06050137 CITY OF CUPERTINO T
BUILDING DIVISION PERMIT �CON1CTR ;. MATId
BUILDING ADDRESS: VICKIE PENG PERMIT NO.06050137
10038 ORANGE AV
OWNER'S NAME: PERMIT LSUE DATE
VICKIE PENG 17 2006
NE: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUIIDING PERMIT INFO
BLDG ELECT PLUMB MECH
i00 LICENSED CONTRACPOWS DECLARATION 706 DESCTI O
U I duchy affirm Net 1 am fucvod intim nd fimf s of Chapter 9(commencing P �����
t p�a withllto=]dAffect.""A'onJo(tM Budxvand Profrssiav Code,andmyliccnse is R
±n„ lofanfarceamercva TEMPORARY POWER POLE
y u�Z Lice Class Lin,p
_Conaraclaor
ARCall It,717Sum DECLARATION JUN 47— 200x,
I
'9' 1 understand my plans shall bused as public ruprJa MV
>yU
`01 Licensed Pm@ssianal
OWNER-BUILDER DECLARATION g l p���s as g7 �prgyA
iE I Melly a1Brm on I em exempt from the Canwctols :Any c taw(or tb � ■ILD I N�.C' O
❑O following moon.(Scotian 703 L5,Business and Professiuv GWC:Any city or county V Y
Sm ff which requires a Permit w crostrucl altar.W prove.domaiLsh.Ar repair any anucws
_ivi prior or its issuance.Also requires the Applicant(Orsuch permit to rile a signed suicmem
< Nat he is licensed pursuant o Nc pmvisimuof tb Canuactor's U..tAW(Chap¢r 9 Sq.Ft.Floor Area Valuation
ReO (commencing with Section NXX)9 Division 3 oftb Business and Professions Code)or
u Out he is exempt therefrom and the bases for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects do,applicant w a civil penalty of Rifiviftir u Occupancy Type
no,mote Nan five hundred dollar(5500).
O I,At owner of the propmty,or my amployees with wages as Neo to cnmpensadan.
will do th.work.and ds mumure is not intended or offered for sale(Ste.7W.Businen Required Inspections
and Professious Code:The Conmvnnfs Limsce Law don eat apply w an Owner of q P
property who Wilds or improves thereon,and who doessuch wink himulfmduuugh his
awn employees.provided Nat such improvements tie notintended aro@red for sale.If.
however.Ne Wilding or improvement is sold within one year of completion.the owner.
Wilder will have the Widen of proving Nat he did net build or improve for purpose or .
sale..
I.a owner of the pmpeny,am exclusively contracting with Bceused contractors to
vwn Ne project(Sec.7044,Business and Profussious COde:)The Commuc rY Li-
cene taw don not apply An an owner of pmpeary wins Wilds or improves thareon,and
who contracts for such pmjccu with a emonscwr(s)licensed pursuant An Ne Comrutars
License taw.
❑Ism exempt
u/nd'm_59r) .B&PC for this mason
Owner. . _iLLyRIDIe 4
WOR4.ER'S COI PENSA N DECLARATION
I bemby aRrm under penalty Of perjury,one of tb following dalantiov:
Iha.e andwill for byneCmtiriaw Of Covemw seule.for for
were for
as provided(m ra Section 3700 0!the Lobar Code,far the performance of Ne
work for which Nis permit is issued
❑1 bave and will maintain Worktei Compensation Insurance,as required by Section
37W of the Labor Code.for Ne performance Close wart for which this permit is issued.
My Warkets Compeass ion Warrancc artier and Policy numb,Are
Carrie. Policy No.:
CER77FICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE r
Crhes=I.need nut becamplemd if ft Permit is fa one hundred dollars($100)
or leu)
I certify that in the perfarman a Of the work for whit is permit is issued.1 shall not
cmpioyanypermniri ny mut em m Ne Worlam'Compensation
fAwsofCalifamia.Dat
e _
Applicant
NOTICE TO APPLICANT:If,after making this Canblieum O Exen n,youshould
Wcome subject ro the Worker's Compensation provisions of Ne labor Code,you mesa
.JO foMwiN amply with such provisions m this Permit shall tic moA k
decrerocd.
Z r CONSTRUCTION LENDING AGENCY
[—� I hereby aRm Out Nos is a eonatrta:tion lending agency rot Use performance of
D: >
the work for whim this permit is issued(Sec.3097.Civ.C.)
GQ lenders Name
7 z Lendee's Address .
U O 1 certify Nat I have read the application and scale that the aWve information is
Fconed.l agree 10 comply with ill city and county ordinances and sum laws relating in
OU building conswction,and hereby authorim representatives of this city to cover upon the
r OW. above mentioned pmpeny rot inspection puryoses.
(We)ague to save,indcmni fy and keep hmmlcss the City of Cupertino against
fMVI liabilities.judgments.ecu and expenses which may to my way accrue against=it City
U Z in consequent.of the S.It.&of this Permit.
APPLICANT UNDERS'rAPPS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �.
SOURCE REG j.7,ONS. /
� t ( �� Re-roofs "—
SignmusofAppli oen��n�mr— V v' s f Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wit]the applicant Or future Wilding occupant mom or handle harallous material
As deRxd by the Captation Municipal Code.Chapter 9.11.and the Halth and Safety
Code,Section lssa(a)T
C3 Y. All roofs shall be inspected prior to any roofing material being Installed.
Will tb appli=l or future Wilding oavpans esu equipment Or tkrviccs which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha,Ardnus or contaminants derineof by the Bay Area Air Quality Management all new materials for inspection.
District?
❑yes u
I have sad the hewed ms mameials requirements under Chnu,0.95 oftM Califor-
his Health&Safmy Code,Suctions 15505,25533 and 25534.1 ma ersund thmif N.Wilding
docsnot cumemly have a snarl Na t m my respovibility w notify de occupant of de
rngaimmcntsWhich m metFri,in a n .cw0ateofrep Signature of Applicant Dale
r I
p
Owner.raathori,ed.gtnt am IAll roof coverings to be Class "B"or better
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35717059 . 00
DATE ISSUED. . . . . . . : 05/17/2006
RECEIPT 4 . . . . . . . . . : 34431
REFERENCE ID # . . . : 06050137
SITE ADDRESS . . . . . : 10038 ORANGE AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : VICKIE PENG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : VICKIE PENG
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : VICKIE PENG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
*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 .47 458 .
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO
IFEYIP POWER
-
CITY OF
ScUH TING PERMIT APPLICATION FORM
APN # Date: /
Building Address:
o"D it
Owner's Name: Phone 4: L
Contractor: Phone: License #:
Contact: Ul Phone: per—/ / Cupertino Business License#:
Q
Building Permit Info:
Elect ❑
Job Description:
TL�lav Ow-P/Z 0 �Q .
Residential ❑ Commercia ❑
Cost of Project:
v �-
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
f EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•