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BUILVING DIVISION PERMIT
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Bu1LDINCADDRESS:
NICE & RIGHT CONSTRUCTION
Y "f NO.06050120
21839 LOMITA AVE
OWNER'S NAME:
PERMIT ISSUE DATE
GARY LI
10663 SANTA LUCIA RD
05/15/2006
NE:
SANITARY NO. CONTROL NO.
(408)861-0928
ARCHIIECDENGINEER:
BUILDING PERMIT INFO
ELECT 'PLUMB MECH
EQ
LICENSED CONTRACTORS DECLARATION
lob Descriti
P
I omby aRtm Nu 1 sm licensed under provisions of Chapter 9 (commencing
with Section TOMB afDividan 3 of the Business and Pwhasioru Code. AM my Ikeun la
I. fail foam. and effect.R21 4�S
INSTALL TEMPORARY POWER POLEMAY�
l,cers Lit P
x nu
Dew Caatmwr
Q ZUUG
ARCHITECT'S DECLARATION
tJ
(understand my glens Mall be used as public rtcords
A �{ I�La� ,v��
BUI(DI
IL
Licensed Profecom.al
OW NER-BUIIDER DECLARATION
1 Wm(firm 1 em eanmpl from Ne G.n'raclCo Lien law far Ne
y c
71D l.i Rumness and iau Caw: Any city or county
following mason. on
$200 2 0 0
'7
uircaa(Section
are, do
which equlrea a email w cnnmm4 after. Improve,
,permit . or eealr any
Sq. FI. Floor Area
Valuation
prior b, issuance. mm Acquires larsu omnant
far Con rector' wire s Law (Chapter
IW -Pions Conus,
tothm o
Ute heI,cued pumuetwthepavisiou of dial,
l p
andcmelaw(Chape9
Cade)or
of the BusUtuuMon.
th Diais
Myavi
pttSenior7000)
fear
Nat he b uempt thertfmm and the bub ra Ne alleged esnnptloa My mabUon of
that
APrq Nidrfibrcr
Occupancy Type
Scenes 7031.5 by any spiritual for a permit labj¢u the applicant to a civil penalty of
not mom than firs hundred dollars (5500).
1, u awns of the property. army employeeswith "Flu Nets wteeanpem,Uon.
Required Inspections
q P
win m thewarkand Nesuunurt bnctktendedaraRucd forsalc (Sm. TON, Business
and Professions code: Tha conmctor, Lkeme Law, aces tot apply w an names or
progeny who builds or impmvestimmen, and wbod.,..hwmk himself arthrough his
own employees, ptavided thataueh ImprowmewN art notinwnded oraQered fm,ale B,
he... the Wilding m improvement is sold within 0. year of mmplWon. Ne owner-
builhr will haw Ne burden of p ming Na' he did nm buiki m improve fm purpose of
ark.).
1. u s ownof the properly, am emlusiwly consoled, with Bewared conmcwn, w
uuuct the project (Sec. 7044. Business AM Professions; Code:) The Canmcwrs U-
...-' Isw data mot Apply as an avec of property who Wilds an Impmws f.. red.
who conaam, fm such projeeu with acommuct named personal to the eonmcwrs
License Law.
❑ 1 am exempt under See. . B A P C for this reason
owner i—/ ..-,— � Dat j 6
WORKERS COM SATION DECLARATION
1 thereby air= under penalty of pejury ane offt following dsel-rmomm
.] Thaw ono Ter s -
eCeninrnw of ConcentwCode.
fart
edam cc of
s providedSection 3700 of cite Labor Code. fm the perfoman¢ of Ne
providod far
e& f r mi
work for rM1leb Nis pencil is issued.
❑ I Mw and will maintain Workmes Compensation Ituurar x. As rtquirM by Section
370Dof the LsorCam, for cit performance of the teak fawhich this permit is issued.
'
My Workers Compensation Insurance ¢sic and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
OTB vacuum ¢ed natbecamphoul if ft pcmmit b Forane hundred dollars ($10)
or less.)
1 ¢nify Net in the per(mmao¢ of the work for which Its permit is bound. I "I not
employ any peuon in any memtrmasgbcoangwbjmw Ut warkaY Compensation
Utes of California. Dam // -s'
Applicant
NOTICE TO APPLICANT: If. after making NH Cenitham of Exemption, you should
,moms Subject W the Workers Compensation pmviuom of the Later Coda, you Most
' forthwith comply with such provisions or this permit shall W d¢med mvokcd.
,
ON LENDING AGENCY
CONSTRUCTION
1haehyiBrtn & c agency for the Performance of
thnre4•ed(Sc..
307, Cing
' Na work for which this permit b road (Sc. 7097, Civ. e.)
Pe
Leadices Name
Lm<nmes Add,..:
I cenify that I have read Nis applim des and mw that the move infmmmiun b
v correct 1 sgme to comply with all city and county ordinances and sum laws elating to
building consuuction'and hereby au pori¢ eprtsenmives of this city to cnmr upon'hc
fm impaction
wove-numd.ned property purposes
(We) agree 1m saw. Indemnify and keep hasnlem Ut City of CupaMM -gains'
I Imbilidu, juagmcnu, calm And expenea which may in any any same aIllut laid City
in consequence of Ne grandng of Nis permk
q APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date 6
SOURCE gBG{�LA770NS.
�
! ��
Re -roofs
Type of Roof
Slgn m Appli¢nUCon ter Date
HAZARDOUS MATERIALS DISCLOSURE
Will tit applicant or future building a¢ur mts'om"handle henaaus material
As defined by Ut Cupertino Municipal Code. Chapter 9.13. and the Health and Safety
Cam, Section 35532()7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicwt orf tum building Occupant use equipment or devices which
emit Iuurdous air commolnanu u muncd by that Bay Amo Air Qulhy Management
all new materials for inspection.
DistrinT
•
❑ Yea Nu
Its mad the ha>srdeu materials mquiremesu under Chapmrd.95 ofthe Califor.
niaHNIN'Nicty Cam, Smdou2.5305.25533and25534.1uM WWNulf Nc Wilding
does tot eaeeMy have a tram. Nat It Is my respsulbility st.odly tW occupant of Ne
rcgmemcnu ' muttontt nutuu-ms ,Censlkaw ra/
Signature of Applicant Date
All roof coverings to be Class "B" or better
1a
Own., ar erbad agent Dow'
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35716999.00
DATE ISSUED.......: 05/15/2006
RECEIPT #.........: 34405
REFERENCE ID # ...: 06050120
SITE ADDRESS ......
SUBDIVISION .......
CITY .............:
IMPACT AREA .......
OWNER ............:
ADDRESS ..........:
CITY/STATE/ZIP ...
21839 LOMITA AVE
CUPERTINO
GARY LI
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: SHIRLEY K NG
CONTRACTOR .......: JIA HUO YU LIC # 23446
COMPANY ..........: NICE & RIGHT CONSTRUCTION INC
ADDRESS ..........: 10663 SANTA LUCIA RD
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
TELEPHONE ........: (408)861-0928
�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
----------------------------- ------------------
OTHER 100.47 VISA
TOTAL RECEIPT 100.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--
-------- ----------------------------
103 UFER 304 ROUGH ELECTRICAL
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c
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�CITY OF
UPEkTINO
CI'T'Y OF CUPER T'INO
TEM.P POWER
PERMIT APPLICA'T'ION FORM
()coo,50 120
APN # 551 -1 (0
. _I I q
ELECTRICAL
Date: / S O O
Builth/3
g address: L / P /
ELECTRICAL
BUSLIC
Owner's Name.
L Z
BUILDING
Phone #:
s -666--
Contractor:
R
H &oovs
Phone:
4o - - 0 2
Licens
Z f q SC9-
Contact:
Phone:Cupertino
Business License #:
—O 2
Building Perm4t Info:rJJd�
Elect ❑
Job Description:
Residential Rf
Commercial E]Cost
ofProject:
00
•
Qty. if
Applicable Fee ID
Fee Description
Fee Group
BTEMP
Temporary Power
ELECTRICAL
EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING