06080227 CITY OFCUPERTINO 'I`•4 "` ^'^'-'
BuaDINo01VISION PERMIT COAffla`O"T�R=II�FORMA`�IOFi 4,
ING ADDRESS: M-TRAN CONSTRUCTION, INC PERMIT NO,06080227
641 RUNO CT
OWNER'S NAME: PERMIT ISSUE DATE
CANH PHAN 348 SURBER DR.
NE:
SANITARY NO. CONTROL NO.
(650) 996-6099
1A.CHmECTMNGINEER: BUIIDINO PERMITINFO
BLDGELECT PLUMB MECH
(� I� E (�
loo LICENSED CONTRACTOR'S DECLARATION - Job Description
w 1 homey affirm that 1 am licensed umCr provisions of CT6Pur 9(commencing P
with Secdon 70(111)of Division 3 of Business;aml Professions Code.and my license if
mfedmrce and effec OZ-
ZEE, TEMPORARY POWER POLE
;'p= uaee a Lic.g
i t-w Dau AT2 Comae
ARCHITECT'S DECLARATION
I understand my plans shall W used in public neat&
tyU
Licensed Professional
5 OWNER-BUILDER DECLARATION
(�f I hereby M.Not I am exempt from the Conmcaafs License law for
the
:o O following mason.(Section 703 1.5,Business and Professions Cods:Any city or county
which requires a permit m construct,alcor improve,demoli h,or repair any sweture $800
.I` prior lois issuance.alga requires the applicant for such permit to file a signed comment
;FO Nat he islicensed punuanuathcprovisionso(theCommenriLwensoLaw(Clopr9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of dm Business and Professions Code)or
s loot he is exempt therefsam and the bum for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of r Occupancy Type
not mom than 0w hundred dollars(SSW).
0 I,u ower of the property,or my=play=with wags as their sole compensation,
will as,the work.and the imma.u not landed isoRered for sam(See.7061.Business q Re mired Ins Fe '
and Profession.Code:The Conuacmno
r's License Law docs t apply m an owner of P ns
property who Wilds or impmm thereon,and who does such work himmelf or through his
own employees,provided dausuch impmsemmus us not intended orofferad for We If.
however,the Wilding or improwmmt is said within am year of completion,0e owner-
builder said have the Wrdcn of proving that he did rot build or improve fm purpose of
caro.). c
❑h u ower of theac.7property..B cause;and commuting with licensed contractors i.
construct the project(See 7f114.Because;and Professions Code:)The Cmuanu..Li.
cense law does sol apply m an owner of property who Wilds or improves Comm,and.
emuanspar,
for shah projects with a conuanor(s)licensed pursmm m lar Communities
Y Law.
OF exempt under Ps"
,B A P C for Nis recon
Owner Dam
WORKERS COMPENSATION DECLARATION
I thereby spirits under penalty of perjury am of the following declarations:
I haw and will maintain aeertifiate of Consent to self.insum for WorkclsCompcn-
saian,u provided for by Sccuon 3700 of the labor Code.for the performance of the
work for which this permit is issued.
0 1 have and will maintain WorkcYs Compensation Insurance,as required by Sccuon
3700 of the labor Code,for the performance of the work for which this permit is issued. '
My Waimea Ciera ereardom linsurmce artier and Policy,number me- --r�
Cartier. S r n7iLlbs N f Policy No.: 1'7S-15S
`a
CERTIFlCA 61`1710N FROM WORKERS'
COMPENSATION INSURANCE
(Thu scab.need notbc completed if the permit is faro.hundreddaBars($100)
or less.)
I certify that in thc perfarmance of the work for which this permit is issued,l shall not
employ any person in my maner an u in become subject in the WorknS'Compensation
Laws of Califamia.Dam
Appliant
NOTICE TO APPLICANT:IL after making this Cedificale of Exemption,you should
become subject b the Worker's Compensation provisions of she Labor Cade,you most
�Q farthwith comply with such proviGav W this permit shall W demand hawked.
Z� CONSTRUCTION LENDING AGENCY
[-i I hereby affirm Jut share is a construction mooing agency for the Performance of
ai r1 the work for which this permit is issued(Scc.3097,Civ.C.)
W 0 lender's Name
7 Z lenders Add..
U O 1 comfy that 1 have mad this application and sum that the aWrc information u
W F^ correct.1 agree in comply with all city and county ordinances and Stam laws misting to
0 C.J building conswction.and hereby milicuou mpmsenutivesof this eitymenmr upon the
W maw-mentioned property for inspection purpous.
(We)agree to save.indemnify and keep harmless the City of Cupertino against
rn linalitla,judgments.eom,and eapensn which may in my way scenic against said City
V z Im
APPLLICANTKOS
eUNDE STt th D WILL COMPLY WITH ALL N .POINT Issued by:S4t(2�&�& Date
SOURCE REGULAT
�� Re-roofs
nam fAppla uConuacmr am
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or fume building occupant stare or handle havrdou material
defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Code.Section 155314)?
[I Y. All roofs shall be inspected prior to any roofing material being installed.
u
Will sW applicant or rULUum building occupant use equipment or&vie=which If a roof is installed without first obtaining an inspection, I agree to remove
emit harasdaus air anomia ea u defined by the Bay Area Air Quality Management all new materials for inspection.
Dim1ct?
DYcs ya
I have mad the hmardous materials requirements under Chapter 6.95 of the Calirer.
nia Halth&SafetyCodc au15M5. 33ud25536.1mderswd Nuifthc Wilding
docs of umall,haw Wimplabotit' my mspomibdity,to notary da,=up.,or Je
zaidgmLisselimhoust suarmeofaCeruficutc upane. Signature of Applicant Dale
Owner ar authorimE agent see All roof coverings to be Class"B"or better
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37525025 . 00
DATE ISSUED. . . . . . . : 08/28/2006
RECEIPT # . . . . . . . . . : 35795
REFERENCE ID # . . . : 06080227
SITE ADDRESS . . . . . : 18641 RUNO CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CANH PHAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : MINH TPAN
CONTRACTOR . . . . . . . : MINH TRAN LIC # 26922
COMPANY . . . . . . . . . . : M-TRAN CONSTRUCTION, INC
ADDRESS . . . . . . . . . : 348 SURBER DR.
• CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (650) 996-6099
•FEE 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
-- ---------- -- --- ---------- -- ------- - - ---------
OTHER 100 . 47 VISA
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
•
Community Development
• 10300 Tone Avenue
If `J Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
`UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
Ru 56 d kz�-7--q- "7
OWNER'S NAME: PHONE # 63b q&-6
GENERAL CONTRACTOR: kA— � c-Ao, AX # O8 Z L
I am not using any subcontractors: g h6
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
60 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 Roc
Tile
er/ ontractor Signature Date
��. CITY OF CUPERTINOo8d� ,
TEMP POWER
�UPERTINO PERMIT APPLICATION FORM
APN# 3�1 J Date:
Building Address:
O
Owner' Name: '\\ Phone #:
15PA CA
Contractor: Pone: License #:
ccx� ciio� 65 0 6-6s 8
Contact: Phone- Cupertino Business License#:
M 71t-79
Building Permit Info:
Elect
Job Description:
Residential Commercial ❑
Cost of Project: g�
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING