05100188 CIT`:OF CUPERTINO �a'
BUILDING DIVISION PERMITaCONTRAC`TORINFQRMATION �,>
BUILDING ADDRESS: NICE & RIGHT CONSTRUCTION 5154ITNRL 05100188
1029S MENHART III
„W NER'S NAME: PERMIT ISSUE DATE
CHIANG SHIN T E
. NE: SANITARY NO. CONTROL NO.
(408) 861-0928
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� (� 0
=oo LICENSED CONTRACTOR'S DECLARATION
1 Mmby affirm Nal I am licensed under provisions of Chapter 9(COmmon"ng Job Description
with Scction7IX1U)of Divi'on 3olthc Busincvs ark Pro Tuna Cadc,and I mm is FINALE notions sneer, t. TEMPORARY POWER B�gl(ep�`�C4•■ �®
Ucenm Claze Lk.4 6
�_p Dan Camnctor
i� \, A ITECT'S DECLARATION
z� I OndcrstanJ y plana Mall M used u public mores
;Cr^ Licensed Professional NOV �. 1UU[ _
5 OWNER-BUILDER DECLARATION aa�t
+0 0 I Mr .(Bens that 11. exempt from the cssions oro License Law for the
my
p O following emb miss .(Section irm that
](I am Business and Professions Cods:Any city w county
K S� which requires a permit to construct.alcor,improve,demolish,m mrsur any structure lau ! ,(:i F $750
LZi prior u,its issuance,also requires the applicant for such pctmiuo file a signed msmmcnt
ESG
that M is liecitsed pursuml to the provisions of ux,Courauctor's lJosone Law(Chapter 9 Sq.FL Floor Area -" otl \J Valuation
�~S (commcmingwith Sation7")of Division3ofU Busineesand Proressions Coul
_ Nat M is exempt therefrom and tM hese for the alleged exemption.Any violation of
Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of
not mom Nen firs hundred dollar(550OL 5 0 0 Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7144,Business
ane Professions code:The:Conuacmri License Law does not apply to in owner of Required Inspections
propery who buildsor improves common,andwho doessuch work himselforduough his
own employess,provided that such improsemenu are not in ended oroRered formic.If,
however.the building or impmvemmt is mid within one year of complchon.the owner.
Wilder will have Ne burden of proving that he did not Wild m improve for puryose of
sale.).
1,as owner of she property,am exclusively contracting with licensed contractors to
construct IM pmject(Sec.7044.Business and Professions Code:)no Contractors Li-
ceme Law docs not apply in in owner of property who builds or improves daemon,and
who contracts for such projects with a conuaaaKs)licensed puruam to lM Comtnctors
LkUtse law.
lam eaemrt under See. ,B&P C for this reason
caner Dan
WORKER'S COMPENSATION DECLARATION
I hereby aR,m under penalty of perjury one of dm following decorations:
❑Ihsrc and will mainuina Cerufinm of Consenuo self-insumforWohersCompcn-
.sation,az provided for by Seeman 3700 of tM ISM,Code,for tM peRormv,a of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as mquimd by Section
37Mof NC VD r Ccdc,fmlMperfEamce I thc work for which this Permit is issued.
My Worker's n ensation Insunn auric one Policy number art: /
Cartier. Olicy No.: i
C IFIL OFEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
ser loss.)(Thu sectio recd not he completed if the permit is for ane hundred"Hass(SIM)
I eemty that in the performance of the work for which this permit is issued,I Moll not
employ any person in any m unarm az to become subject to the Worker'Compensation
Laws of California.Dan
Applicant
NOTICE TO APPLICANT:If,after making this Cenifinn Of Exemption,you should
become subject to the Wmkcr3 compensation provisions of dm Labor Cods,you must
.,0 forthwith comply with such provisima or Nim permit Mall M doomed revnkcd.
r.. CONSTRUCTION LENDING AGENCY
r l hereby affirm NU there is a construction lendinga Ithe'
.)enc Y or rcrformarmc of
W' the work for which this permit is issued(Sec.3097.Civ,C.)
ALender's
z Leader's Add. .
U Q 1 certify that 1 Ian read Nis application and sato Nat do aMst inforcroom ca
correct 1 agree m comply with all city me county omimmsm and sun laws relating to
pU buil ding consvunion,ane here by authorim rePrommativts of Nim city to enter upon the
Move-mentioned property for inspection purposes.
04 (We)agree to save,indemnify and keep harmless the City of Cupertino against
W) liabilities judgments,costs and expenses which may in my way&„me against mid City
t.)z in con((xCCquerrec of the grm'ing 0""1"
f O S this permit.
r OURtE RRULAT1UNDER0�1'Sl7 ND W MPLY WI LL NON-POINT Issued by:App
Date -��r �d �'
60
Stgn. uclacarmLon orD �-� Re-roofsole
,Z .
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle havudous material
as defined by Ne Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,S„tinn 85374?
Ores ❑No All roofs shall be inspected prior to any roofing material being installed.
Will the.,pliant or room building occupant use equipment or do,!.which If a roof is installed without first obtaining an inspection,I agree to remove
f omit havardous air em mminana az defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes r-1 No
I have mad Ne ha,amrms materials mquiaemcnts under charm,6.95 of the Califm-
niaHralth&S Code,Sesuons 8505.75533 and 8534.1 underUUM thuirde Wilding
Jccs t<urcntl Inst a mune Nat it u my ihnity to hod Ne occupant of the
mya omens wok mast Dc rnr nc ¢am or Occur Signature of Applicant Date
L0 L°
Gwn ode ag,m
One All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
JCupertino CA 95014
Telephone(408)777-3228
CIN OF Fax(408) 777-3333
JPEkTINO
Building De utment
JOB ADDRESS: i. OZq r - M eqqhar� PERMTT (
#V`—O(i bo
OWNER'S NAME: L J PHONE # J 7-0 ro
GENERAL CONTRACTOR: - FAX #
I am not using any subcontractors: -- (Nt/ eo,Z
Signature Date
Please check applicable subcontractors and complete the following ' o=ation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
41 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
CITY OF CUPERTINO
Z� 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 37515032.00
DATE ISSUED. . . . . . . : 10/24/2005
RECEIPT #. . . . . . . . . : 31708
REFERENCE ID # . . . : 05100188
SITE ADDRESS . . . . . : 10295 MENHART LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHIANG SHIN TIEN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : HAN CHIEH LIN
CONTRACTOR . . . . . . . : JIA HUO YU LIC # 23446
COMPANY . . . . . . . . . . : NICE & RIGHT CONSTRUCTION CO
ADDRESS . . . . . . . . . . : 10663 SANTA LUCIA RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 861-0928
•
FEE 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 1430
TOTAL RECEIPT 100.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
CITY OF CUPERTINO
TEMP POWER
C UPERTINO PERMIT APPLICATION FORM
APN # �C5 /<—o ,3 Date: I O\Z t `'` p�
Building Address: Z� /� L LV T
Owner's Name: C I `�N iv 6�L �� l� `eA Phone #: t Z� Z�
l/�t ,t,
Contractor: IV (Ce (_ p l Phone: �f 2o5-PgTD License #:
Contact: NAT� Phone: `f/, vry �kyj_ "d Cupertino Business License #:
Building Permit Info: LQ
Elect � ��jl �� -rC.K/l 1-;b�
Job Description:
Residential Commercial ❑
Cost of Project: S� 0
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING