08040173 CITY OF CUPERTINO � ,t ', .a +' '*-�
BUILDING DIVISION PERT .,oNTRACTO'RINFURMATIf1N•&
BUILpIr�G gORETS: PERMR NO.
1VlSbl PHAR LAP DR D & D CONSTRUCTION 08040173
OWNER'S NAME: PERMIT ISSUE DATE
CHARLES MA 1447 HAMPTON DR 04/24/2008
NE: SANITARY NO. CONTROL NO.
ARCHnECC/ENGINEEK: BUILDING PERMIT INFO
TEMP POWER O O PLUMB O
30o LICENSED CONTRACTORS DECLARATION Ib Description
1 hemby Mm Wson CSCrIpt 1 lied motor provisions of Chapter 9(commencing
ii with Section 7")o'Division 2 offt Busirws and Prormmed,Code,and my liceste is
=N in full forte andclrea
$z Llceam LIC.
Y .
Dao: Contractor
S ARCHITECT'S DECLARATION _
I undewnd my pan"I no used as public ocords
sed Licensed Profnsianal
5 OWNER-BUILDER DECLARATION
Con clo
E a 53 1 hereby amm Nn 1 ern nealn Item the ConUastCo License Law for J,c
O O whichfolhoving moon. panda t RD I3,Realness and Prooc.do inns Cale:Any my m county
S which mqusra•permit re rectums;
alter,improve.h pCndit t or a pair ed awdum
prior mit,tensed c,aroroqulrn tlse applicant for suchpemi.m0less,". naemcm
�<
thathepursuant 7 the gDi,iio Provisions.(the Contractor..ssard rase Uw(Chapler9 Sq.Ft. Floor Area Valuation
9 (cam a is exa with Section,70013)and mDiasis F J order Bminmand on.Any Proksohna Cade)or
Nos he a esempt therefrom and the but fm the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subject,the applicant M a civil penalty of APN Number Occupancy Type
rot wort Jun live nundmd dollars(5500).
Luow orL( iepoputy.milmlin nded .ff.Wfu mer sutecmnpenuden,
wW do thewmt.and thehe C= m .Lt.dmawdo fact Ptly in
Hou ten
uW Professions
code The CoabseroYs Liven=law dons rot apply m an owner of Required Inspections
yapertY vho bui14 a improwa thereon.and w ha tion seen wan himacif m thrmgh hba
awn emPloym,providW Nat such imProwmana are nos inteadadmoRerad fmssi,R, '
handle, theave Bat arImPmwmvinbasoldwithinoro year ofmmPicdfortheowner-
buildn will low Ne barman a(proHng the k did rot ddld ar Improve for pumase of
ole.).
raj.as ower of the Property am exclusively mama ring with licensed conlrumra a
contNet the project(Sec.7016,Basin=add Pro(minns Coda:)The Conuanmr's U.
Gem Taw does not apply m an owner of property who build$or Improve Demon.and,
who contracts for such projects with a commor(s)licensed pur n a,t m the Contracces
License Law.
❑Ion /t9n der See .B d PCfm Jdsmamn /1f,
Owner /fit. 5C PFNSATIOND LARATION �+
I ncreby aRim under penalty of perjury oro of the following declaradmsc
1 have and will maintain aCotiQou of Consent in self-iesurt for Woftes Comprn
action,u provided for by Section 3]D[1 of the Labor Code.for f peAamatc of the
van for which this Permit is hatted.
❑1 law and will maintain Wmkces Compensation Insurance,as acquired by Section
3700 ofthe Mbar Code,for the performance ofthe won for which the permit is luted '
My Waiter's Comlemadun Insurance renin and Polley number am:
Cartier. Policy No.:'
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crabs seNm and not bccampleu:d if six Ferris is forum hundeeddoJm(SIM)
or leu)
I comfy thus In the perforeac of the won for which NH perch Is banned I dull nm
employ anYPerson in rsuumbttome subjectathe Wodrtn'Com m
Lswsaf Gllfomra.,Da (� _ J
Appliant
NOTICE TO APP .IL after &164 thin crti0ate mpoon, should
become subject m the wmkm'a Compemda ''o the Lana Code you must
.,O forthwith comply with such Provision m this pewit all be deemed owtrd
„'Zy� CONSTRUCTION LENDING AGENCY
[-v I herobraRim the Jere is a construction lendingagenpy for the perrumameof
f]i > the whets for which to.permit Is honed(Sec.3097,Ch.C.)
W Landow Name
az lender's Add. '
U Q I comfy Nat 1 Mw read Ws aWlicadon and state that f above immmsdon in
W comm I agree m comply with all city and county ordinances and said lawn misting in
(] building construction.and hereby awhorie mpnedetacm of this city in enterupon the
W ahove-mentioned Property for inspection purpot
06 (We)&Vcc to sew,indemnify and trop harmless the City of Cupertino against
res IixblliJns,judgmcros.coat and upenms which may N any way emu against said Cry
V Z in conuyuvee of the Looting of this Pamir. ,sr
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON i POINT Issued by:S4-k Z Date
E R USLI
SOURCL�TIONS.
Z o Re-roofs
sin o —
g pP t HAZA M' AIS DISCLOSURE
Data Type of Roof
WIII th$applicant Or rump building occupant some or handle huamuu material
as detlned by the Cupenino Municipal Code.Chapter 9.12.and the Health and Safety
code,Section 2533:(a)7 ,,YY o
C]
All roofs shall be inspected prior to any roofing material being installed.
t
Yea uri
Will the applicant or future building occupant one equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
h cordon air contsminan s as defined by the Bay Am Air Quality Management all new materials for inspection.
❑Yea
than road f haumms maenalsmquimmenu unhr Chaper6.95 ofthe Califor-
na HWthk Safay Cod,Secdw 25505,25533 uv125534.I uruYvsmtd Junifth boldin{
does not currently haw a decant,Jus it a my nsyorschllity be notify Ne occupant of f
mquimmentsw ' muvbe me 'arm ivuvc ora Cmifeat or ignature of Applicant Date
Oweerma irxdgcnt Dal All roof coverings to be Class'%¢"or better
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: B1k: Lot:
APN . . . . . . . . : 32618026 . 00
DATE ISSUED. . . . . . . : 04/24/2008
RECEIPT # . . . . . . . . . : BS000004566
REFERENCE ID # . . . : 08040173
SITE ADDRESS . . . . . : 10061 PHAR LAP DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHARLES MA
ADDRESS . . . . . . . . . . : 10061 PHAR LAP DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1111
RECEIVED FROM . . . . : DEBBIE PANG
CONTRACTOR . . . . . . . : ENDE WU LIC # 23939
COMPANY . . . . . . . . . . : D & D CONSTRUCTION
ADDRESS . . . . . . . . . . : 1447 HAMPTON DR
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087
TELEPHONE . . . . . . . . : (408) 666-5298
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 70. 00 0. 50 0. 00 0 .50 0. 00
1EPERMITFE FLAT RATE 1 . 00 40.79 0. 00 40 .79 0. 00
1FRT2001K UNITS 1 . 00 61. 19 0. 00 61 .19 0. 00
------ ------- --------
TOTAL PERMIT 102 .48 0. 00 102 .48 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 102 .48
---------------
TOTAL RECEIPT 102 :48
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- ---------------------------- -------- ----------------------------
402
- - ----------
402 TEMPORARY POWER
CITY OF CUPERTINO
TEMP POWER
® CUPEklYINO PERMIT APPLICATION FORM
6gQ1 -73
APN # Date:
L O .oc� - o
Building Address:
Owner's Name: Phone #:
Contractor: Phone #:
EFax #: b I
Contact: Phone #:
Contractor License #: 7? (p I G
Cupertino Business License #: �3 l
Job Description:
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑
Residential Commercial ❑
Valuation (cost of project):
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>IK Res. Temp Power>1K E 1REAP14
Amps
IERT<200 Res. Temp Power<200 E
Amps
i IERT2001K Res. Temp Power 200-1K E
Amps
IEPERMITFE Electric Permit Issuance E
/ IELCPLNCK Electric Plan Check E
/ IBSEISMICR Seismic Residential B
CITY OF CUPERTINO
,.
TEMP POWER
CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
IECT<200 Commercial Temp Power E
<200 Amps
IECT>IK Commercial Temp Power E
>1KAm s
IECT2001K Commercial Temp Power E
100-1 K Amps
1TRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
g�UPERJINO
Building De artment
JOB ADDRESS: 1 eU� �o r La 10 9-A' PERMIT #
OWNER'S NAME: C PHONE - 3,
GENERAL CONTRACTOR: FAX #
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
iGlass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
er/C trac lgnae Date