03110154 n
CITY OF CUPEWrINO a " � s
BUILDING DIVISION PERMIT CONTRACTOR�INFORMATI
i ILDINGADDRESS: STEVE NAN -CONSTRUCTION PERMITNO.O311O154
20696 SCOFIELD DR
OWNER'S NAME: PERMIT ISSUE DATE
IAO-MEI NAN 10599 N STELLING RD 11/26/2003
NE: SANITARY NO. CONTROL NO.
(408) 203-3933
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
3Op LICENSED CONTRACTOR'S DECLARATION lob Description
ee 1 hereby affirm Nat I am littved under provisions of Chapter 9(commencing p
with Section 7")of Division or the Business and Profcssinns Codc,md my license is
ism mem,ermn.
z in Period
Lk.N� TEMP POWER
=F�Ft$::q Da Cu r
fN A CHITECI'S DEC A I
'Le, \(y nand my Alam shall he used u IIc records
ho G Licensed Proruaiotnl
3 OWNER-BUILDER DECLARATION
I 1 hereby affrm that 1 am exempt from the Commetor's License Law for the
00 following moron.(Secum 71131.5,Businessand Professions Code:Any city.county
3$� which requires a permit to consumer,alter,improve,demolish.or repair any structure $500
is, prior In its issuance,also rtquiresthe applicant for such permit to rile a signed statement
< that he is licensed pursuant othe prvisiomnfthe ConuacmriUee s,Law(Chapter9 Sq. Ft. Floor Area Valuation
$ (commencing with Section 71100)of Division 3 or the B usimm and Professions Code)or
e
dust be is exempt therefrom and the basis for the allcgc l exemption.Any violation of
Section 7031.5 by any applicant for a permitsubjeOs the applicmt to a civil penalty of
not more than Ore hundred dollen(8500). Occupancy Type
0 1,as owner of the property,or my emplaycu with wages as their sole compensation,
will do the work and th.mrsho a is not intended or ofined Waste:(See7044,Business Required Inspections
and Profess lona Code:The Contractor's License Law docs not apply to in owner of q p
pmpeny who build,or Improves thereon,and who Ooessuch work himselfor through his -�
own employees,provided that uch improvements are nal Intended oraRered rorssle.If.
however.the building or improvement is sold within am year of crmplction,the owner.
builder will have the burden of pmving that be did not build or improve for purpose of
ale.).
❑L as owner of the property,am exclusively comore ing with licensed=net=to i
comuuet the project(Sec.7040,Besiness and Professions Cade:)The Conuacmr's Li. + -
came Law does not apply m an owecr of property who Wilds or improves Ihemon,and
who convects for such projects with a contraetora)licensed pummot to dm Comorcmr's
License Law.
❑I am exempt under Sec. ,B&PC for this...a y� '—
t3700
ner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of produty one of the following declarations: -
I have and will maintain a CenlGcam of Consent to self-imum for WorYeta Compctr
on,as provided for by Section 37M of the Labor Code,for the performance of the
k for which this Permit is issued.
1 Mw and will maintain Workces Compensation Insurance,m required by Sccdon
or the labor Cade,for the performance of the work for which this permh la Issued.
W�oIlOce.Compenmtion Insurance carrier and Policy number am:
Wrtyr Poli No.: LP ak
�
V E IFR I ATE OFF EXEMPTION MWORKERg'
COMPENSATION S NCE
(Thismetion need not W completed If be Permit Is for one hundred dollars(SIOD)
or leu)
1 cenify that in the performance of the work for which Ibis Permit is issued,I shall not
employ any tenon in any mannerso as Or become subject o be Workers'Compensation
Laws of California.Data
Applicmt
NOTICE TO APPLICANT:If,after making this Ceniflum of Exemption,you should
become subject to the worker's Compensation provisions of the Leber Code,you must
.,O forthwith comply with such prnvininm or this Permbe dmm
it shall eeed eted.
Z.~NrCONSTRUCTION LENDING AGENCY
1 thereby alRrm thaI there is a conawOion lending agency for the performance of
x.moi the work fur which this permit I,issued(Sec.3W7,Civ.C.)
aF) Lender's Name
7 ,Z Lender's Address
U 0 1 cenify until 1 haw read this application and We that the me.information is
ky P cornet I agree to comply with all city and county ordinances and spite laws reining to
�U building construction,and hereby authorise representatives or this city to enter upon the
IT7 above-mentioned property for Impeetion purposes.
LL (We)agree m an,indemnify and kccp harmless the City of Cupertino against
14.r vA liabilities,judgments.cons and expcnaes which may In any way aceme against mid City
U Z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date
S RCEREGU TION /J
wtor Si Wirt of Appliued
Re-roofs
HAZAm/ConBDOUS
MATERIALS DISCLOSURE Type of Roof
Will theapplicmtor future Wilding occupant vertm handle Heardoesmaterial
az it.Soc by the Cupertino Municipal Coda Chapter 9.13.and IW Health and Safety
We.so❑cy.25532(4)7 No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant o rf mdra building occuprit u cquipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It tantrums air cenaminam'as dcOncd by the Bay Area Air Quality Management all new materials for inspection.
isuictT �i/°
❑Yea /
[have mad the WuNsws materiah rtyuiremcns under ChaPmr lY3 of the Callror.
nia33calth&Safety Cher,SeNmu15505,35533 and15534.1undcmandd,atiflW Wilding
docs not currently hese a tenant that it is my responsibility to notify the,ncupanl of the
m Iremmtawienmma me, umecafaceNhcateoraenpene. Signature of Applicant Date
�_.
rearamhorizcJogcm Dae All roof coverings to be Class "B"or better
CITY OF CUPERTINO
TEMP POWER
_UPEkTINO PERMIT APPLICATION FORM
APN # 3S- Date: j �Z7
Building Address:
.Ze<9� Seo cl�r• G"u .a 9.10 /•�
Owner's Name: Phone#:
Contractor: Phone: License#:
.5&v-e ,4-4 forS Stogy - 2033 33 7TH 93
Contact: J Phone: Cupertino Business License #:
e if/ �n - J-0 d 33
Building Permit Info:
Elect ❑
Job Description:
Residential 19Z Commercial ❑
Cost of Project:
Qtyj
A li ab e Fee ID Fee Description Fee Grou
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
23 �(a
•