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05090169 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR3INFORMATION �' BUILDING ADDRESS: LYNN CHING PERMIT NO-05090169 10264 LOCKWOOD DR OWNER'S NAME: 1'ERMR LSBUE DATE . LYNN CHING 09/26/2005 NE SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uOci LICENSED CONTRACTORS DECLARATION lob Description ; F❑ I hereby afrom that 1 am licensed under provisions of Chapter 9(commencing iW with Section 7")of Division 3 of the,Business and Professions Code,and my license is e`oH in full to=and effect TEMP POWER POLE aw '�\a ,,n? License Class Lie.g LF, Dale co.tracbf ,Y 1 1<tkl Tu f9,pp� 'Js ARCHITECTS DECLARATION 6 I understand my plans shall the used as public«cords �u.� LiccnudPmfcssionel 0FP 2005 `0vt 5 OWNER BUILDER DECLARATION Y 1 loch,alErm Nal I am exempt from Ne Convector's Liccnse Law for the n O following reason.(Section)(131.3.Business and Pmferoiom Code:Any city or county �.�s7[yf C g�• ( itd! which requires a Permit to construct,after,improve,demolish,or repair any Someone �t�f } f;��I;S�S)a�y•]6 7 Pdo,to its issuarec,alw reyuiseuheapploxin for such permit to Sit a signed statement .wy F othat heisRect¢edpursuant inthe Provisions ofNcContfacwr' U,C.law(Chap¢r9 Sq.Ft. Floor Area °� 't1NValuation y�$ (commencing with Section 7")of Division 3 of the Business and Professions Code)or Q .. that he is exempt remfrOm and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of er Occupancy Type not mom Nan five hundred dollars(5500). T,u owner of the pmpenX or mY CMPloYces wish wages u Noir wlc eompensauan, will do the work.and Ncswctum is not intended oroffcred forsale(SCc.]044,Business Required Inspections and Professions Codc:The Coto nuacfs Lim.Law e dors not apply he an owner of q P property who build4orimpmves thereon,and who does such wart himself or through his own employes,provided that such improvements tie not intended oroRered rot We.If. however,the building or improvement is sold within one year of completion,the owner builder will have the burden of proving that he did not build or improve for purpose of We.). 1,as owner of Ne property,am exclusively contracting with licensed contractors to Lmct the pmjcct(Sec.)044,Business and Professions Cade)The Contnemes Li- cense Law does not apply 10 an owner of property who builds or improves thereon,and, Who contracts for welt projects with a conuzetor(s)licensed Durwam to the Contractor's License Law. . ❑ tom aero tender sec. _ .B k P C for this mown Owner Data�41�45 O C COIv ENS ION DECLARATION Ihereby aRrm der penalty of perjury one of the following declarations: 1 ham and will meimain a CeeNeam of Cortical to self-mimic fm Wmkcr's Compen- sation,as provided for by section 3700 of the Labor Code,for fee performance of dtc work for which this permit is issued. I have and will maintain WOrkar's Compemnion Insurer¢,as mquimd by Section 3700 of the labor Cade,for the perfomeanm of the work for which Nis Permit is issued. My Workers Com pereauon Insurance canter and Policy number am: Czricr. - Polity No,: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This senion need not becompleted little Permit is for one hundred dollars(SI W) or Ings.) 1 ccmfv that in the pcffmmonce of the work for which this Pcon t is issued,)shat not employ any person in any manner so as to!Tme subjat to Rworkers�GgsOperl tion Laws of Califomia.Date !T I y1Et1 Appiicom A A„ n NOTICETO APPLICANT:If.of er making1b s c lr{i c Ption,you should become subject to the Worker's Compensation pons of the r Code,you must .J O forthwith comply with such pfnvisimu of this Permit shall the themed conked. Z " CONSTRUCTION LENDING AGENCY F 4 IMreby affirm deal then is a eoesuuction lending agency for the performance of rL> the work fof which this permit is issued(See 3D91,Ci,C.) V] A L<ndcr's Name 0. n Lenders Address U C) I certify that I have mad this application and scam that to chose information is (2, co rect.I agree to comply wit all city and county ordinances and sum laws misting to 0U building construction,and hereby authorim repescmativu of dor City to enter upon the Fkl move-mentioned property for inspection purposes 0. (We)agree to give,indemnify ant keep harmless the City of Cupertino against Fto liabilitmajudgmenca,coms and a ikirgea which may in any way accrue allies said City U in consequence of to granting of this permit. APPLICANT LINIIERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date s— SOURCERECUL TIONS n - /�/ Signature �� Re-roofs Signatureof Applin UCo actor Date HAZ RDOUS MATERIA DISCLOSURE 'Type of Roof Will the applicant or tutu¢building occupant atom or handle harallous mamdal az denecd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety adc.Section 25332(x)? ❑Y All roofs shall be inspected prior to any roofing material being installed. Nu Will the applicant of tum building occupant uta equipment m dcvias which If a roof is installed without first obtaining an inspection,I agree to remove it hanodous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Disvim4 ❑Yes No Thaw mad the haaardsxu amdalsrequimrncnts under Chap¢r6.95ofNSCalifof- nis Health&Safety Code,Steuom 25505,25533 and 25534.1 understand that ifthe building docs not Currently have a tonant,tat it u my fupomibility to noufy the o¢upon of the mquimmcnks which mux met priortoissu hof a CCmfl,Cate of Occu array. Signature of Applicant Date Owner or authorized agent - Dom C All roof coverings to be Class"B" or better Community Development a e 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 � CITY OF Fax(408)777-3333 UPEI�TINO Building De zutment JOB ADDRESS: PERMIT # OWNER'S NAME: 1— PHONE # GENERAL CONTRACTOR: FAX # 1,10 Zjq I am not using any subcontractors: 24 U Signatie 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 C Owner/C tractor Signature Date CITY OF CUPERTINO TEMP POWER /n�°"/4;� SCITYIG� CUPEkINO PERMIT APPLICATION FORM APN # Date: 3�Id -�4 -03 7 Building Address: /O) t( Owner's Name: / NN CGt, Phone#: f�/S-),7 77 9(li t Contractor: L Phone: License #: �� U� ilii Idw Contact: Phone: Cupertino Business License #: L INCk aos ss�� Building Permit Info: /J Elect ❑ Job Description: Residential Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group / BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING a