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08040170 CITY OF CUPERTINOnrsnm.e` d3'r« Mi BUILDING DIVISION PERN HT 'COMMACTOWINI' Mrr U,�tMA BUI1,pIL+gnpDWOODLARK WAY TBD - TO BE DETERMINED P�08040170 OWNSEWS NAME: PERMIT ISSUE DATE CLINT MIN 04/24/2008 NE: SANITARY NO. CONTROL NO. ARCHRECTPENGINEER: BUILDING PERMIT INFO TEMP POWER HOME GENERAL BLDG ELECT PLUMB MECH O O O 30o LICENSED CONTRACTOR'S DECLARATION Job Description e M I mby a(Ermu w NI licensed under provisions of CMpur 9(maSCrIP mmenein{ Sj NN Section 7")of Division Sof Ne Business and Professicru Code.shad my liceasseis in Pull(oneMd errei �^ z Lic m.CI Lie.a Cormier CH1 ECI'S DECLARATION (r' Vjy I understand my plana shill h mod As Public records a6 S Od Lid Pmfessienal y OWNER-exempt RDEthe Com ION COO heresy reason.(Rte Nat 11. exempt from Ne ConuactCo :A nce Law for Inc is O O following ul.. (Section 7031.5.Bwtna.i and Pmfeesinh Code:Any shy or county z 4�i which requlma a permit re rnnsw0.alcor,tmpmve,hemmW,or erepairsig any swam Z S^ Prom b its issuance,also require Ne provisions (Detach panne m nice signed wmment tiwheulmswit pmRunt m Ne proHsioos Na[ an But Constantine, From law COCA) 9 Sq.FI. Floor Area Valuation 8 (cat he is n{with Section 7000 tof heDivision 5 a[Man But.cA rad on.Any Cade)or . Nu io u exempt IMaehmc and dte haw for bj alleged exemption Any l Penalty of Section]0513 by airy red doll for a permit rvbjeeu tite applmanl m a civil penalty a( APN Number Occupancy e ml mom Nan Rw 6umlted molars(5500). P Y TYP 1,h owner of die pmpvry.m my mPloYers NN w+gh u theb sole amnpewtim, And Pr Ne work,and Ne muctm ra cot inmdW a Lave dos.1 Apply to M,Busims And Pmr.ho W ld. improved ved ender. nd.1va Live meth Ml apply lf N owMr of Required Inspections propertywho s,Tech i improve Naeon,andwho dorsuchworkhimselfedNrou{h Au own .theeWiprovided pr such imPmvenwitinnot immndWmoQamd formula.Ir. however.Nepoietin{or Improvementismem did oroyearofComoveforNaOwner. build.w14 have Nc burden of proHnl Nal ha did cot shad m Impamc for puryoe of om.h ❑1,h mw r of Ne property,am exclusively conu unini wide licensed ConreMmn ad ' Cooswct the project(See.70/4.Buainus and PrefeWeru Cade:)The Consomme,LI- _ acme Law does not apply m an owner of property who Wilds or improves Nemon,and, who contracts for such projects NN a cons anor(s)Exceeded partum ne Ne Conuactora Llunse raw. ❑Iunnmptunder See .BdPCfmthurarvn . OArner Dam WORKER'S COMPENSATION DECLARATION ... 1 hartby afltm under pemlly of pecjmy oro of dm folmMn{decWuloos: I haveaMw01milnwn.Catiriamofcomntmwlf-iwuermwo ICmpch, n.u provideni fm by Section 3700 of the labor Cede,f.the perform- of Ne wrk for which this pmmtt is issued. ❑I have and will maintain Workers Compeosaden Insurance,As requited by Schon 3700 of Ne labor Cods.far the perfomana of Ne work for which Nu pemit is loved ' My Worker.Cmpensamon Insurance cacti.and Policy nmbu art: Carrie: �9 1 �h.�- Policy ROMWO7-�— CERI7Fl CO OF COMPENSATION NFROM WORKERS' COMPPNSATION INSURANCE (fherxmlon Med Out be completed if Ne permit Is forom hundred dollars($100) or mss) 1 certify Not In the p.fomaxam of Ne were for which Nis permit is issued,l shill ON employ any person in any mmmted As m become subject As Ne WormO Compeneadon Laws of CalifomlL Data Applicant NOTICE TO APPLICAN71 If,after making this Campcste of Exemption,you should become abject to the Workers Compensation provision of Ne LAW Code you man .J O forthwith Comply with provisions N ch proveru u sold all he deemed revakad 'LE.I y CONSTRUCTION LENDING AGENCY [-I 1 norohy affirm that Nem is a construction lending agency for the performance of CL the Arms fm which this permit Is issued(Sec 3097,CIA.C.) Landers Nme z lander.Addtha 3 0 1 Codify that I have mud the applieadon and sum Nn Ne above befomatim u [7. come"', omaI agree m emPly with all cilY and county oNineme and Arm laws existing so .0 building construction.and hereby autioriAa representatives of Nis city to enter upon Ne W above-mcntimrmd pmpeny for Indication norhes 4 (We)agree to save,indemnify and keep hamlen the City of Cupertino almost CA Ilmilitih.judgments,cow and expanses which may in any way amus agaial said City V 7 in cenxqueme of Ne Lanting of this pemLL I1- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -ZL'�c'-✓- SOURCE REGULATIONS. Re-roofs Signa. of AP nVConuanor Data HAZARDOUS MA=DISCLOSURE Type of Roof WIII W appBnnl m forum builNng aaupanlnert or Randle haaNam materim u defloed by the Cu Nno Municipal Crede.Chapter 9.11.Add the Health and Safety cede, 0Yon xss3z(a. All roofs shall be inspected prior to any roofing material being installed. pyx a WIII Ne appnt licaor future building oaapamse m M uequipment etas which If a roof is installed without first obtaining an inspection,I agree to remove It heallow air, umianu u defined ray Ne Bay Area Air Quilily Mmagemcnl all new materials for inspection. vicl7 ❑Yee u [have mW Ne ha7N m datsmWimmcrosunderChapwd.95ofNeCNfor- nuHWth&Safety Cod0.Stttiw2550S25575w125534.Iumbwnd Nnifft building dors Out camody have a tenant that it On my responsibility to mdfy the aavpanl of the mquimmcnu wnian roan be met pdormissuame aro retry f�«cyp�xy� > Signature of Applicant Date uP Yg owner adesent Date All roof coverings to be Class'%¢"or better CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36204036 . 00 DATE ISSUED.'. . . . . . : 04/24/2008 RECEIPT #. . . . . . . . . : BS000004563 REFERENCE ID # . . . : 08040170 SITE ADDRESS . . . . . : 7984 WOODLARK WAY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CLINT MIN ADDRESS . . . . . . . . . . : 7984 WOODLARK WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 94024-6828 RECEIVED FROM . . . . : TOP INSPECTIONS CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO '.BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 300, 000. 00 30. 00 0. 00 30 . 00 0 . 00 1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 1ERT2001K UNITS 1. 00 61 .19 0. 00 61.19 0 . 00 ------- -------- ---------- ---------- TOTAL PERMIT 131 . 98 0. 00 131 .98 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 131. 98 2054 --------------- TOTAL RECEIPT 131 . 98 VOICE ID DESCRIPTION VOICE ID DESCRIPTION --- ---------------------------- -------- -------- 402 TEMPORARY POWER i -�, CITY OF CUPERTINO < � TEMP POWER CITY CUPEkTINO PERMIT APPLICATION FORM OgOH of 4-0 APN # Date: 36� — ©L-l — O 04fl2 103 Building Address: -790514 INoo6kI ark 1� C r h rte Owner's Name: Phone #: C1.iv\:t Mit V\ Contractor: Phone#: 51a—'7 4�0�j''jb Fax #: Contact: Choy Phone#: Contractor License #: Cupertino Business License #: 01 — Job Description: 0,ck 6"b✓\ (R_)"Cpvt k Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No Residential Commercial ❑ Valuation (cost of project): Quantity Fee ID Fee Description Fee Group Permit Type IERT>lK Res. Temp Power>1K E 1REAP14 Amps 1 ERT<200 Res. Temp Power<200 E Am s IERT2001K Res. Temp Power 200-1K E Amps 1 EPERMITFE Electric Permit Issuance E / IELCPLNCK Electric Plan Check E 1BSEISMICR Seismic Residential B -1 CITY OF CUPERTINO >! J TEMP POWER CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group Permit Type IBSEISMICO Seismic Commercial B 10EAP14 IECT<200 Commercial Temp Power E <200 Amps IECT>1K Commercial Temp Power E >1KAm s IECT2001K Commercial Temp Power E 100-1K Amps 1TRAVDOC Travel & Documentation B Fee 1BUSLIC Business License B wit Community Development iy10300 Tone Avenue F. Cupertino CA 95014 Telephone(408)777-3228 CITY OF� Fax(408)777-3333 :UPE�TINO Building Department JOB ADDRESS: PERMIT # -792; Dodd -0"-re/ 70 OWNER'S NAME: GU\vt F PHONE GENERAL CONTRACTOR: leo ene cov t &&r FAX # S10 1-f 41— 0-7e6Z I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin 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 ner/Contracto ature Date