08050122CITY OF CUPERTINO
BUILDINCDIVISION PERMIT
CONTRACTORIIFURMATIONil,,
BUILDjt1LAOPRESs._AI AVE
P08050122
LR'SLNYAIMEU: V
NATIONAL CONSTRUCTION
PERMIT ISSUE DATE
CIIIA-LUN FERNG
15319 CHATSWORTH ST
05/14/2008
HONE:
SANITARY NO. CONTROL NO.
(818)221-6057
ARCHRECT[ENGINEER:
BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Y
Job Description
1 hwcbY affirm dhu 1 w fr B under dftfm ofCM , (myli w g
with Smreca fgBefDivWanlof tho BUJwuv and Profeasiom C.M,aM myliccrwu
TEMP POWER POLE
in full foams eUtmL
Dao: `E Contractor
DamChir Corr
DECLARATION
As
1 uMervanJ my Pues dull on ttxA sa Public rcemds
mat x t ood
Licensed Poor esaknel
OWNEmBUILDER DECLARATION
1 Wmby that 11. exempt from the Convectors Lew for the
e:LicenseAny c
. sec Code: Any city county
]IDL4 Butlmss and ProImprove.
wW.hfolloso e.. (anti 1 do mfi sig any Wwmm
wWch mquimsnpewit to mnxft Wtw,improv,h st
me
Nmiit a
! trier to iscenewe.alw requites lheapplicant f for suehpermbuofcenseLaw(Chtomem
Nulmencingitpursuant to the (Chapmr9
Sq. Ft. Floor Area
Valuation
of Division othic ftCnnuumr: uProlaw
n7 euondon.A, ml='of
(cothat
700Minand
-
380
he s mucepdhSuaon
! Nn the Cassis the alleged erwan, n Any violation of
a Otemfmm antl the aper for Ne
_
our 7 subjects
Section 31.5 b awry applicant r« a perms suajecs arc appluw W a veil pecalty of
3 620502 ��Number
Occupancy Type
tit mom than five huMrtd tlollua ($300).
an, thass n
6
P Y YP
Q I,peowwr of the property,wmY wPlaycu with wagupeJmv role compemWon,
will do the work. and the suuctum is not intended or offered for sale (Sec. 70". Bpeinam
Clx camrxmn tet Lice se Law dom appy men owhw of
and Prefectures Calc T
Required Inspections
Property who Wilds w imposes therew, and who dwa sue, .,it himself or through his
own empluyeo. Provided that such improwmenln tie net intended or offered fmsak ff.
however. the building or imponmmt In told within orc your of mmpkd.. tae owner.
builder will bun ate burden of proving that he did tet build or improve fes puryose of
sale.).
t4 1, as sum of the property am uckusively convecting with licensed mnttuctws to
construct the project (See. 7014. Business aM Pmfualom Cade:) The Contractors V -
cense law it. out appy to an owner of property who Guilds or impmvw thereon, and,
who contacts for such projects with a cesurmi r.) licensed pursuant m the Contractor
License law.
Clow esempt d Bow .08 PC for this wan
/
De,
R s M N ATION DECLARATION
f
1 hereby Num under y of perjury was of the following welatauonc
1 hem ked will murrain •Ccnifinto o(Canunt to self-iiuurt for WarYCSCmnpcn-
Wash. u provided for by Section 37M of the Labor Code. For the perfarmanm of the
worts for which Otis permit is isaued.
I ban and will maintain Worth's Compeesnson InBua.ce, as mquirm! by Station
37M.f the Labor Code. fee the pertawsnce of the were for which this pernit is bound.
'
My Wmters Compensation Insurance carrier and Policy number are:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thusecaon wed amW co pleted ifthe pwir is (am hundred dopes(SIM)
or kis)
this Permit u shi
issued. l n not
1 certify, tent in the moomanm of the worecyfesrp
employ my perm. is my arson". W m �fwhich
to ft Wnrtera' cwpeeWawm
Laws of California. Dam !/fubd"t
Appfl/
-
NOTICE1T0 APPIJ (?a a g this Certificate of Erwption. you NwW
bwwme subjmt W th 'Dreesmpctnyp tion provuium m the lobar Cadeou mee
, yt
N
fwwith comply with swh pro'(\Qmope dr thispewit shell be deewC aewked.
CONSfROC11ON TENDING AGENCY
I worry affirm than mort us comwwinn leading agency for dN performanceof
the were for which this Permit u ivw4 see. 109]. Civ. C7
Lenders Name
lenders AM=
I certify dist I bun read this applkuioe and seen tem the move informaaun is
correct. l agree W comply with all city and csonty ordinances and fate laws reusing W
Wilding comowflon, and hereby nthodx representatives of Nu city to enter upon the
abon-mmaoned pm. coy Ire inspection puryh
(We) agree to saw indemnify and keep harmless We Cit, of Cupertino agai=
lia'museq,Judgmenhecostaand of may
which hey in any wayaweegumt said City
ofthe{Setingof Nr
this
A APPLICANT
APPLICANT UN ERSTANDS AN WL COMPLY WITH All NON -POINT
,
Issued by: Date
SOURCERE,"
Re -roofs
/—/
'� , J
Sm of woractw�
-
HAZARDOUS M AIS DISCLOSURE
Type of Roof
Wilt the applicant or luture bu iami; weuPant atom w lurdk harutlom material
dNned by the Cupertino Muniabu Code. Chapter 9.12, and ate Health and Safety
per, ear 2553200? f/
El Yea �No
(]
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant man equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
TIIt hvstMhm air commomar s as defied by tho Bey Area Air Quality Management
all new materials for inspection.
Oyer o
I have read the hasaadwu mateAussquirtmmu under ChaPmr495 of the Califor-
niaHeelNBSefmYCotle,Satiws25505.25517 erhJ 2553d.lanJerpurd thuffdm building
ilitY notify the occupant of Ne
dam net cowndY Mn a tenan. it iamyf-1A—C
rmto
mquiaerecna which sen1.icofocm�
p
Signature of Applicant Date
roof coverings to be Class a%¢.. or better
ownerwoath mea iDemAll
40
\CRY OF
T
CUPE(�TINO
CITY OF CUPERTINO
TEMP POWER
PERMIT APPLICATION FORM
DSOS D /�-
APN #
.3 boa 0 5(702.!0 , v o
Date:
Building Address:
21�tD
00L �}vP
Owner's Name:
Phone #:
Contractor:
Phone #:
Fax #:
0 — 2 0 U
Contact:
Phone #:
2�0
Contractor License #:
Cupertino Business License #:
Job Description: 46
Residential
Commercial ❑
Valuation (cost of project):
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1 ERT> 1 K
Res. Temp Power >I K
Amps
E
112EAP14
1 ERT<200
Res. Temp Power <200
AMDS
E
1 ERT2001 K
Res. Temp Power 200-1 K
Am s
E
IEPERMITFE
Electric Permit Issuance
E
1 ELCPLNCK
Electric Plan Check
E
/
1BSEISMICR
Seismic Residential
B
ITRAVDOC
Travel & Documentation
Fee
B
CITY OF CUPERTINO
F' TEMP POWER
CUPEkTINO PERMIT APPLICATION FORM
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1BSEISMICO
Seismic Commercial
B
10EAP14
IECT<200
Coimnercial Temp Power
<200 Amps
E
IECT>1K
Connnercial Temp Power
>1KAm s
E
IECT2001K
Commercial Temp Power
100-1K Amps
E
1 TRAVDOC
Travel & Documentation
Fee
B
1BUSLIC
Business License
B
Is
0 4 ITEMS OF 4
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36205026.00
DATE ISSUED.......: 05/14/2008
RECEIPT #.........: BS000004774
REFERENCE ID # ...: 08050122
SITE ADDRESS .....: 21410 VAI AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
--------------
122.87
---------------
122.87
VOICE ID DESCRIPTION
-------- ----------------------------
402 TEMPORARY POWER
REFERENCE NUMBER
--------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
OWNER ............:
CHIA-LUN FERNG
ADDRESS ..........:
21410 VAI AVE
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-4935
RECEIVED FROM ....:
CHIA L FERNG
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 380.00
----------------------------------------
0.50 0.00 0.50
0.00
1EPERMITFE
FLAT RATE 1.00
40.79 0.00 40.79
0.00
IERT<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
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
--------------
122.87
---------------
122.87
VOICE ID DESCRIPTION
-------- ----------------------------
402 TEMPORARY POWER
REFERENCE NUMBER
--------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
F
CITY OF
UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
2(4- 0 V vP eu ,'Pib
PERMIT #
OWNER'S NAME: - _Q�K
PHONE# >o - SC
GENERAL CONTRACTOR: ,` N
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
COw-nLe Contractor S' tune
1 —
ate
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
COw-nLe Contractor S' tune
1 —
ate