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08050066 (2) CITY OF CUPERTINO ��,x� ,Y "', �" BUILDING DIVISION' PERMIT *"�C��IzTJ��'��lIZINI`'0 ,,M:'TION BUIL D�tNOi�IZDBPssE:LENDA DR K & M DEVELOPMENT INC PERMIT08050066 0':/NELR'SUNAME: PERMIT ISSUE DAM ALICE TAN 1060 WEST HILL CT 05/06/2008 NE: SANITARY NO. CONTROL NO. (408) 253-9787 ARCTIC ECWENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 u O p LICENSED CONTRACTOR'S DECLARATION I therebion? )of sun 1 am of the Bu ander And isions ProessofC rule, 9(commencingsis - Job Description withSectionDiviaionlo(theBusiness and Professions Code,and mylicenxu POWER POLE RELOCATION in full force and effen LicenseClue Lk. a Dtex FO Dem Contmetur DEC i ',f` arts A.0 use DECLARATION �ca<i 1 understand my plans shall w used As puhlic records Soy Licensed Pmfessionel OWNER-BUILDER DECLARATION 1 thereby affirm Nal I am escmpt from tw Contranofe License Law for the OO following mason.(Section 703 1.6,Business and Professions Code:Any city m county RSV which requires a permit to eonswc4 almm impmve,demolish.As¢Noir any structure Lai pnorto its issuance,Out mquims the applicant far such Permit o rile a signed statement < that he isliccnssdpursuanttotheprovisionsOftheConuacter'sUccmc, aw(Chapter9 Sq.Ft. Floor Area $ Valuation xzF� 000)of Division 3 of the Business and Profeuians Code)or 100 (commencing with Scedon 7 y $ Nat he is exempt thetefmm and the basis for the alleged cumptioo.Any violation of Section 7031.5 by say applicant far a permit subjects Ne applicant m a civil penalty of Oceu ane Typenot mart dom fw hundred dollars(M). 32630023! Number ❑L as owrmr of the property,army employco with wages u their sole comparemon, will do thewodt and thesruclure is notimmoded or offered tussle(Sec.70x4,Business and Professions Code:The Conlacars License Law does not apply an an owner of Required Inspections property who builds or int prow thereon,arul who dues such work h imself or through his awn employno,provided thatsuch improvements art notimmnded coffered forsale OL ' howewt the building or improwmmt is sold within arm year of completion,the owur- wdder will haw the burden of proving mat re did not wild m impmte for pamose of ak.). 1.as no,of the property,am exclusively contracting wins Hcenud cams auras to Fectutruct the pmjen(Sec.7004,Business and Professions Code:)The Conuxun's Li- cave law dos not apply b an owner of property who wilds or improws thereon,and, who convects for such projmns with a co macror(s)licensed pursuant to the Conuanofs License Law. ❑lam.morptunder See ,B&PCfurthmrOAaa Owns �G_ Dam WORK COMPENSATION DECLARATION 1 hereby afllon under penalty of perjury oro of the following declarations: I haw and will maintain a Certificate ofC.man,nt to elf-insure far WorkersCompen- sellon,as provided far by Section 3700 of the Labor Cade,for the performance of the work for which this permit is issued. ❑I haw and will maintain Workes Compensation Insurance,As mgaired by Section 3700 ofthe labor Cole,for the performmcc of the work for which this permit is issued. ' My WarkeeS Compensation Ona nor.oris and Policy numwr are: Carrier, Policy No.: CERTIFICATE OF EXEMPTION FROM WORXERS' COMPENSATION INSURANCE COMA sect¢need not An completed little permit isforme hundred dollen(5100) or leu) I certify mat in the perfatmance of me work for which this permit is issued.)shall not employ any person in any manacraoaskbccomewbI'er4 ffootM Work 'Compensation ' Laws of Califootia.Dem G'/Lyr-0 Applicant NOTICE TO APPLICANT:If,after miking thiFCcRIftem,of Eacmption,yru should become luau.W me WmkerS Compensation provisions of the Labor Code,yen mw .JO forthwith comply with such ryrvisinns ar this permit shall be deemed mw ked. 'Z'y CONSTRUCTION LENDING AGENCY [r I wmhy a11sm that there is a consuuctinn lending agency for the performance of FL he work for which this Permit is issued(See.3097,Civ.C.) �W lender's Name .7 z Lender's Address C)Q 1 certify that I haw reed this application and we Nat the show infowad.is caawcL 1 a me m cam 1 0 f, g p y with all city and county mains of and stem laws r upon to V x1mvingeotuwctireNrrd hereby aumonpurpoesenudw of this cup to cater upnn the W awve-m,judgments. udg d pmpeny,for inspection purposes (We)agree to saw,indemnify and lamp harmless the City of Cuperino against h in of Standing eapusMwhich may in any way attruc againstssid City ^ �� V z A consequence of me granting of A permit C �. �< APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date J SOURCE REGULATIONS._ Srgnaurc of Apphnnt/Contncsor—!_ Data Re-roofs . HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building accupantaom m handle hvaadons material as defined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety ' code,odor 25532 (,)7 All roofs shall be inspected prior to any roofing material being installed. Ycs [�Na Will the applicant or slum building Occupant use equipment or dcHst which If a roof is installed without first obtaining an inspection,I agree to remove isuaz otlrus air canmminantt As defined by the Bay Arta Air Quality Management all new materials for inspection. ❑Ycs No I have mal the heradow crateriabreprim ccres under Chapter 6.95 of the Califor. MA Health&Seely Conk,Section M505.25533 soul 15534.1 un lcrsmnd thatifde wilding dura nal currently haw a mrumt that it u my responsibility to notify thn occupant of the requiremcns which m met prior w isatc.of a Ccnifieam of japan Signature of Applicant Date Owner araathd.—,.d agent DamAll roof coverings to be Class';W'or better CITY OF CUPERTINO • 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 32630023 . 00 DATE ISSUED. . . . . . . : 05/06/2008 RECEIPT # . . . . . . . . . : BS000004683 REFERENCE ID # . . . : 08050066 SITE ADDRESS . . . . . : 20896 ELENDA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ALICE TAN ADDRESS . . . . . . . . . . : 2672 BAYSHORE PKWY #702 CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043 RECEIVED FROM . . . . : AILI TAN CONTRACTOR . . . . . . . : MARTHA KANG LIC # 22244 COMPANY . . . . . . . . . . : K & M DEVELOPMENT INC ADDRESS 1060 WEST HILL CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 253-9787 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1EPERMITFE FLAT RATE 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 81 . 58 0 . 00 81 . 58 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 81 . 58 VISA --------------- TOTAL RECEIPT 81. 58 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER • CITY OF CUPERTINO « ' TEMP POWER CUPEkTINO PERMIT APPLICATION FORM APN # Date: OA 3 . 6-0 s - - 6� Building Address: 208q L a �� r%r`vc�trJ , C�� /SCS Owner's Name: Phone #: Contractor. t f i hone #: �0� 3 �O s/z Falx #: Contact: vPhone #: Contractor License #: ZS 7 . Cupertino Business License #: Job Description: rr _ Residential [ Commercial ❑ Valuation (cost of project): Quantity Fee ID Fee Description Fee Group Permit Type 1 ERT>I K Res. Temp Power>I K E 1REAP14 Am s IERT<200 Res. Temp Power <200 E Am s IERT2001K Res. Temp Power 200-IK E Amps J 1 EPERMITFE Electric Permit Issuance E ` IELCPLNCK Electric Plan Check E IBSEISMICR Seismic Residential B / 1TRAVDOC Travel & Documentation B Fee CITY OF CUPERTINO �(v TEMP POWER CUPEkTINO PERMIT APPLICATION FORM e Quantity Fee ID Fee Description Fee Group Permit Type 1BSEISMICO Seismic Commercial B 10EAP14 1 ECT<200 Commercial Temp Power E <200 Amps_ I ECT>1 K Commercial Temp Power E >1K Amps IECT2001K Commercial Temp Power E 100-1 K Amps 1TRAVDOC Travel & Documentation B Fee 1BUSLIC Business License B e Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 4UPE(�TINO Building Department JOB ADDRESS' I PERMIT # -2006 t5 V-Iu 'lq J �6 OWNER'S NAME: RZ Z6:cPHONE # GENERAL CONTRACTOR: !1?7ti FAX # I am not using any subcontractors: —r 0 A Signature Date Please check applicable subcontractors and complete the followinginformation: 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 Owner/Contractor Signature Date