06050176CITY OF CUPERTINO
;,CONTRACTC?RINk'ORMATIOIV
BUILDING DIVISION PERMIT
B UIL.DING ADDRESS:
WONG ELECTRIC INC
PERMITNO.06050176
19050 STEVENS CREEK BLVD
OWNER'S NAME:
PERMIT ISSUE DATE
UNITED POLARIS
Mk UNITED
4067 TRANSPORT ST
OS/22/2006
SANITARY NO, CONTROL NO.
(650)813 -9999
ARCHITECT(ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job DeSCilp(lOn
I h.my affirm that I am licensed under provisions of Chzpmr 9 (commencing
with Section 701X)) of Divldon 3 of IM Business and professions Cade, and my license is
in full force am effect. tf �'f-S S-��
TEMPORARY POWER 200 AMP, 3 PHASE 120/240 VOLTS
License Clas, O Lic. p
,
ARCHT(ECTS DECLARATION
1 understand my plans shall M urcd as public records
Licensed Professional
OWNER-BUILDER DECLARATION
I hcmhy alarm this I am ..crept form the Centracrora License law for the
following mason. (Section 7831.5, Business and Profession Cod.: Any city or munsy
which miromes a Monitor consuucL alter. improw, demolish. Or repair my awctue
$2000
! prior to its issuamc. also mqui,esthe applicant for such permit to Ek a signed statement
Canuncter's Ikon, Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant m ft provision of the
t (commcuing with Section 7") 9 Division 3 of de Business and Profession Code)m
: that he is exempt thcmfrom and the basis for the alleged exemption. Any violation of
00erLI U
Occupancy Type
Section 7831.5 by any applicros for a permit subject de, applicant to a civil penally of
cot mom than Rw hundred dollars (3508).
❑ I. as owner of the property, or my employees with wages u their mle cvmpenadon,
'red Ins ections
n 7 oan minus
slum is of i Business
will the work. and the hetluenceres License awe
[ apply t O
and Profeework Code The in e m mwocr
I' Ucrose Law doea ms apply
P
property who builds orimpmves themon. and who docssrmh work himselforthrough his
_
Own employee, provided thassuch impmwmma tae ttatinmtded aroRered for sale. If.
however. the building or improvcu mt is sold within roc year ofcomplexion. de owner.
Wilder will haw de burden of proving that he did sot build or improve for pugne of
❑ 1, as owner a( the property. am exclusively contracting with Bayed amoucmn to
/
cousu r..1 dte project (Sec. 7014, Business and Profession Code:) The Comoseeri Li-
ccese law deer not apply b an owner of property who builds or impmwf thereon. sod,
ie.onvaea for such projects with a eontrxxar(s) licensed pursuant w dm Conuanols
who,
License law.
l am
❑ 1 am exempt urrdc Sec . B & P C far this maven
/
(V_
Owner Date
WORKER'S COMPENSATION DECLARATION
m
1 hereby affir under penally of perjury am of the following declaration:
I haw and will maintain a Certificate Of Consent On self -inert for Worker. Compen.
station, n provided for by Section 3708 of the labor Code. for the performance of the
work for whim this permit is issued.
Q 1 have and will maintain Workers compensation I.,.. as oxinred by Section
37W of the labor Code, for the performance o(the work for which this permit is issued
My Workers Compenatiethromnc.�cpBierand Policynom m::
G
Carrier #41. -LICE FF'3 Policy No. oono
boy
CERTIFICATE OF EXEMPTION FROM WORK RS'
COMPENSATION INSURANCE
(this section occur nut W compicted if the permit is forme, hundred dollars ($100)
or is.)
I certify that N the performance of the work for which this permit is issued. I shall not
employ any person in my manner an as to become subject to the Workers Compensation
Laws of C.1iftnua. Date
Applicant
NOTICE TO APPLICANT: IL after making this C.nlReam of Ea.mption, you should
become subject to the WorkeYs Compcmm mn provision of the Labor Cade, you mum
z forthwith comply with such provision or Nu permit shall b. decm.d mvokcd.
CONSTRUCTION LENDING AGENCY
I hereby affirm them u lending agency Ter cite performancee of
permit s ed (Sec. 3
' the wish for which this permit u issued (Sec. J097, [iv. CI
Lenders Nam.
lenders Address
1 certify Nu I haw read this application and sae the the above infonam.. is
'
' correct. I agree to comply with all city and county ordinances and sum laws misting to
building construction, and hereby authorize mprescr atiwa of this City to enter Upon tM
.hove- mentioned property for inspection puq a.
(We) agree to saw, indemnify and keep harmless the City of CupcNno againt
liabilities. judgments. costs and expenses which may in my way accrue against said City
of the in
' APPLICANT c NTUNDERSTANDS this Permit. WILL COMPLY WITH ALL NON-POINT
Issued by: Date S,a Z- eG
SO URC EGULATION
`V
Re -roofs
Type of Roof
Signature of ApplicamContrachdr Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant Bore or handle bvaNnus material
as d,8ned by the Cupertino Municipal Code. Chapter 9.11, and the Health and Safety
Cade, Section 15532(x)?
❑ Yu [fo
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining n inspection, I agree to
g
Will the applicant or (umm building occupant use equipment m devise which
P g remove
it hmadoes air contaminants u dcOned by the Bay Am Air Quality Management
all new materials for inspection.
District?
❑Yn In No
I haw read de ha undon materials mquircreents under Chapter 6.95 ofthe Cxlilm,
nice Hcaldt& Safety Code, Sections 15505.15533 and 25534.1 umknuM that if the building
dWa not c on it u my m Nmimlity w noCfy e ecupmt of th
ly how a�a-i
m gamm LswMmmeAnmetpna nm.emracertR,aney./
Signature of Applicant Date
da�O
7sl�
All roof coverings to be Class "B" or better
1V/'h
67crOr&u1hor17,cdagcn1 Date
CITY OF
WUPEkTINO
•
•
Owner / Contractor Signature
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777 -3228
Fax(408)777 -3333
Building Department
JOB ADDRESS:
1g0S o STcucnl S
PERMIT #
OWNER'S NAME: V VI T&D D L
PHONE #
GENERAL CONTRACTOR: Ate � C-TOE4C
FAX # (- 7o )
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
Date
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
Date
&m 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37507046.00
DATE ISSUED.......: 05/22/2006
RECEIPT #.........: 34487
REFERENCE ID # ...: 06050176
SITE ADDRESS ......
SUBDIVISION .......
CITY .............:
IMPACT AREA ......:
OWNER ............:
ADDRESS ..........:
CITY /STATE /ZIP ...
RECEIVED FROM
CONTRACTOR ...
COMPANY ......
ADDRESS ......
CITY /STATE /ZIP
TELEPHONE ....
19050 STEVENS CREEK BLVD
CUPERTINO
UNITED POLARIS
OPERATOR: amyw
COPY # : 2
SAM PEPPAS
WONG, STEVEN L LIC # 2036E
WONG ELECTRIC INC
4067 TRANSPORT ST
PALO ALTO, CA 94303
(650)813 -9999
*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
----
OTHER
-- - - -- --
100.47
---------------
MASTERCARD
- --
TOTAL RECEIPT
100.47
VOICE ID DESCRIPTION
VOICE ID
DESCRIPTION
103 UFER
---
- - - --
304
ROUGH ELECTRICAL
---
- - - - --
�C
OCITY OF
UPERTINO
CITY OF CUPERTINO
TEYiP POWER
PERMIT APPLICATION FORM
0Q050 NO
APN # n , O1 - O4l n
'/� 1X
BTEMP
Date: 6
Building Address:
l 70 S o 5-leve,�,L.S CKpc /<
IKt v/)
EPERMITFEE
Owner's Name:
LA) 7 =� P�c.4 r2 iS
ELECTRICAL
Phone #:
Contractor: Phone:
Business License
License #:
(NokU6= C•oUC 6� 8/3 -4499
Contact: Phone:
Cupertino Business License #:
s�
g-f x 2�
Building Permit In(o:
Elect ❑
Job Descr�ption:
. %e -;')p Po ✓ 200 �, r �s
3- Pr st i
z o/Zr/o vot >S
Residential ❑ Commercial
Cost of Project: 2
c:>
/oon
Qty. if
Applicable Fee ID
Fee Descrintion
Fee Groun
•
BTEMP
Temporary Power
ELECTRICAL
EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
•