08070030 CITY OF CUPERTINO
BUILDING DIVISION PER-NUT CONTRACTOaxR;INFORiVIAT; O.N".
.�✓.a`a, ."r4 re. TMde.z g ,c. r•�a=
BUILDING ADDRESS: PERMIT NO.
20571 SCOFIELD DR NATIONAL CONSTRUCTION 08070030
OW NEWS NAME: PERMIT ISSUE DATE
LESLIE LUONG & THANG DO 15319 CHATSWORTH ST 07/03/2008
lipNE: (818) 221-6057 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
t� 0
woo LICENSED CONTRACTOR'S DECLARATION 1 IOb Description
m 1 hereby affirm that 1 am lizard under provisions of CWPmr 9(commencing .. P
- wiNSecuont7000).(Dlvirion3ofNeBusrutsandProlamin.Code.and mylicenreu TEMP POWER POLE
^uN infull Form and alrom-
Licenm Clan Lie.0
Dam Cannoneer
ARCHITECTS DECLARATION
` I understand my plans shall be used as public mcon s
j6
a o t; Licensed Professional -
OW NER-BUILDER DECLARATION
a� f I hereby&from that I set cuumpt from the contracted License law for ft
D o following mown.(Section 70313,Rod.and Profusion Cade:My city or county
29 which requires a permit an consumer.alter.improve,dem flam.m.,no&thy structure
prior an its issuance.alw mquires the applicant for touch permit to file a signed consumer,
�< Na,he is licensed pursuant o the pmvisiou of use C.nuacm'r Name Law(Chapter 9 Sq.Ft. Floor AreaValuation
men
6 (comcing with Section 7000)or Division 3 of the Business $and Professions Cook)or 350
Net he k uemp,therefrom had use basis far the alleged exemption.Any A.lauon of
Section 7031.5 by any applicant for a perm,subjects Ne applicant w a civil Penalty of
w,muse Wo five hundred dollars(M). 35909004Number Occupancy. T'pe
1,u owner of six property,a my maPloyw with wages u dre'v sok eusnpewdr,
vend dethework,ande The ,omcarrot Nmndns Law
(Sec.70 an,Business
and ortywh oar Cade The ConhseNrs Lw•»Iaa aces not apply m rt aw•nr of Required Inspections
propmy who builds a improves thvmn.and was dao sato work himself cr through his
however,
Wiprovitled Nat satoimprowm within
tnet year
ofcmoaded ret sola Ir,
however,Nc Wilding or Improvement u hard within on Wild or comm a for the owner-
"In.).r will have the Wden Of proving Net K did on,build m improve ler purpose of
u1k.l.
pf 1.as&war of the property,am ewlosively manacling with Band contractors to
conrmn the penjoet(Sec.70441 BMm=and Norassiom Code:)The Commissars U. .
ane Law does no,apply to an owner of property who builds or improves thereon,had
who concocts for such prejeeu with a aranar(s)licensed pursuant no the Contranors
License Law.
❑1 not exempt under Sea B&PP}C ff'or thhusreuon
Owner Data 11— �
WORKER'S COMPENSATrOy ECLARA'ItON
I thereby air=um pwhY of perj,uy o of the folmwing declaradoru:
1 haw and will maintain a Cenifiose of Consent b self-iuwe far Worters Compen-
mm...u provided fus by Sic im.37M of de Mbar Cede,for Ne perfomana or the
work for which this permit is bound. .
❑1 have had will maintain Workers C.mpenadon luta .,as roquired by Sued.
3700.1'Ne Labour Cade,for the peRerwce of dw work forwhich this peri,is butted.
My workers Compensator,insurance anis had Policy number an;
Cartier: Policy No.:
CERTIFICATE OF E%FMPDON FROM WORKERS'
COMPENSATION INSURANCE
(Dusaatimt need set bccaspicu d Irene Permit Isfusooehumdrd d.Bara(SloO)
or lost)
I e nifY that in the perrommen of the work Ire which this Permit is issued.1 shall not
employ anyW.inany muocrw u to become subject to the pmtsenudon
Laws of Calif M I ,It'l,. �P (.TX
NODCE TO APPLICANT:IL after making this Ce ate of Exemption,you should
Went"sublet m the Worteh Comperssubm Provisions of doe labor Code you am
.J O forthsin Nu sh
with comply with such provious Permit all he domed rerokd.
Z'-' CONSTRUCTION ION LENDING AGENCY
D; I hmeb afrir Nd Nem its construction lendin
F Y Y e geray fm the perfurwa of
(Yi> use work for which this penin Is issad(sec.3097.civ.C.)
W� A LendersNmm
7 z landAddyer,Adds,
U O 1 aniry dean I have read this application W sum Nss she shove information is
Iy (•' rorcL I agree N amPly wish all City and county ordinances and sum Ian missing N
0Wilding construction.and hereby wtherim representatives of this city to enter upon the
r IV37 &abetmentioned pmpcny for Impaction puryuet
H G (We)agree to save,indemnify ad keep hamlets the City.r Cupenin.aSsiul
1'q judgments.the Snarling
uind Ofpeuawhichmryln any nYaccme agsiv,said Cid.
C.3 z A APPLICANT
of the gaming of Nu permit. ---s_ J O
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date l/
SOUR REG I,AT10rys.� ` p � � _
1l I l7 7i)Iuo
11 srgmnm.rwppfiranHAZARDOUS MATERIALS SURE °i Re-roofs
Type of Roof
Will the,applicant.r suture Wilding ce mpwtsrom us handle hazardous material
u de0ned by Be Cupertino Municipal Code.Chapter 9.1;and the Hulth and Safely
Code.sermon 25532(g7
❑Yes dN. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
thazallou air coutmiunu u dcloed by the Bay Arra Air Quality Management all new materials for inspection.
❑Yes N.
Ihave revel the hmrdusu materiab requirements under Chapter 6.95 ofthe Califor-
nielicalm&Safety Code,Section 25505.25533 and 75534.1 undcrsund the if dm Wilding
dusa not cumndy Ww a unant.that It u my rospomibility us notify the aeupunt of the
re.im ntawltchcausabcomilm missuanccofaCvtificam.fOccmp y Signature of Applicant Date
owner or haNctnOwd goal Dam All roof coverings to be Class';."or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT - OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35909004 . 00
DATE ISSUED. . . . . . . : 07/03/2008
RECEIPT # . . . . . . . . . : BS000005342
REFERENCE ID # . . . : 08070030
SITE ADDRESS . . . . . : 20571 SCOFIELD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER LESLIE LUONG & THANG DO
ADDRESS . . . . . . . . . . : 20571 SCOFIELD DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2920
RECEIVED FROM . . . . : LESLIE Q LUONG
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 '
1ERT<200 UNITS 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC 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 VISA
--------------- --
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----- -------------------------- -------- ----------------------------
402 TEMPORARY POWER
•
Of o7 o00 v
CITY OF CUPERTINO
TEMP POWER
• CUPEI�TINO PERMIT APPLICATION FORM
APN # Date:
35a0900�+.00 l 3 0g
Building Address:
010511 &--ofie C( Ir. Cu hho 95014
Owner's Name: Phone
LeA i e, Lu on
Contractor:
a Phone #: c;O`J-7DO
(
�`7 to I Fax #:
Contact: Phone #: ,255-G(3( Home
L ,sh& �uc�r� X34 - 7G&4 ( cet►�
Contractor License #:
Cupertino Business License #: ✓ /`
Job Description: /� I
Residential Commercial ❑
Valuation (cost of project):
--$8e)bte —
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>IK Res. Temp Power>IK E 1REAP14
Am s
J IERT<200 Res. Temp Power<200 E
Amps
I ERT2001 K Res. Temp Power 200-1 K 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
TEMP POWER
CUPEkTiNO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
1 ECT<200 Commercial Temp Power E
<200 Amps
IECT>1K Commercial Temp Power E
>1KAm s
IECT2001K Commercial Temp Power E
100-1K Amps
1TRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
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