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06050120 (2)ipiLyCCLy��j�� ?�G 0� z. V wZ Gr Ui UC OF FD UV `s CITY OF CUPERTINO'� ^may: » " ' ' ` ''C)RI� U tMATION:� BUILVING DIVISION PERMIT �. �1,N=.['RAZ ° m.A,."ro".'Fw=.•, .,math , Bu1LDINCADDRESS: NICE & RIGHT CONSTRUCTION Y "f NO.06050120 21839 LOMITA AVE OWNER'S NAME: PERMIT ISSUE DATE GARY LI 10663 SANTA LUCIA RD 05/15/2006 NE: SANITARY NO. CONTROL NO. (408)861-0928 ARCHIIECDENGINEER: BUILDING PERMIT INFO ELECT 'PLUMB MECH EQ LICENSED CONTRACTORS DECLARATION lob Descriti P I omby aRtm Nu 1 sm licensed under provisions of Chapter 9 (commencing with Section TOMB afDividan 3 of the Business and Pwhasioru Code. AM my Ikeun la I. fail foam. and effect.R21 4�S INSTALL TEMPORARY POWER POLEMAY� l,cers Lit P x nu Dew Caatmwr Q ZUUG ARCHITECT'S DECLARATION tJ (understand my glens Mall be used as public rtcords A �{ I�La� ,v�� BUI(DI IL Licensed Profecom.al OW NER-BUIIDER DECLARATION 1 Wm(firm 1 em eanmpl from Ne G.n'raclCo Lien law far Ne y c 71D l.i Rumness and iau Caw: Any city or county following mason. on $200 2 0 0 '7 uircaa(Section are, do which equlrea a email w cnnmm4 after. Improve, ,permit . or eealr any Sq. FI. Floor Area Valuation prior b, issuance. mm Acquires larsu omnant far Con rector' wire s Law (Chapter IW -Pions Conus, tothm o Ute heI,cued pumuetwthepavisiou of dial, l p andcmelaw(Chape9 Cade)or of the BusUtuuMon. th Diais Myavi pttSenior7000) fear Nat he b uempt thertfmm and the bub ra Ne alleged esnnptloa My mabUon of that APrq Nidrfibrcr Occupancy Type Scenes 7031.5 by any spiritual for a permit labj¢u the applicant to a civil penalty of not mom than firs hundred dollars (5500). 1, u awns of the property. army employeeswith "Flu Nets wteeanpem,Uon. Required Inspections q P win m thewarkand Nesuunurt bnctktendedaraRucd forsalc (Sm. TON, Business and Professions code: Tha conmctor, Lkeme Law, aces tot apply w an names or progeny who builds or impmvestimmen, and wbod.,..hwmk himself arthrough his own employees, ptavided thataueh ImprowmewN art notinwnded oraQered fm,ale B, he... the Wilding m improvement is sold within 0. year of mmplWon. Ne owner- builhr will haw Ne burden of p ming Na' he did nm buiki m improve fm purpose of ark.). 1. u s ownof the properly, am emlusiwly consoled, with Bewared conmcwn, w uuuct the project (Sec. 7044. Business AM Professions; Code:) The Canmcwrs U- ...-' Isw data mot Apply as an avec of property who Wilds an Impmws f.. red. who conaam, fm such projeeu with acommuct named personal to the eonmcwrs License Law. ❑ 1 am exempt under See. . B A P C for this reason owner i—/ ..-,— � Dat j 6 WORKERS COM SATION DECLARATION 1 thereby air= under penalty of pejury ane offt following dsel-rmomm .] Thaw ono Ter s - eCeninrnw of ConcentwCode. fart edam cc of s providedSection 3700 of cite Labor Code. fm the perfoman¢ of Ne providod far e& f r mi work for rM1leb Nis pencil is issued. ❑ I Mw and will maintain Workmes Compensation Ituurar x. As rtquirM by Section 370Dof the LsorCam, for cit performance of the teak fawhich this permit is issued. ' My Workers Compensation Insurance ¢sic and Policy number are: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE OTB vacuum ¢ed natbecamphoul if ft pcmmit b Forane hundred dollars ($10) or less.) 1 ¢nify Net in the per(mmao¢ of the work for which Its permit is bound. I "I not employ any peuon in any memtrmasgbcoangwbjmw Ut warkaY Compensation Utes of California. Dam // -s' Applicant NOTICE TO APPLICANT: If. after making NH Cenitham of Exemption, you should ,moms Subject W the Workers Compensation pmviuom of the Later Coda, you Most ' forthwith comply with such provisions or this permit shall W d¢med mvokcd. , ON LENDING AGENCY CONSTRUCTION 1haehyiBrtn & c agency for the Performance of thnre4•ed(Sc.. 307, Cing ' Na work for which this permit b road (Sc. 7097, Civ. e.) Pe Leadices Name Lm<nmes Add,..: I cenify that I have read Nis applim des and mw that the move infmmmiun b v correct 1 sgme to comply with all city and county ordinances and sum laws elating to building consuuction'and hereby au pori¢ eprtsenmives of this city to cnmr upon'hc fm impaction wove-numd.ned property purposes (We) agree 1m saw. Indemnify and keep hasnlem Ut City of CupaMM -gains' I Imbilidu, juagmcnu, calm And expenea which may in any any same aIllut laid City in consequence of Ne grandng of Nis permk q APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date 6 SOURCE gBG{�LA770NS. � ! �� Re -roofs Type of Roof Slgn m Appli¢nUCon ter Date HAZARDOUS MATERIALS DISCLOSURE Will tit applicant or future building a¢ur mts'om"handle henaaus material As defined by Ut Cupertino Municipal Code. Chapter 9.13. and the Health and Safety Cam, Section 35532()7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicwt orf tum building Occupant use equipment or devices which emit Iuurdous air commolnanu u muncd by that Bay Amo Air Qulhy Management all new materials for inspection. DistrinT • ❑ Yea Nu Its mad the ha>srdeu materials mquiremesu under Chapmrd.95 ofthe Califor. niaHNIN'Nicty Cam, Smdou2.5305.25533and25534.1uM WWNulf Nc Wilding does tot eaeeMy have a tram. Nat It Is my respsulbility st.odly tW occupant of Ne rcgmemcnu ' muttontt nutuu-ms ,Censlkaw ra/ Signature of Applicant Date All roof coverings to be Class "B" or better 1a Own., ar erbad agent Dow' CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35716999.00 DATE ISSUED.......: 05/15/2006 RECEIPT #.........: 34405 REFERENCE ID # ...: 06050120 SITE ADDRESS ...... SUBDIVISION ....... CITY .............: IMPACT AREA ....... OWNER ............: ADDRESS ..........: CITY/STATE/ZIP ... 21839 LOMITA AVE CUPERTINO GARY LI OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: SHIRLEY K NG CONTRACTOR .......: JIA HUO YU LIC # 23446 COMPANY ..........: NICE & RIGHT CONSTRUCTION INC ADDRESS ..........: 10663 SANTA LUCIA RD CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE ........: (408)861-0928 �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 ----------------------------- ------------------ OTHER 100.47 VISA TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL U c �f- �CITY OF UPEkTINO CI'T'Y OF CUPER T'INO TEM.P POWER PERMIT APPLICA'T'ION FORM ()coo,50 120 APN # 551 -1 (0 . _I I q ELECTRICAL Date: / S O O Builth/3 g address: L / P / ELECTRICAL BUSLIC Owner's Name. L Z BUILDING Phone #: s -666-- Contractor: R H &oovs Phone: 4o - - 0 2 Licens Z f q SC9- Contact: Phone:Cupertino Business License #: —O 2 Building Perm4t Info:rJJd� Elect ❑ Job Description: Residential Rf Commercial E]Cost ofProject: 00 • Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING