08050085 CITY OF CUPERTINOf/'-r
BUILDING DIVISION PERMIT ��Co1�iTRAGTUR; 'S`^OAIV,Lt.
BUILDING ADO FSS: PERMR NO.
1876 LOREE AVE BAY CONSTRUCTION CO 08050085
OWNER'S NAME: PERMTT ISSUE DATE
VIN LUONG 924 KENNETH AVE 05/09/2008
NE: (408) 590-4263 SANrIARY NO. CONTROL NO.
ARCHITECT,ENGTNEER: BUILDING PERMIT INFO
BLDG EIEC? PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION Job Description
u headlim
1 hemby afrion r 1 am nxd under provident; I of chapter 9(commencing P
4 W with Sustain 7OnM tit Dividon 3ofde Business;anQProfsekns Code,and my license is TEMP POWER POLE
m full force end off 'L '7 / j�
din Licerue Class Lk.# N�4�''2�/1_ .
din
— DateConlr ECLApA T
o fl ARCHf1ECfS ossein, ATRIP %
1 u nhos and my plans"I be used u public recmrtls
6
G res
Licensed PmreasienJ
3 OWNE mexcinDE0.DECLARATION
COI hcmbY.(Sero than 11.cumpt f an h Cssions o License Law for ne
KCOO which hu reason.(Schon 710 op B.id nS and Rofesduns Cede:Any city or monis,
m which mquima a permit m conswn.Jten improve.demolish,m mpalr any swcuro
°=< prior to its issuance,also,rcquima the applieam for such Permit o file a signed statement
that be,u licensed pursuant to the provisions of do Conmclm's license Law(Chaptm 9 Sq.Ft.Floor AreaValuation
I ig (commencing with Section 7000)of Division 5 of line BusinessBusinand Prefnsi $ons Code)or —" 200
.- that he is ewnpt therefrom and the basis for the alleged eaemption Any violation of
Section 7071.5 by any,applicant for a permit subjects the applicant in a civil penalty of Number Occupancy
not mise then five hundred dallan(SM 37515026 ( p y Type
o
I,u owns of clic prepeny,a my wpleycn with wgo o sire"vxk comp:wdon,
will dethewoh andthe he ctontranors LMed er oReW(,role(Sec.M a r,marms Of
and erywh ons Cede The contractors Liana Vw don rot apply lf rd owner N Required Inspections
pmpesywho bisIla orimprewcat
mn,and who doesstilwank himselfedthrough his
owe employees,preNdd"such ire semmu in rot intended moQamd for ale If.
however,th.WildingmimpvemlI.sold
-
within one year ofcompletion,the poser-
bd'.). will haw tie buNm o[proving that K did rot bulk a Impose for purpose of
chic.).
0 1,u ow.of rhe protest,w exclusively conhaaing with licensed mntranms in
mnstmcl the project(Sec.7014.Buviness and Pmfossiom Code)The CmOaem'a V- .
cense Law don not appy as an owner of property who builds or improves ibemon,and,
who cmuacu for such Pmjeets with a conuaeof(s)licensed pursuant m tic Cmumacrofs -
IJmnx Law.
olwtemptumm See .Bd PCforibia.
D. Date
WORKER'S COMPENSATION DECLARATION
barely a1Brne under penalty of perjury,oro of Ila following declaration:
w and will..low.•Ceri ficsu of Oup e,an self-home for worke'.compeo-
radon,as provided for by Secli m 3700 of the Labor Coda,for the peAormetce of the
work for which this permit is issued.
and will maintain Wore.Compensation insurance,as rationed by Section
7 of Ne labor Cade,fa tie Pert9rrname olds vert fa which this Permit u issued. '
My Workers ComPensadm Iman a carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu account teed mtbe completed 9 the permit u ferenchundaddoBats(5100)
car leu)
1 certify,Will in the pefonnatcc of Is,rob for which thk permit is Wood.I shall am
employ any poison in any manmrSw. ep(I tbjat to the Worken'Cempense0m
lawn of CJIforNL Date
Applicant
NOTICE TO APPLI�Mr making this Certificate of Evwption,you owl;
become subject in Ne Wrmk s Componsation previsions of the Ulan Code,you mute
.J O forthwith comply with such provisions or Nu Permit shall be deemnd revoked.
z r CONSTRUCTION LENDING AGENCY
E-v� I hereby affirm this dice is a corutrcimt lending agency for the Performance of
site wmk for which this permit is issued(Sec.31171,Civ,C.)
W Q Lender's Name
Z Under,Md.
U O 1 cedfy,the I have rail this application and sutra the the above infomatiun u
LL corm 1 agree to comply with all city and county aNinances and sac laws mhum:in
Q Wilding consuueim,and hereby authorise repmaenu im of this city in anter upon the
'yaW.-mcndimest pmpcny,for inspection purposes
(We)agree m raw,indemnify and keep harm4o de City of Cupertino against
iVi liabilities,judgments.tints and catchiest which may in any way acerae Mittal Md City
U Z in cottscquence of the granting of this Perot.
'-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of Apphicano'Cmuaeor Date Re-roofs _c
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tic applicant or forum building occupant sum,m Nndk hhsamoo nobi
as deOned by the Cupertino Municipal Cote.Chapter 9.13,and the Health and Safety
Code.Section 25532(.)7 g�Nn All roofs shall be inspected nor to an roofing material being installed.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hvaNnns air contominanu an dcfrmd by the Bay Area Air Q ahiy Management all new materials for inspection.
O Yea XNu
I havereal the hvatduu materialsmquirements underCMpkr 6.93 of the Glifar-
nia nithhSJelyCodu Senior25505.25533and23534.1undeaatuthatirdc building
dose rut currently have•Lmanl,than It is my responsibility On notify the occupant of the
regmmmenswhkhmue be,mel poiormixnaau Isla eerti0cae.lOccu sent'. Signature of Applicant Date
Dw c,orimmmi reagent �> Date All roof coverings to be Class';q"or better
CITY OF CUPERTINO
• 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37515026 . 00
DATE ISSUED. . . . . . . : 05/09/2008
RECEIPT # . . . . . . . . . : BS000004718
REFERENCE ID # . . . : 08050085
SITE ADDRESS . . . . . : 18760 LOREE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VIN LUONG
ADDRESS . . . . . . . . . . : 18760 LOREE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : CHONG HWI KIM
CONTRACTOR . . . . . . . : KIM, CHONG HWI LIC # 20498
COMPANY . . . . . . . . . . : BAY CONSTRUCTION CO
ADDRESS . . . . . . . . . . : 924 KENNETH AVE
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 590-4263
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 200 . 00 0_,. 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 .00 0 . 00 110 . 00 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
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0. 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 232 . 87 0 . 00 232 . 87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 232 . 87 VISA
---------------
TOTAL RECEIPT 232 " 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER
0s 2
6) 0
CITY OF CUPERTINO
TEMP POWER
CUPEkTINO PERMIT APPLICATION FORM
APN # 375-15-026, (.0 Date: 05-08 08
Buildin, Address:
18760 LOREE AVE , CUPERTINO, CA 95014
Owner's Name: Phone It:
NGHIEM T. LUONG & VINH T. LUONG 408-829-2139
Contractor: Phone #:
Bca-yusfi u #,,�1 -r.c Fait k 4-c e - 2 9�- eM
Contact: Phone #:
t rn C-gVc .ANCT 44 _ Spa _a X63
Contractor License #: Z� 3 J 3 aoq(7
Cupertino Business License #: S„, SSC
• Job Description: DEMO (E) 1 -STORY BLDG.. BUILD (N) 1 -STORY WD. BLDG.
Is the proicct in the Wildland- Urban Interrace Fire Area? Yes ❑ No X❑
Residential ❑X Commercial ❑
Valuation (cyst eject):
Quantity Fee 11) Fee Description Fee Group Permit Type
IERT>IK Res. Temp Power P. 112E;�PI i
Amps
/ I ERT<200 Res. Temp Power<200 E --^--
Amps
I IRT2001 K Res. Temp Power 200-1 K E
Amps
I EPERMI CFf Electric Permit Issuance !
1 ELC'PLNCK Electric Plan Check E
. IBSI_:ISMICR Seismic Residential B
CITY OF CUPERTINO
• TEMP POWER
CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Typc
IBSEISMICO Scismicconuncrcial B ICEA11I4
I ICT<200 Commercial Temp Power I
<200 Amps
I ECT>I K Commercial Temp Power E
>I K Amps
I ECT2001 K Commercial Temp Power E
100-1 K Amps
ITRAVDOC Travcl & Documentation B
Fee
IBUSLIC Business License B
•
Community Development
10300 Torre Avenue
iF ✓ Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: 0,4 PERMIT # C��O �� U
6:'' 60 �o QFC GC- , Cc, �zrivn K0 G
OWNER'S NAME: AI H/-M7, Luo NC � V'M PHONE # _dQ
GENERAL CONTRACTOR: one 4j uQ 6 FAX #V IL/2
2
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
Owner/Contractor Signature Date