06070090 (2) CITY OF CUPERTiNO rF
BUILDING DIVISION PERMIT ;: ONTRt1.�'��RI1�II`WnR'Mr� ?IaNN
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BUILDING ADDRESS: NA NAL CONSTRUCTION RENT R.9 NO06070090
7488 DE LA FARGE DR
OWNER'S NAME: PERMIT ISSUE DATE
LISA CHAU & ALBERT CHAU 1355 FILIPE AVE 07/14/2006
NE: SANITARY NO. CONTROL N0.
(818) 221-6057
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION lob Description
j 1 Nmby aBbm Nat i am limrimd under provisions of Chapmr 9(commencing
with Section 7000)of Divis on 3 oflhe Business and Pruressions Codo,and my license is
b(all Wcoand.r(eci. TEMPORARY POWER RISER
s 0 Z Licenm Clan Lie.if
g1 Dau Contractor
7 s-
ARCHITECTS DECLARATION
S a 1 understand my Plans Mall N used a public mcnrda
3
°o Licensed Pndcssionel
e
OWNER-BUILDERexmptDECe Contractors
ON
f 1 hereby,Vitro that 11. exempt faro the Cssuouso Licenm Lew ra,th.
O4
following mason.Permit
703 comer LahBusinet. endow. emORCadc:My city at county
39 whichitsirequires,•permit'e tom the dice Npmw,dcmOlW.ore a Sai any u=lure tOMOM $500
za thathe itsiummperso ,inithe the ismoamfar such tinesmit 1.tire Law(Chapter
pthalhalslk.nwitpuwantbthe pmvisionsmfNCCmmcam/a Licenmlaw(Cost)or Sq.Ft. Floor Area Valuation
yy55 $ 'haat a is axe pt Section 700d the basis
for of the Buainusantl Professions Cade)of
C'3 Nu he is 31Z b therorrom and the anis for the alleged uemant to Any l lemon of
Section7031Zthane 6Y anyhum red dons for puma mbjeeu the applicant m a civil penalty of er QCCDpanCy Type
not more Ilan five hundred dollars(5300).
❑1.m owneraf dSe Naperry,a my empbyaa Wth w,gm u they role compcwdon,
will dothewons Cosiand thThe Committee,
Licdesse Lw ad
does
apply an an ower of Required Inspections
and Pmfesalork Code:The Canuacu i Lkuue law dam rat apply b an owner of q P
property who builds or improv thereon,and who does such work himself or through his
Own employees,provided that Such impmsememu one not intended or offered for sueif,
howew,the bufldingar imprownem Is and within am year of mmpledon,the morins. 7/
Wilder will hove the burticn of proving that he did ml Nita or improv for purpose of
.It.).
Fri,as aver of the property.am704.Business reclusively conaactfng with )Ties C conuubss .
tomcod the es nota(Sec.7014,wnrofand rty who ns Cndr:) pr Conv neon, n
came law does not apply tu ts Dana of property who build,or improve themon,and, - O
whaeu for such projeeu with a<onuxwrt,)licensed pursuant u W Contractors /
Liceems enm Law. (�
❑loco uempt undo See .BkPCfor that mown
Ow Dam
ORKER'S COMPENSATION DECLARATIO
1 hereby canna uses,pcvlry of perjury one of the following declarations:
1 haw and will maintain a Certificate of Consent as Self-Wum fm Workers Campen-
.d..,ss provided for by Serum 3700 or the Labor Code,AS the performance of the
work for which this Permit is issued.
❑1 haw W will maintain Warkers Compensation bsWnnce,as required by Section
3700 of die Labor Code.for the perfortanceofder work forwMch this permll is issued. '
My Workers Compensation Wumme earia and Palicy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rlTu Section mad cot he completed Blue permit Is foram hundred tlollH(5100)
or less.)
I coni"Out in the performance of the work for which this permit is 4ried.I haul not
employ any person in any manna fP um become sabjmI to Ne Warkcrr Compensation
laws of Cuiroru D SSS// trtr[[aa
APPlkant
NOTICE TO APPLICANT.If.after making this Ceninule of Exemption,you Mould
become subject be the Workers Compensation provisions of the IAWr Code,you mesa
Zforthwith comply with such provisions or this permit MVI N deemed mmked.
?O� CONSTRUCTION LENDING AGENCY
[—i I hereby Salon that them is a conslruNrn lending agency for the perfarunm of
a the work for which Ws permit u Stied(Sec.3091,Civ.C.)
6Wi Q Lenders Nam.
Z lenders Addmss
U 0 I comfy dial I haw mad this application and sou mu the Show information Is
f,t'+ comet.I agom in comply with all city and county ordinances and suss laws mladng in
U building construction.and hCmbY,urharim repmsenmiw of this city to color upon the
Uabove-menduned pmperty for insmcuon purposes.
CLI (We),gree to mw,indemnify and trop harmless die City of Cupertino against
sFi fn liabilWu.judgments,case and expenses which may in any my&come against mid City
U z In eomequmm of the granting of this peonil.
�-+ APPLICANT UNDERSTANDS AND WIL .COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. `///- �/
slgrwe 't�.arivCanuec��L/1 7 /'pans�• Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WN due applicant a future building oaupanlsuu or handle hamdou mamrfu
as defined by the Cupertino Municipal Cork,Chapter 9,11 and the Health and Safety
Code.Section 35532(3)7 �/ All roofs shall be inspected prior to any roofing material being installed.
❑Yon
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
soh havamom air conuminsntt on defied by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ye. u
I hew mad the hasadousmaurials mquimmens undcrChapur6.95ofNeCalibr-
nitHcai &Suety Code.Samans25503,25533utu25534.Iun&nuidthatifdu Nikdng
dons not currently haw a unanl that It isgty responsibility in notify the Occupant of the _
m al hew N maanmar,cednatearacopamr. Signature of Applicant Date
Owneronutharixd,cotDom'
All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35926036 . 00
DATE ISSUED. . . . . . . : 07/14/2006
RECEIPT # . . . . . . . . . : 35268
REFERENCE ID # . . . : 06070090
SITE ADDRESS . . . . . : 7488 DE LA FARGE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LISA CHAU & ALBERT CHAU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ALBERT & LISA CHAU
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 1355 FILIPE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (818) 221-6057
�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
----------------- ------------ ------------------
CHECK 100 .47 349
TOTAL RECEIPT 100 . 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
101 FOUNDATION 103 UFER
104 REBAR 105 ANCHOR BOLTS
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL 510 FINAL PLANNING
•
� la, CITY OF CUPERTINO
TEMP 'OWER
aPPERTINO PERMIT APPLICATION FORM
APN# Date:
a6 0 0 6
Building Address: _ /.
ner's Name: r �/ Phone #:
_ 3
54- OU
Con ctor: Pl on License #:
Contact: Pho e: Cupertino Business License #:
1
Building Permit Info: Oh -/0 LeV(S y 0E020/S-'y.
Elect ElJ
Job Description:
u
Residentia Commercial ❑
Cost of Project: 5�
•
Qty. if
Applicable Fee rD Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•