044,Bar.and Pretenders;Cede:)The C--ba es Li-
came Law dean not apply M an owner orpmpeny who hands or Improwa hereon,and, ,
who contracts far such pmje=withacomrxmr(O Rearm l pursuant m he ConvuYor&
Limen law.
❑I am exempt under See. .B&PCI maven
0wn.2
fuse
oath
1 hemhy affl m under penally of perjury om of the following dealamfons:
and will mdnWn a Certificate of Consent as calf-Wase fns Warkela Campery
udm,as provided for by Second 3700 of he Labor Code,ran he Performance of the
work for which this permit is issued.
❑I haw and will endnuin Workers Compensation Was ream,as requlrcd by Section
3100 of the labor,Cade,for the perfamunm of than static fns which this Permit as Wood'
My Warkmra Compensation Wondered carrier ad Policy number sen:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fish smaded wed mtbccamplemd Hhe permit Is f"arc hundred dollars($100)
w loll)
1 certify that In Ute perfwmuee of use work fa which his permit IS lased.I shall raw
employ any person in any manners las bjem M the Workers'CompmnUon
LAM of CalifoMa Dam
ApPllant
incomes TO subject
1$M ng rtmas of of FLeenpicn,you should
become a court M the Wo er1 Compewtian provisions of the meed Coda you most
vJ.`L fonhwih comply with such provisions"Ulla permit slWl Wdncmed rewkcd.
tic CONSTRUCTION LENDING AGENCY
f" 1 ha¢by grim that here is a construction lending agency for the performance of
> ite work for which this permit is issued(Sec 3091,CIv.C.) ,
W E Lenders Name
F�Z Landers Address
U 0 1 rarefy hu I haw Had his application and sum this he abase information is
U. F carte"I agree M comply with all city and county on insaus s and sum law nlning M
0U Wilding eansouctian,and hcmby authorice rapreantallwa of his city M enter upon he
L2a ahoromnmiunN property for pecdon Proposes.
harmless(We)agree M saw,indemnify and keep he City of Cupertino against
yIiabilluu.Judgments.eosu andmspenw which may in any wYaceruc agalnstaid City
U 7 in connc lmncc of he trumm of thisperm Date
rte• APPLICANT UNDERSTA ND COMPLY WITH ALL NON-POINT Issued by:
souRCB
v1 Re-roofs
signuurc IinndConlncMr am of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the appBans or in=building aaupwtstwe"handle haardeus material
u deRand by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code.section 25532(01 All roofs shall be inspected prior to any roofing material being installed.
❑yes 01C.
If a roof is installed without first obtaining an inspection,]agree to remove
Will he applicant or faun Wilding occupant use equipment or devices which
malt haallons air mntsminsnss as outland by he Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yas ( U
IhawrcW Umhmm tiusmamdalsmquimmenaunderCWpmr6.95ofthe Callfor-
nia Health&SsfoyCada.Seed.25507,25533vnd255M.Iundemund hulfhe Wilding
does Out currently base a nen than I It If M murY he occupant of he
mmanss P
myuidar uance MaCcrurmate or mar. Signature of Applicant Date
l 6 All roof coverings to be Class"B"or better
u uhorvcd agcm sem
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # : 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34214016 . 00
DATE ISSUED. . . . . . . : 06/05/2006
RECEIPT # . . . . . . . . . : 34674 '
REFERENCE ID # . . . : 06060024
SITE ADDRESS . . . . . : 10255 LOCKWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAVI RAO DAVALA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : RAVI RAO DAVALA
CONTRACTOR . . . . . . . : CHUNG YIN WONG LIC # 23900
COMPANY . . . . . . . . . . : CHUNG YIN WONG
ADDRESS . . . . . . . . . . : 1049 SITKA TERRACE
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086
TELEPHONE . . . . . . . . : (408) 985-9289
�EE 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 2897
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
ilia, Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
rJ d 2
OWNER'S NAME: eoylft e,� PHONE # lip
GENERAL CONTRACTOR r - FAX #
I am not using any subcontractors:
ignature 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
•
Owner/Contractor Signature Date
uoiaaiauuo a;%o:80 Yrl -u/Vu me utn emu& c yr a
CITY OF CUPERTINO OtOOIOGD94 -
';'EM11, POWER
• CUPERTINO PERMIT APPLICATION I+ORNI
Date-
Buikling Address: /p2 5 0l A r
_ C" s Zo�r�efl
Owner's Name: /' -- Phoned: ----
RAd Vl' �OI yot Yq �(bg'�{Gb' 83 8
ConlIaetOr: ./7KioL° ?.vC Phone: License I#: —
Contact: Phone: Cupertino Business License
4Aog-306- ,T769
Building Permit Info.,
Elect N__�
Job Description: +
T�11f' ""POLAR
Residential ®' Commercial ❑
1
Cost of Project: ---- --
•�250 .�
• Qty. if
A plicable, Fee ID Fee Descri tion _ Fee Group_
I BTEMP Temporary Power ELECTRICAL
EPERMTTFEE Elect.Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
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