06060119 F
OF CUPERTINO .ILDIN I DIVISION PERMIT C®NTRA. MORINFORMA.TIONGADDRESS: (] AUL PERMRN0.O6O60119
63 RIVERSIDE DR
NAME: PERMIT ISSUE DATE
CHAN PAUL 06/14/2006
NE:
SANITARY NO. CONTROL NO.
IARCHInCTIENGMEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
up0 LICENSED CONTRACTOR'S DECLARATION
a wC 1 thereby am.Nat I am liavcd under pm ,s visiaof Chad.,9(<ommeaing Job Description
!iW with
Section)OOU)Of Division Sof dte Bud"•••aM Pr ssimusC de Wm licensnis
nMy inful
Date lfm¢caMcffca POOL DEMOLITION
:'q= eelasa Lied WPC CONSTRUCTION PAID FOR BL 6/14/06
n70 Dam RCHTfECTS DECLAR 10
I understand my plans shall W used u public records
1.0
Licensed Professional - ' �H 1
g OWNER-BUILDER DECLARATION "'444www/t�
Z I hereby alRrm Nal I am exempt from the Contractors License Law for no JUL\,3—
E00 following reason.(Section RD 1.5,Business and Professions Code:Any city or county _ n
K m T which rtquia permi,to....LennsShur.improve,demolish,or repair any swctme 1'dlln
sZY prior to iB issuance.also requires the applicant for such permit to file a signed statement
< Na,he is licensed pursuant o the provisions of the Cc nuacmr's Liana law(Chapter 9 Sq.Ft.Floor Area Valua[ 5 0
0-
EEC (commencing wish Secdo.7")of Division 3 Of Ne Business and Pronounces Cods)or lett, p tyy
i that he It exempt dmrtfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjccu the applicant to a civil Penalty ofppN 1.7�(y�yber 0 0 ecu ane T e
Nan
not mom Bvc hundred dollars($500). 3 5 6D 4 2 p y yp
Q I.asownm of the pmpoty.omY emPloyas wish wages uthcv sol campe,uation,
will do dte ansic and the structure u nolNtended oroffesvA forsale(Sce.7Oa4,11usinesr
and Pmfessimu Code:The Contractors License Law dam Out apply to an owner of Required Inspections
property who builds o impmvus Hereon,and who does such work himself or through his
Own employers,provided Na,such impmvemenu arc not intended or offered for sale.If,
however,the building or
Improvement however, sold within one your of completion.to owner-
Wilder win have she Wrden of proving Nat he did ret Wtd or improve for parpux of
sal.).
Q 1,as Owner Of the Property.am exclusively contracting with licensed contractors he
muswet the Project(Sec.7044.Business arm Rofmsime,Code:)The Cou mean's U. _
cave law does Out apply to an ownm of property who Wilds or improves themun,and.
who contracts for such projects with a comncwr(s)licamand pursuant to the Conumemes
License Law.
Q l am exemp,node,See ,B&P C for Nis maven
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby stRrm under penalty of perjury One of she f011owin6 declaratimus:
1 have and will maintain a Certificate of Consen,to self insure for Workers Compen-
sation.as provided for by Section 3700 of the labor Code,for the peeormarce of the
work for which this permit is load.
Q 1 have and will maintain Worker's Compensation Ivurance,u roquired by Section
3700 of the Labm Code.for the performance of the work for which On Permit is Wena '
My Workers Compo yi n 1 a carrier and Policy number art:
Cartier. Policy No.:
CERTIFIQA F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
mvisacctioo need amho completed if dm Permit is foams hundred danaes(51 W)
m
loss.)
1 cenifv Nat in the performance of the work for which this permit is issued.I shell not
employ any person in any mannerm as to become subject to the Worke,s'Compevation
Laws of CaRfomia.Dam
Applicant
NOTICE TO APPLICANT:If.after making Of,Ccrufcate of Exemption.you should
become subja,to On Worker's Compensation previsions of the Labor Code,you must
.Jz forthwith comply with such Provisions or this Permit shall W deemed resaked.
E'O CONSTRUCTION LENDING AGENCY
(-+� I hereby affirm Out there is a constroctinn lending agency far the perfrtmmocof
f�>
the work for which this permit is issued(Sec.3097,Cl,C.)
S0 Lemle,'s Namc
= Z Landers Add.
U Q I ce,dfy Nat I hale read this application and sum Nu the above information It
LL F toren.I agree to comply with all city and county ordinancesand state laws relating to
C) building cnnswctian.and hereby au,horimmpresenmivcsor Nis city to enter upon Nc
rty
[Z7 ahovo-mcmioncdpr,Omen for i copecum,e..purpowhich a
s.
(We)agree to sari,indemnify and kap harmless the City of Cupertino against
h in consequence
of ueSos�a,Wof this Permit. may in artywaY same againstsad City
O z in conscgneae a(NC Stenting of Nis pernit.
APPLICANT UNDERSTANDS ANgAYIEL COMPLY WITH U NON-POINT Issued by: Date
SOURCE REGULATIONS. � 1� d�
Re-roofs
gv
Si ,um OlAppli—VC.n--' Bass
Dam
fl 2'RDOU ALS DISCLOSURE Type of Roof
Will IW applicant or factum Wilding OccupanlmOm or handle hazardous m oerind
'Curit
dcfirard by the Cupertino Municipal Code.Chapter 9.12 and IW Hcahh and Safety
Code.O on 35531(a)? All roofs shall be inspected prior to any roofing material being installed.
Y future
NO
Will the applicant o//forum Wilding acupant tare equipment or dcviaa which If a roof is installed without first obtaining an inspection,I agree to remove
h?Mous air conum,nous u defined by she Bay Arta Air Quality Mavgmecat all new materials for inspection.
QYcs �u
I have mal the hvardonsmaterials requirements a dc,Chapter 6.95 oftie Califon
nu HeAh"SaftelYCOde.Sectirru 25505.25533 and25534.1 unticnuntl thaif the Wilding
dura not currently hast a tenem,Nat it is my mu
spenslity to ami Nocc
a upant nr the
regmromene.whtmm ,W to., anca"raceniBeamnraapenry. Signature of Applicant Date
Owner or auOuri ed agcn Date All roof coverings to be Class"B"or better
CITY OF CUPERTINO
*am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35604002 . 00
DATE ISSUED. . . . . . . : 06/14/2006
RECEIPT 4 . . . . . . . . . : 34860
REFERENCE ID # . . . : 06060119
SITE ADDRESS . . . . . : 22363 RIVERSIDE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CHAN PAUL
ADDRESS
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : WPC CONSTRUCTION
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : CHAN PAUL
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- --- -------
BPERMFEE VALUATION 5, 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00
BSEISMICRE VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 259 . 43 0 . 00 259 .43 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ --------- ---------
OTHER 259 .43 VISA
TOTAL RECEIPT 259 . 43
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
704 DEMO DEMO
•
06/15/2006 19:24 6505932323 WPC_CONSTRUCTION PAGE 01
community Dw"lopmeer
10300 Cerro Avenue
CupertLtoCA 95014
Telephone(4)8) 777-3228
Fax(4)8)777.3333
CUPEQTIN0
►uildinit
JOB ADDRESS: - PE'RMrr w T
�-atd3 Fad ,'Oc: i �o11q ^i
OWNER'S NAME: I PHONE # Z�
GENERAL CONTRACTOR:WR FAX#
Xam not using any subcontractors:.
SLente
Please check a HrAble subcontract r is an lete the followin inforutatl .n _
SUBCONTRACTOR USINESS NAME BUSIP ESS LICINSE t.
Cabinets &Millwork
Cement Fi U"tg
II4ut:ical �"
Excavation
Ferucing
Linoleum/ Wood I —'
Heatiting —�
Insulation
Landsca
mg
Lathing
Masonry
Ornamental Sheet Metal
P . . / Wall per —�
Paving
Phsteriin --�
Plumbing
Roo�Itlg -
Septic Tank
Sheet Metal
Sheet Rock
Tile —
Owner/Conbmcuor Signat re Daft
1 CI'T'Y OF CUPERTINO
(f'f DEMO
CUPER INO PERMIT APPLICATION FORM
APN# 35(x-O�—Ob2- Date: G q�
Building Address: -Z,��
Owner's Name: J //� Phone #: �s
Contractor: � DN License #:
Contact: Phone#: 0300
ftil
Applicant/Contractor:
Building Permit Info:
Bldg Elect Plumb Mech
Job Description:
Residential: oL RmD Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: (� Valuation:
Type of Construction: ` // Wig
y- Occupancy Group:
Qty. if [/
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
cd
BUSLIC Business License BMIDNG
s