06060037CITY OF CUPERTINO *,g*
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'BUILDINS DIVISION PERlx'11T '�
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BUILDING ADDRESS:
WONG ELECTRIC INC
PERMIT NO. 06060037
19805 STEVENS CREEK BLVD
OWNER'S NAME:
A
PERMIT ISSUE DATE
CHUCK E. CHEESE
4067 TRANSPORT ST
2006
WIN E:
SANITARY NO. CONTROL NO.
(650)813-9999
ARCHITEC rENGWEETR:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
- Job DCSCi1pI1On
I hereby affirm that 1 am licensed under provisions of Chapter 9 (Commencing
with Section 7") of Division 3 ofthe Business and Professions, Code. grad my licene is
in full force and effeer, L((7tF SSy
PROVIDE TEMP POWER TO EXISTING METER
License CI _ Lic. g
Dam—Contrac�ri c'a-ec
ARCHITECTS DECLARATION
I understand my plans shall M used as public records
Licmtscd Professional
OWNER -BUILDER DECLARATION
1 hereby afrm that I am exempt from the Conmecmr's Licenu Law far the
i following reason. ($moon 90313, Business and Professions Cook: Any city or county
f which requires a Permit to consweL alter, improv:, demnlboh, or repolr any structure
$700
prior n its assvame.A.m,tit.W.pplicant for such Permit o Al, it si,mA summate
a Canlncur's Licens, Law (Chapter 9
Sq. Ft. Floor Area
Valuation
that heulicensed potential todoprovisions ofthe
1 (commencing with Section 7000)of Division 3 of the Basin= and Professions Code) or
. that he Is Bump thenfmm and the bass for Ik alleged exemption. Any violation of
FW Mrill5bir ILI ILI
Occupancy Type
Section 7031.3 by any applicant for a permit subjects the applicant to a civil Penalty of
Ina mom dun Oro hundred dollars DIM
❑ I. as owns, of tate pmprary,mmy rmplryecs with wagusss their sole campassuon,
Required Inspections
dofar We(Sm.at
will dothewon, ands:
he Ostinaesandedaraw
an Owner
and Cade: The Cantrutafs Umnse law moa not apply if owrcr or
property rt his
pmputywho builds mimpala therein.and who tieseterswork
Carofflransuough
awn emplayca. provided thetsmh impmvemau art not inmrmed araRerW ran sale lf.
However. Ne building m improvement is sold within oro yea or completion, the owner-
hat did Mid a improve for purpose
have the bucn of proving tk mu dd
ilderpili N
.I
tale.).
/
❑ 1. as owner of dte property, am exclusively contracting with licensed cantru:nrs th
I I
construct the project (Sec. 7004. Business and Professions Code) The Contractors U.
ammo law dos, not ap,ty to an owner of propny who builds or improves therem. and.
,
who contracts for such projects with a comout or(s) licensed pursuant to the Contractor's
ems
0 w.
La
lam uempt under See
m Ns manCome,Dam
Ow r D ate
! /
WORKER'S COMPENSATION DECLARATION
1 hereby e1Bnn under penalty of perjury ane of the fallowing declamuans:
hue and will mdnuin • Certificate of Consent to aelf-imuic for Worker's Compo -
I h
j
more. as provided for by Seamon 3700 of the Lab. Cade, for the performarcc of the
wort for which this permit is sued.
71 1 have and will maintain Worker's Compnssubm Insurance, as mislead by Socamn
37W of the Labm Cade, for the performance of the work for which this permit is issued.
My Worac�ye, component . n Inwrana arsrcs and Policy number are:
Carrier. Jl`�7G' Wks.f a'� Poliry Na.Ig6 OSSbo;�
CERDFlCATEFSP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thi, scrim reed Out becanpleted if Ne permit Is Troon. handled dollars ($I00)
or las.)
I certify that in the performance of the work for which this permit s issued. l ahall not
employ any person in any manner so as to become subject in the WaitersCompensation
Laws or California Dam
Applicant
NOTICE TO APPLICANT: IL after making this Cenifiam of Exemption, you should
become subject th the Waheri Compensation provisions of the Labor Code, you mus,
' forthwith comply with such provisions or this permit shall be decmcd rooked.
CONSTRUCTION LENDING AGENCY
I bombh sur there ice cm¢truNnn lending agency for the per(ormana of
cErm
' the wish for which sus permit s asswA /Sec. 7097, Civ. G
I., den's Nam,
1<ndei'rs Address
1 certify Nat I have rad this application and sum rut the above information s
'
' correct. I agree to comply wit all city and county ordinate" and state laws relating to
Wilding Conswction, and hereby amhodn mems in ums of this city to enter upon the
above-memiuncd pmpcny for inspection purposes.
(We) agree n vas, indemnify and keep harmless the City of Cupertino against
j liabilbia,judgments. casts and exPensa which may in any way accrue against said City
in consequence of the grooming of this permit.
' APPLICANT UNDERSf NDS AND WILL COMPLY WITH ALL NON -POINT
'
Issued by: Date
SOURCF�F�IlEGULATIO
✓�la.0-a a.O,oa-� 6,���/-06
Re -roofs
Signature ol'Aplicano/CoikiniElor Na'c
HAZARDOUS MATERIALS DISCLOSURE
Type Of Roof
Will the applicant or future building occupand state m handle hanr h us material
as defincti by the Cupertino Municipal Code. Chapter 9.13, and the Heald and Safety
Code. secoen 255324)7
❑Ya �t0o
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I to
Will she applicant or future Wilding o supra use equipment or devices which
agree remove
emit hazardous air contaminants as dcfimd by the Bay Arca Air Quality Management
all new materials for inspection.
Dia ksl
'rNu
❑Ya
1havemal the Wva m=e 3mquimmenuunkr Chapmr6.95oftheCalifor-
niaHcalN&Sally Cade.S,cd.nSU5.35533and25534.1 understand thuifthc building
drca tea curmnny Pone a Omani, that it is my Mspnsibility to notify the accupm nr de
rutrim niswhchm met Pd.,nism. f. Certificate a
Signature of Applicant Date
All roof coverings to be Class "B" or better
owner ar aatharivaa a ,t Dam
low
f
CITY Of
WUPEkTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRES
vees Cry(, gIvd,
PERMIT #
06 66 -1-7
OWNER'S NAME: r C*�C
PHONE # 6 J (D
GENERAL CONTRACTOR: U6&3 ' C
FAX #
I am not using any subcontractors: / 1 �l 612, 0 �
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/CQ44cior Signature
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
Owner/CQ44cior Signature
Date
am 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31621032.00
DATE ISSUED.......: 06/06/2006
RECEIPT #••••••...: 34700
REFERENCE ID # ...: 06060037
SITE ADDRESS .....
SUBDIVISION ......
CITY .............:
IMPACT AREA ......
OWNER ............:
ADDRESS ..........:
CITY/STATE/ZIP ...
19805 STEVENS CREEK BLVD
CUPERTINO
CHUCK E. CHEESE
a
OPERATOR: amyw
COPY # : 1
RECEIVED FROM ....: WONG ELECTRIC
CONTRACTOR .......: WONG, STEVEN L LIC # 20368
COMPANY ..........: WONG ELECTRIC INC
ADDRESS 4067 TRANSPORT ST
CITY/STATE/ZIP ...: PALO ALTO, CA 94303
TELEPHONE ........: (650)813-9999
•FEE ID UNIT QUANTITY AMOUNT
-------------------------------------------
BTEMP FLAT RATE 1.00 62.10
EPERMITFEE FLAT RATE 1.00 38.37
TOTAL PERMIT : 100.47
PD -TO -DT THIS REC NEW BAL
----------
0.00 62.10 0.00
0.00 38.37 0.00
---------- ---------- ----------
0.00 100.47 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 100.47 18535
TOTAL RECEIPT 100.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
SCITY OF
UPERJINO
CITY OF CUPERTINO 010010()03-1
TEIViPPOWER
PERMIT APPLICATI®N FORM
APN# �3I LF�� ^ b�n
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Temporary Power
Date:
Building Addresss-jiqo
b)
X71 /� q
OW,
ELECTRICAL
BUSLIC
C�T�' S ��lC'
BUILDING
Owner's Name:F--
Phone #:
C (4-u c k C -
_
(–C�
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Contractor:
f/,)DA 6 eec
hone:
>O3-Ctq0/
Licens #:
Contact:
hone:
Cupertino Business License #:
zozus
Building Permit Info:
Fro0;�-A
Elect ❑
Job Description:
Residential ❑
Commercial EjL
Cost of Project:
•
Qty. if
Applicable Fee ID
Fee Description
Fee, C'mun
BTEMP
Temporary Power
ELECTRICAL
/ EPERMITFEE
Elect. Permit Issuance
ELECTRICAL
BUSLIC
Business License
BUILDING
9