08060236 CITY OF CUPERTINOtv° sxo'RF :aa"3
BUIL'DING-DIVISION PERMIT CONTRACTOR INFORMATION[:, _
BUITILJS/iP9R PPERMU NO.
RUNE TREE LN NATIONAL CONSTRUCTION 08060236
OWNER'S NAME: RENTALS PERMrr ISSUE DATE
DAVID HWANG 15319 CHATSWORTH ST. 06/27/2008
ONE:
SANffARY NO. CONTROL NO.
ARCH=1ENGINEER: BUILDING PERMrr INFO
TEMP POWER POLE BO EO PLUMB 0
u O p LICENSED CONTRACTOR'S DECLARATION IOII D05Cil [I00
!V I hereby affirm dist 1 w I'et seal umkr Proisians of Chapmr 9(amtroncing P
with Section 7010)of Division 3aftW Budross and Prefassimu Code.and my licensee
o. in full(once and effect.
j = Liecnm Class Lk.g
n F p Data Contracbr
qq7W ARCHMIC1'S DECLARATION
WU 1 undervand my plans shall W used u Public records
go
o t; Licensed Professional
3 OWNER-BUILDER DECLARATION
E I Wm N
rehy aRrat 1 am exempt from do Contractor's License law for the
A O following rta.n.(section 71B 1.5,Business and Pofecslons Code:Any city or county
S$ which requiresa premI to cnnswcc,alms,improve,dcmoiLN,at repair any stmtture
_Ij, prior to its issuance.auo sequims Ne applicant forsuch permit to Tileasignedooment
mm< dust W u licensed pursuant to the provisions of the ContrxtmY came Law(chapter 9 Sq.Ft. Floor Area Valuation
r1-$ (commcming with Section 70M)of Division 3 of the Business and Professions Code)or
_ Nat he Is exempt thesefom and the basu for the alleged ewnptian.My violauan of
Section 7031.5 by say applicant for a permit subjects she applicant m a.Ml penalty of APN Number Occupancy Type
not mart Nan five hundred dollars(SSW). P y yp
❑I.uowrcr of the propeny.amy wplayw with wagnu the'vsok cW.Busution,
will Pr the work.anee,`f&cture u not intended o Law clus Tarsale(Sec.toad,Bualr.of
and property
Wilds Cnd0 The Ceatrxton.Lal he Vw ave oat apply lf,t awrer is Required Inspections
propertywW . revi ed that sthcreprowerwho..atitende doaawch htm.ereA for W his
owm,na.dyrs,pmv(dad Wtmmenti ovld within
suene ear oftloroRnrod for tale
builder,Neanth ger improvement is old Wild
or completion,de owner, _
builder will haw the burden of proving Nn W did not Wild or improve for purpose of -
.k.).
til,u owner of the property am eacluaively cnnuatting wish licensed onuutme to
answct the project(Sec.71144.Business and Pokssions Code:)The Contractor's Li- _
cense law does not apply m an owner of property who Wilds or improves thereon,said,
who contracts for such projects with a conuamon(s)licensed pursuant to too Cantracots
Lass""
Law.
m
❑1 acos mpt under Sec / B h P C Forthis ounce
Y/4w+`✓�i Jg+v �v/n//aeDue^ay�/�7�QfS
W ORKENS COMPENSATION DECLARATION
1 bareby,affirm under penalty or Perjury one of the following declarations:
❑Ihsveandwillmalnuina Ceruftueof Consenuo.lf-insumrw Wor esCompare
.tion,u provided far by Section 37011 of the labor Coo.fm the performance of she .
work for which this permtt it intent.
❑I have send will maintain WwWa Compensation Insurance,as wined by Section
3700 of she Latter Code,far the pcRarmance of the work for which this permit is issued.
My WorWs Compen.uon Insurance crier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EKEMPITON FROM WORKERS'
COMPENSATION INSURANCE .
CIT;weldor rood not W complea:d if the Permit is return hundred collator(SIM)
or lest)
1 certify Nat in the performance of thus work for which this Permit Is issued,I shall not
cmpley any peracen in any restn beamc objrtmthe Workers!Compensation
Laws of Cal'omia.Data oSS
Appliunr
NOTICE TO APPIJ :IL after m g Nu tum of Eamptivn,you.NouW
become subject be the Worker's Compensation provisions of the Labor Coes,you most
.JO forthwith comply with such provisions or this permit shallW drurod milked.
z" CONSrRUCnON LENDING AGENCY
r�
[—t lausby which rel this there uaconsuuN3097,Cng agency for thcpMormamc of
CYi
the work for which this permit is issued(Stt.]097,Civ.C.)
UndoesName
D z Isndee,ts Andrus ...
U Q 1 certify Nat 1 have read Nis application and sale Nat the aWve inlmmatiur u
Ir. F arrow I agree to comply with all city and cowry ondicances and one:laws relating to
.0 V Wilding censwction.and hereby authority depre.ntathes or Nis city to cnerupon the
r W aWve-mcnuorod Property for inspection which may
E„C.. (We)agree to save,indemnify and keep harmless,the City of Cupertino against
ern incouse judgments,coming randing of thiseswhtMmayinanywayseraagalutsaieCity /�
V z APPLICANT UNDEcaunce of to RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date C- Z7
SOURCE REGULATIONS.
r9t o ' N Re-roofs
Signature afApplianUCan her Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding acupam an.or handle Incemou material /
u de0rod by the Cupertino Municipal Coda,Chapter 9.11.and the Health and Safety
nd
c.Section25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes rule
Will Ne applicant or future Wilding occupant see equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
cmtt Imendnus it conuminans u&rad by Ne Bay Arta Air Quality Managcmcnt all new materials for inspection.
District?
❑Yes [�Iu
1 have mad the ancestors materials mquirerants under Chapter6.95 of the Califor-
nia Heal"Safely Coda,Sections 15505.25533 and 25534.1 understand thetlfde Wilding
does not co emly have a count.that it is my responsibility as or,tle occupant of the
requtremens which must W met prix o issuance of a Certificam f Oce
ovpmey.
�` }p 6y Signature of Applicant Date
5� v
ow�;amn�rrods� 7" All roof coverings to be Class'%W'or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
SUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
Aneo/ lorsf ,.e jreL Ln 0"o 2.3 0,�
OWNER'S NAME: apu:" a N PHONE # V---0-6/9 bl
GENERAL CONTRACTOR: FAX # WC--
I
OL —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 /l/af'a„�/ Ca�,s1 /(eti�ull 2z S-317-
Excavation
3Excavation
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
O r/Contractor Signature Y Date
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylvidM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31633032 . 00
DATE ISSUED. . . . . . . : 06/27/2008
RECEIPT # . . . . . . . . . : BS000005269
REFERENCE ID # . . . : 08060236
SITE ADDRESS . . . . . : 10386 PRUNE TREE LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DAVID HWANG
ADDRESS . . . . . . . . . . : 10386 PRUNE TREE LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2023
RECEIVED FROM . . . . : JERRY HWANG
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 15319 CHATSWORTH ST
CITY/STATE/ZIP . . . : MISSION HILLS, CA 91345
TELEPHONE . . . . . . . . : (818) 221-6057
FEE ID UNIT QUANTITY AMOUNT... .. ' PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -=-------- ---------- ---------- ----------
1BSEISMICR VALUATION 350 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
IERT<200 UNITS 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 122 . 87 0 . 00 122 . 87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 122 . 87 MASTER CARD
--------------- ..
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER
•
CI CITY OF CUPERTINO
TEMP POWER
CITY OF
CUPEkofiNO PERMIT APPLICATION FORM
��O(o02�310
APN # 6 _33_03 Z Date:
Building Address: /
/0�5 a {'fNne TrLC. L,,
Owner's Name: Phone #:
Contractor: Phone #:
Na�`'�nal Cb N1 �NNC�/'QrJ /1eh¢c �O(f—ZS'� 270o
Fax #:
Contact: Phone #:
jerry
Contractor License #: 18710
Cupertino Business License #: ZZS37
Job Description: /
pop%vr ,pole (aver4ac✓
Residential jz Commercial ❑
Valuation (cost of project) ��0
Quantity Fee ID Fee Description Fee Group Permit Type
I ERT>I K Res. Temp Power>1 K E 1REAP14
ATRs
I ERT<200 Res. Temp Power<200 E
Amps
lERT2001K Res. Temp Power 200-1K E
Amps
/ IEPERMITFE Electric Permit Issuance E
1 ELCPLNCK Electric Plan Check E
1BSEISMICR Seismic Residential B
1TRAVDOC Travel & Documentation B
Fee
*� CITY OF CUPERTINO
t 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>lK Commercial Temp Power E
>lK Amps
IECT2001K Commercial Temp Power E
100-1K Amps
1TRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
•