05090037 CITYOFCUPERTINO '� • aw +, � e �� *% �'�` ''?
BUILDING DIVISION
PE MIT
BUILDING ADDRESS: YOUNG' S CONSTRUCTION PERMIT NO.0 CJ 090037
0911 RIC-14W001) DR
-OWNER'S NAME: PERMIT ISSUE DATE
CHUN YTU VRUNQ 14839 CONWAY AVP 09/07/2005
NE: SANITARY NO. CONTROL NO.
408 377-6839
ARCHITECVENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
am LICENSED CONTRACTOR'S DECLARATION lob Description
1 Wreby alum that 1 am licensed under provision of Chapter 9(commencing P
n� with SCedmt7M)ol'Divislon 3 of the Business and Professions Code,and my licevn is
a ufmttomsmeeffect. TEMP POWER POLE FINALE
2 License Class Lk.M
DahsContractor
ARCHITECTS DECLARATION
�i 1 understand my plans shall be used as public records NOV
n
3 C Licensed Professional NO V
ln�l�
2005
e3OWNER"BUILDER DECLARATION
I I hereby effim Net 1 em uempt from the CoolnnoA License Law for the
❑O following reason.(Section 7031.5,Business and Profession Code:Any city or county
$ which retains a permit in ennsuud, her.Improve,demolish,fir repair any stmcmm !�N\1 i •'Z.0 0
r��' priortoits issuarme,alto mquimsIW Applies",let such permit to IIIcasignalaratement ...
pp WlheislicensedpursuanttotheprovisionsoftheContractor'sUccnscLaw(Chapter 9 Sq.Ft.Floor Area Val an n v
d�a (commencing with Section]00M of Division 3 of the Business and Profeulons Code)or
iv R— that he Is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applimeL 10 a civil penalty of Occupancy Type
not more than five hundred dolum(55003
❑I,as owner ofthe property,or my employ¢with wages as their wk compenmtion,
willdo theworL and thestructure isnotimended oraRareed forme(Sec.7044.Business Required Inspections
and Professions Code:The Communes License Law does not apply to ton owner of q. p
property who build,or im proves themon,and who docusuch work himself or through his
own employees,provided that such improvemenuame ootin ended oroRered formic.If.
however,the Wilding or improvement is sold within one year of compledon,the owner
Wilder will Mw tie bum en of purring that he did out Wild or improve for purpose of
VI,as owner of the property,.B exclusivelynesand
Profession
ng with:)licensed comb tar's u
canswn the project(Sec.]04x.Business end Pro(eaoons Cade:)The Cmiaemon.Li
cense Law dos nm apply to an owner of property who Wilda or iotproves thereon,and
whocontractsLace for such project with aconlrmtoK0lkenmm to tl puravathe Contractor'saw.
0 1me L 1 am exempt under Sec. ,B A P C for this recoTn
Owner . Dau�
R
WOEWSMPENSATION DECLARATION
I hereby statedunder peas ty of perjury me of tie following derlarWons:
1 have and will maintain a Certificate ofConsetn to selFtasure for worker's Compen-
137."Iffl
ile,as provided for by Section 3700 of the labor Code.for the performance of the
rk for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
of the labor Code,for the performance of the work for which this permit is issued.
Worrier's Compensation Insurance carrier and Policy number ses:rrico Policy No.: _
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
mbis section treed notbeco npuud if IW Icrmit is future,hundred dollars(SIM)
m Mu)
I certify that In the performance of the work for which this permit is issued.I Nall oat
employ anypctson in any manner"�becmn�W bject Io Um Worken'Compenasdm
Laws of ca ifamia.D•w
NOTICE
tit
E TO ctto0APPLICANT:IL after eking this Certificate of Exemption,you should
become object y the Worte r Cao s or tis Provisions of the labor Cade,you mum
OfoMwith comply with such provisions or Nis permit Mall W decmW revoked.
Z"" CONSTRUCTION LENDING AGENCY
[—tom Ibereby,(fins that Bert is a consuuctim lending agency forthe lcRumartm of
�i the wart for whicb this permit h luted(Sec.3(19].Civ.C.)
l7 Lender's Name
z Lander'$Addw -
U0 I certify that I have read this application and stats that tie move informNon is
L1.F tomo.I agree to comply with all city and county ordinances W mu laws rttating to
O U Wilding conmmction.and hareby authorive representatives of ths city to enser upon the
til above-mentioned ptopeny for inspection P1dPWL
G (We)agree to save,indemnify and keep hamieu use City of Cupertino against
In liabilitbujudgmmW cots and espemes which may in any way acctue sgainal said City
U,'iv in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE E LATIONS.
A Re-roofs
Signemrt ofAppli UCa Vapor oak N Us MATERIALS DISCLOSURE Type Of ROOF
Willtheappliam (core building occupsul more olundle haratdems material
as dented by tie Cupertino Municipal Cade.Chap=9.11.W tie Health and Safety
Code,Sections 25532(,)? �a All roofs shall be inspected prior to any roofing material being installed.
❑Ye
Will the applicant or future Wilding«"spent um equipment«deNcas which If a roof i$installed without first obtaining an inspection,I agree t0 remove
it haratdnm aircm=I. as defined by the Bay Ams Air Quality Management all new materials for inspection.
utr!"? �/
DYea D4
Ihavcrrad the harudlnummriW mquirtmenu underChapmr i95oftie Califon
nu Health k Safety Cade.Scc9w25505,25533 W 25534.1 undetstand dwiflW Wilding
dors Inst cmmntly haw a mnxel Thar h u my responsibility to amity the occupant of the
requircoams hick most W met prior to issuance ofd Ccruncau of Occupancy. Signature Of Applicant Date
Ow a,a meEa I Dam y All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aClOF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: PERMIT#
a dao 3'7
OWNER'S NAME: C PHONE #
GENERAL CONTRACTOR N FAX #
I am not using any subcontractors:
Si at •e 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
CITY OF CUPERTINO
Q' TEMP POWER o SZ' ° 03
7
UPERTINO PERMIT APPLICATION FORM
APN# 3 / G Date:
Buildin,g Address:
( 03 ( fNo-oA
Owner's Name: Phone #:
v v ti (iso)
Contractor: Phone: License#:
0 4o
Contact: Phone: Cupertino Business License #:
Building Permit Info:
Elect 9
Job Description:
Residential Commercial ❑
Cost of Project:
a �
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
� � q7