06050253 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMITQNTR°t�CTQR'INkC1IrrN .
d.`Nu'. uaK Ali"
BUILDING ADDRESS: PERMIT NO.
SHENG SUWU 06050253
OV"FA411AN&RESTLINE DR PERMIT ISSUE DATE
NE 0EIMSIC5 007su SANITARY N L NO.
ARCHITEC tENGINEER: BUILDING PERMITINFO
OEO PLUMB MOECH
)0 LICENSED CONTRACTOR'S DECLARATION Job Description
1 1 burcImre NIkue
by& at 1 sm ed under provisions menc
of Chapter 9(roming p
with Soccntande)of DIW,Ion3efNe Businmsed Pm(caatons Cod n� Emyllcena la
a� in full Tota and mte6
J� oi¢neClua co vaxm DEMOLITION OF A SWIMMING POOL AT SFDWL
understand my plans
ARCHITECT'S
RCHITE xd u�hRATIO TV GENERAL CONSTRUCTION PAID FOR BL 5/31/06
G
Licensed Professional
m 3 OWNER-BUILDER DECLARATION
I I hereby strums Nal 1 am exempt from the Contractors Liccnm law for the
]o following recon.(Section 7031.5.Business and Profession Code:Any city W county
fv which requines a permit he comment.Wer,hmprove,demolish,nr repair sey suuclum
prior to its iuuanca,site MQUIMS the APPlicset for such permit o file a signedmmment
�oNuheislicensed Instrument tothe provisions oftheConuxwalJeneLaw(Chapor9 Sq.Ft. Fld?IrANaW 10111 ValuatiQn
-a (commencing with Section TODO)ofDivision 3ofthe Sesineuand ProfminnsCrude)ur 82000
9- dust he aem
expt Braefeam and The bash for de alleged essnption Any vlahoun of Ann
Section 7031.5 by My applicant for a permit sobjecu the applicant m a civil penalty of APN Numb Occupancy Type
net mom than fn hundred dollars,(S503h
❑1.u own of Nan pmperty,m mY employm wW wegu u thebmle wmpemdon,
witl de Ne work.and the stnmtum a net inwbed ar ortemnd furule(Sec.]014,Busi^^-•
sed Profensiau Cade The Contractor's Lkeue law dm nal apply m an earns,a a 'ons
Property who build,or im prom thaxmn,and who dm such work hdmaelf or through his Dull
awn employs,pmWded Wssuch impmmemenu art not intended erOBund for We IL
however,the building or improvement is sold within came year ofmmpietion,the owner.
buildu will have the bmdse of proving that he did not braid or improve for purpose of
MkJ
0 L u aweer.of tie property.am exclusively covu icuft with licensed contrachera e
mndnct the pmject(Sec.7044,Buinm and Profnssions Code:)The Contractors U.
cone law don not apply m an owner of property who builds or Improves thereon,sed
who mntmN fet cock p.jeem with•enmuu7otm)themed puemmt an the Counselor,
Liam law.
❑lamuempsundssm .BBPCforddareamn
Owner Dae
WORKERS COMPENSATION DECLARATION
1 hereby,I=under Penalty of perjury arc of the following daxlaeWmsm
have and will mninmin a CeNncam of Cone.he selfdnum for Worker,Coupon.
on,u prided for by Saxons 3700 of the Labor Code,for than pc form em of Ne
work for which this permit Is leaned.
1 have W will maintain Worker,Compensation Insurance,as required by Session
37ODof she Labor COM,for the perfomana clubs work for which this permit 4 Issued. '
My Wa Compensation resonance carior and Policy number ase:
Canter. Policy No.:
r-6CERTIFI ^OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thlsaemlom reed not becomphaed it N[purmid 4 i.e.hundred dollars($I00)
mks,)
1 caro(that In the Performance
of the work f. hick Nie permit 4 issued,I"I no
employ any person In any.senor c an e the rk ompenudon
Laws of CalifomlL Data:
Applicant
NOTICE TO APPLICANT:Ir.-aM maldnj 344 Certificate ofFsempdon,you should
become subject a the Wohefs Compensation provisions m the labs Coda You mut
O forthwith comply with such provisions of 344 permit shall Im domvok
ed reed.
CONSTRUCTION LENDING AGENCY
I hereby alRmm that Nem Is a construction lending agency for the performance of
the work for which this permit is iuwd(Sax.3097,Civ.C.) '
QI andco's Name
lander,Address
a Q 1 coolly dust I haw mad this application and cute Nu the above information,is
cones.l agree to comply with all city and county on inanm and tete laws eeleting to
r building counteraction.and hmcby authorise MpeosentAUM of this city to enter upon the
r W show-mentioned Property fm inspection Purpoma
(We)agree to cave,indemnify and keep harmless,time City of Cupertino against
i W) Imbilltimjudgmems,crux Nde[pcns which may In my way a6TlC agamat Wd City
1 in consequence of the granting of this permit.
APPLICANT UNDERSTAND;A3D WILL COMPLY W�ITTTH�iA/LL N(_ POINT Issued by: Date T<a z
SOURCEREGUL
at Re-roofs
Signuurc of ApplislrC —�Data,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dim eCupem.PotuniipalCoe.Chng apter
and the
Health smaterial
u de0ncd by the Cupemno Municipal Codc,Chapter 9.12,and the HcdN sed Safety
Code.Se[uan25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu ON.
Will mea applicant or future building Occupant use If a roof is installed without first obtaining an inspection,I agree to remove
40 PP B W equipment or devices which ,
it huamnu,air conemmanu as defined by the Bay Arm,Air Quality Management all new materials for inspection.
strict?
❑Yca ONO
Ihe.used thehavardmrsmaeritlamquirenums under Chapmr6.95 ofthc Califor. -
niceHcalN&SafetyCodc,SeuMm25505.25533 sod 25534.1 undcmand Natirthe building
dm vel currently have a tenses.Net It itmy mslensibilldy to notify the tic[ net or the
requirements which mus,be pelft iiformlLuanax sofa CcmfmM of [spm . Signature of Applicant Date
ownerm.ntharvnd.gen, a��D°6 All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
j ,' ' '✓' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: jI 4 I Dr PERMIT #
GOt asor 060 sd 2-J-3
OWNER'S NAME: PHONE # — C/
GENERAL CONTRACTOR: i'"lt FAX #
I am not using any subcontractors:
ature Date
Please check applicable subcontractors and complete 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
-AgwiI-tering
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 . . . . . . . . . 36225007 . 00
DATE ISSUED. . . . . . . : 05/31/2006
RECEIPT # • • • • . . . . . : 34635
REFERENCE ID # . . . : 06050253
SITE ADDRESS . . . . . : 1191 'CRESTLINE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. SHENG SUWU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CUC T DINH
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : SHENG SUWU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 2, 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BSEISMICRE VALUATION 2, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 188 . 66 0 . 00 188 . 66 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 188 . 66 120
TOTAL- 188 . 66
VOICE DESCRIPTION VOICE ID DESCRIPTION
_______________________
--704 �
-� CITY OF CUPERTINO
«� DEMO
CUPE�TINO PERMIT APPLICATION FORM
APN# 3 co 2- 25^ 60-1Date. -1
Building Address: l M/ / f„�S l f. � ib r �/3 � ?5 Q
Owner's Name: S r �h l �UW LU Phone#: 4()&- - 916 S- I 39
Contractor: �p j� 11, q License#: B r 7�
Contact: 11 l/l n /IC D� Phone#:
Applicant/Contractor:
B ' ing Permit Info: '
lcl lect Q4w Plum ech
o Description: iri n Pv-D r '�
Residential: J Con rcial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation: `
2000
• Type of Construction: Occupanv Group:
Qty. if
Applicable Fee ID Fee Description Fee Grou
BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG