08010140 (2) CITY OF CUPERTINO 7 Mv� t-YeNrPd _'T_»bQ„ed. y«�'1BllM
BUILDING DIVISION PERT 41 T1Q1OMx19-:!!
Y.
BUILDING ADDRESS: PERMIT NO.
20860 DUNBAR DR TBD - TO- BE 'DETERMINED 08010140
NER'S NAME: PERMIT ISSUE DATE
CATHERINE LIU 01/24/2008
PHONE SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
TEMP POWER BLDG ELECT Plume MECH
o LICENSED CONTRACTORS DECLARATION lob Description O O O D
I hereby a(Bw WI 1 w limed under provisions of CMPmr 9(commencing
Z MNllfmcc1O110af DiHsion7.fthe Bulinus utl Profesatons Cotle,antl mylieenaH
:?
in full forte and effect.
y�3 License Class Lk.N
t{- Dam Contrular
nill ARCHITECTS DECLARATION
2 1 understand my plus Nall be used u public records
ga5 Licensed PmfcWonal
g vOt] OWNER-BUILDER DECLARATION
fi i I hereby.M.that 18M uumpl from Ne CoMoucloYs License Law for the
00 following mason.(Section 703 1.5,Busiuss and Pnefessiom Cade:Any city or county
which rtquiv a Permit to canon ct.abet Improve,domicile,ar repair any$"Mo.
_Z>r^ poor to but issuance,alta rtgmru the applicant for such permit to rile a signed sutwent
< Nat he is licensed Paramus lo the provisions of the Counselor's I-ecom Law(Chapin 9 S Ft.Floor Area
{ o q• Valuation
{ 9 (commencing is whh Sectionrre and the
Division f 7 of the al Business eBatad Prormim.my vi Code)or
L`i than he u ub thwfrom and the was for the cts ed eawpdm.Any vioution of
sectim 7031.5 ve airyreddutfar apermit subjects the applkuuaaevil Penalty of APN Number Occupancy Type
ntot more Nu Bw huntlrtd t1011w(SSW).
❑1,u owner of the pmperty,m my wptomu witb cops u Neirsole mmpenadon,
will da the work•and the structure isnot immnded or offered for Business
(See.7044,Busin
and Professions code:The com users License law sou not apply to an owner of Required Inspections
properly who Wilds or i mproves thmmn.s nd who don such work himself or through his
awn ampl.yeas,provided that each improwareenu w not inunded oraRerN for ale If,
however,the Wilding or Improvwut is sold Whin ons Sear of completion,the owner.
milder NB have the bwden of proving that le did rot Mid or improve for pugroe of
tale.). .. -
1,as Owner of to properly,w exclusively comrso0ng with licensed contractors m
c atmet the project(Sec.70/4.Businw and Professions Cada:)The Con racmfa U.
cense Law door not apply he an owner of pmpeny who builds or improv thereon,tad
who contneufar such projects with aconuamor(s)licensed .at to one Consomme.
Lice se 4w.
❑Iw uempt "dersee B&PCforthanmsmm
r I� Dam (^JGT- U�
WORKER'S COMPENSATION DECLARATION
I hereby a(Drm under permIty of perjury ane of the following dealmadau:
❑1 ham and will me acus a Cortifinm.(Cmmm to self-inseam fm Wusban lCompen-
samn.u provided for by Sections 7144 of de Labor Code.for elm peAowana of the
work far which this permit u ubmd.
❑I have and will mention Workers Compensation Insursna,u required by Schon
7144 of de Leber Code,for Ne perfawuec offt same for which this pewit is issued.
My Womm's Compensation lourance canner and policy number w:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
or ecu)(Thu mulm coned nal becampkmd film Pewit is forum handed miles($1 011)
1 certify that in the perfowsoca of the work for which this Pewit is iaucd.l shill not
employanypersoninuymumrP come act to the Workers'Compensation
Laws of CaliM.M.Dam
Appllcut / ^
NOTICE TO APPUC�!:If,afar mafKl moa Wifinm Of Exemption,you should
become matter m the Workers Compensation provisions of the IAbor Coda you muse
.J O Mulovitb cow
comply with such provisions or this peit shall M rere
deced rokcd.
y CONSTRUCTION LENDING AGENCY
[•+ > I hereby affirm that then ins construction Matting 9CWY for the Performance of
a the work fur which this permit B iuued(Sea 7097,Civ,C.)
0.Q undoes Name .
D z Lmndces Addma
UQ 1 ratify,that I have read do$applintian atto suns thatthe have infawatim is
IL^ caned 1 agree to comply with ate city and county on inaneea and sum laws mending Be
Q kr.'J building construction.and hereby authoom reprommev of this city w color upon the
W shove-mentioned property forinsNeedan which may
(WM agree to um,indemnify and keep harmless the City of Cupertino against
Z IIabllfto ftdg...is,comudexpensor whichmryin LAY way socme Ratnstsatd City
f>z In consequence of the granting of this Numb.
^� APPLICANT UNDERSTAN
SOURSAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
CE R-EGUTATIONS
V� ! " ('2-4 _1'ed Re-roofs
Sgunbe of Applinm/Camraclor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Curanl or(Muni building e.ChA atom or handle Health
Safety ety
Bud!Section
the Cupenina Municipal Codc,Chapmr 9.11.and the HaIN and satety
0 sss7z(.)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yu �No
If a roof is installed without first obtaining an inspection,I
Will the aPPlicul or Mums building Occupant sec eyuipntenl or device which g Pe agree to remove
Murk,�nu ant co menumuu' dcnncd by On Bay Arm Air Quality Managcmcnt all new materials for inspection.
❑Yu �!o
I neve read the huadoa asuarle,requiremutsuMer Cmiurs.95ofthe Califon
doesth&Safety Cade,Sations 25505,25577 am1255M.IundenuM thnif tie Wilding
duo cot uwno,
ham t hurl than it i my issuance
omibiliu to mofy the panty. of the
rcyairtm now nmtr�am rte+ artoivmnr4.nCuniruatoaroceupmey. Signature of Applicant Date
Owner or authamcd agent Dam- All roof coverings to be Class"B"or better
1
5
CITY OF CUPERTINO
TEMP POWER
CITY OF
• CUPERTINO PERMIT APPLICATION FORM
d �
APN # Date:
320 30itiy. 60
Building Address:
Q0 2-66 pUNBAR nRtvE , cW'c-`?"T40 o CA IS--o C�
Owner's Name: Phone #:
P E X g GATHc-p.tarC I itl
�a8 ) 444c, 0
Contractor: Phone #:
G UJA-C-?, pUt L DCS
Fax #:
Contact: Phone #:
Contractor License #:
Cupertino Business License #:
Job Description: .
`rA[U - si6fty R 'bs19t?Ji/AL
Residential Commercial ❑
Valuation (cost of project):
p C�
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>1K Res. Temp Power>1K E 1REAP14
Amps
IERT<200 Res. Temp Power <200 E
/
Amps
1 ERT2001 K Res. Temp Power 200-1 K E
Amps
IEPERMITFE Electric Permit Issuance E
IELCPLNCK Electric Plan Check E
/ IBSEISMICR Seismic Residential B
rl
CITY OF CUPERTINO
'" TEMP POWER
•CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
1ECT<200 Commercial.Temp Power E
<200 Amps
IECT>1K Commercial Temp Power E
>lK Amps
IECT2001K Commercial Temp Power E
100-1KAm s
1TRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
•
r
` CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32630144 . 00
DATE ISSUED. . . . . . . : 01/24/2008
RECEIPT #. . . . . . . . . : BS000003767
REFERENCE ID # . . . : 08010140
SITE ADDRESS . . . . . : 20860 DUNBAR DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CATHERINE LIU
ADDRESS . . . . . . . . . . : 20860 DUNBAR DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : REX LIU
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
------ ------------- ---------- ---------- ---------- ---------- ----------
1ERT<200 UNITS 1 . 00 40.79 0 . 00 40.79 0. 00
BSEISMICRE VALUATION 400. 00 0.50 0. 00 0 . 50 0. 00
TRAVDOC , FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
TOTAL PERMIT 82 . 08 0. 00. 82 . 08 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 82 . 08 DISCOVER
---------------
TOTAL RECEIPT 82 . 08
VOICE ID DESCRIPTION `VOICE ID DESCRIPTION
-------- ---------------------------- . .. -------- ----------------------------
402 TEMPORARY POWER