06080181 CITY OF CUPERTINO
'BUILDING DIVISION PERMIT & 0NTkkGT0R INFORMATION
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BUILDING ADDRESS: NATIONAL CONSTRUCTION REN AEffN006080181
1342 S STELLING R
OWNER'S NAME: PERMIT ISSUE DATE
LISA ZENG 1355 FILIPE AVE ng/22 /2oois
NE:
SANITARY NO. CONTROL NO.
(818) 221-6057
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 (� E (�
lop LICENSED CONTRACTOR'S DECLARATION lob Description
w I hereby affirm Nat 1 am licensed under provisions of Chapter 9(commixing
loo, with Section 70W)of Division 3 of the Business and P.R.mm Cmmrum my license is
�=„ in full force am cffe TEMP POWER POLE FOR. TEMP ELECTRICAL
„y z License Class Lic.p
F O Data Conlracwr
I ARCHITECTS DECLARATION
i < 1 undersand my plans shall be used as public mcorN
iyU
C In Licensed Professional
OWNER-BUILDER DECLARATION
I hereby atLm Nat I am uempt form the Contractor's Uccnw Law for the
p O following reason.(Section 703 L5,Business and Profession Code:Any city or county
m which requires a permit to construct.a@r.improve,demolish,or repair any structure
$500
pdortoiuiuuancc.alwmquimes NeapplicmtforwchpcmitiofilcasignWstaremcnt
that he is licensed portionun Ne provisions.(the Contractor's Limose Law(Chapter 9 Sq.Ft. Floor Area Valuation
:F
(commencing oiNSuuom9000)of basis for
of the Business and Professions Anynvi Cadc)w
•�_ Nal M u ucmpt Nartlrom and the naso lar drt alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil pwlly of r - Occupancy Type
not more Nan five hundred dollars($500).
❑I,as owner of the property,or my employees with wages as their sole compenaroon,
will do thework.aM NeswnumtsnotinreMed aroRcmd(oracle(Bee.7014,BudM••
Required Ins ecti -
and Proleadoes not Code:The Contractor's License Law donot apply to an owner of q P
property who buildsmimpmw themon,and wW does ruchwork himself.,mhmugh his
own employer,provided Nat such improvements are undimmed woRemd for ale.If. fT c
howevm.the building or improvement is sold within arc year of completion,the Owner.
builder will have she burden of proving Nat he did not mild or improve for purpose of
al..
Las awner of amct See.70,.B ucluai and confessions with:)The
mntraams U.
couwsi the project($eco o an owner
of and Prolusion Cade)Tlm Conmetor's Lid V
mite law dor not apply m an.wnu of property who Wildsor improves Comoro ad
who contracts for for such projccwith a c.ntracmr(s)licensed pursuant in the ConvactarY
Llceue Law.
❑lam evempt undu5 c. _ ,BdPCfor this mason
otfae — Datex'(122
WO I OMP ON DECLARATION
1 Wreby aRm der xmlty of perjury nm of the following dccla ons:
I him and will maintain a Cortifimm of Cc mmu toself-insure for Wort Ce3 Compen-
sation,as provided for by Section 3700 of the Labor Code,far one pcof.mance of the
work for which this permit is isued.
1 have and will maintain Worker's Compensation Inwmnce,as required by Section
3700 of the,labor Code.for Ne performance of the work for which this pemit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carrier, Policy No.:
CERTIFICATE OF EXEMPTION FROM W ORRERS'
COMPENSATION INSURANCE ,
(This rim need not he completed if um peri,is fora..hundred dnlhm lS1IXB
or less.)
1 certify Nal in the performance of the work for which this permit u issued.1 shall not
employany person inanymanersoNJ9bYn �tNdC Workeri Comperumful
Laputcam if a, tu_Q �K�� �i•i�/O bb
Applicenl—
NOTICE TO APPtl. !T I a er m ung Nu Ccndleau,of Exemption.you should
ec
bome ubj.to tW Wo a .Nhsafion provisions of be Labor Code,you must
.,z forthwith comply with such prmiiloa or Nu permit Nall he deemed,evoked.
z O CONSTRUCr10N LENDING AGENCY
N
F" 1 hereby chafrionOi Pe them I..Wood
(Sec. lending agcmy for Nc perfumanm u!
(�> Ne work our which Nu Permit u issued(See 1(197,Cir.C.)
z LeLand
z r's
.7 ndeer's Add Addm.<
U O I certify that I have read out application and some that the above information is
W H cormtt I agree to comply with all city and county ordinances and sum laws mlating to
�U building construction,and hcmby aumhonce represcmmiv of Nis city m enter upon dm
r W alcove-menliuned progeny for iro,cum purposes.
(, V. (We)agree to ave.indemnify and trcp harmless drt City of Cupertino against
Icy liabiltimajudgments.coso and expenses which may in any way mane against said City
or he
mashing of this
U z APPLICANT UN ERSTANDS/A.AC�a WILL�C7OM���PLY W�ITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS 4ixa I
Re-roofs
Signature of Apylican onuact Date
HAZARD U ATERIAISDISCLOSURE Type of Roof
Will Ne applicant or future building ocmpantstom err handle hmardous material
as defined by Ne Cupertino Municipal Calc.CWpmr 9.13.and the Health and Safety
code.Section 35532(a)7
❑Yu � All roofs shall be inspected prior to any roofing material being installed.
40 Will the applicant or future building occupant use equipment of derive which If a roof is installed without first obtaining an inspection,I agree to remove
emit hioomous air contaminants as sthrincd by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes NPAKI
1 have mad the Woodous materials mquimmcnu underCWpmr6.95 ofthe Cali(.r-
nuHwlNkSafcsy Code,Sections 35305,25533 and 25534.1 undersand Nuildm Wilding
does not currently have a moadonn. l it u my me orsibility to notify the Occupant of
ocyuirem use c Ccnifwamo Occupammy.
Signature of Applicant Date
owner,termor gen, Dem All roof coverings to be Class "B"or better
Community Development
10300 Torre!tAvenue
l
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
46UPE(�TINO
Building De artment
JOB ADDRESS: PERMIT #
Z } lam
OWNER'S NAME: L� (' PHONE #
GENERAL CONTRACTOR: oto FAX #
I am not using any subcontractors:
Si a Date
Please check applicable subcontractors and com 1 e 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
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN I . . . . . . . : 36611101 . 00
DATE ISSUED. . . . . . . : 08/22/2006
RECEIPT 4 . . . . . . . . . : 35717
REFERENCE ID # . . . : 06080181
SITE ADDRESS . . . . . : 1342 S STELLING RD
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : LISA ZENG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : Z & T DEVELOPMENT
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 1355 FILIPE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (818) 221-6057
EE 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
- - --------------- ----------- - ------- - -- --------
CHECK 100 . 47 1027
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO a9o?b 112)1
TEMPPOWER
CUPERTINO PERMIT APPLICATION FORM
APN # lof . pD Date:�/
'jj (O(011
Building Address:
l �1A-2
Owner's Name: Phone#:
Contractor: Phone: License #:
wkrnopkd�,
Contact: , Phone: p� Cupertino Business License #:
-
Building Permit Info:
01003 11
Elect ❑
Job Description:
re Commercial ❑
ect:
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Qty. if
ApplicablQ Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING