08030113 (2) CITY OF CUPERTINO a$' - •, vr,-vee a*r3.;�-> ""vw '+ '"'"�—i'" '
]BUILDING DIVISION PERMIT 7�CONTRACTOR INFORMATIQN
BUILDING ADDRESS: PERMIT NO.
10438 PRUNE TREE LN TBD —. TO BE DETERMINED 08030113
OWNER'S NAME: PERMIT ISSUE DATE
LIU TSUNG—TIEN YOUNG—CHI TAN 03/20/2008
ONE: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Sop LICENSED CONTRACT'OR'S DECLARATION Job Description
b'r eon TO )of Nn I am f he Bu under provisions of Cheaper 9(commencing p
with s«don]chief Division 3atone Business and Professions Code,and mylicense u
infnllrome.nee(fect TEMP POWER FOR REMODEL PROJECT
p fa Z Licenu Class Lic.N
CJ Dow.Contractor
ARCHITECTS DECLARATION
I onderstanJ my plans Null be uud u public records
5a
a G
Licensed Professional
`H
OWNER-BUILDER
mptfr DECLARATION
Conn ION
t e i I hereby.(Tion that I em exempt from Ne Connector's o License Law for the
my
>:O O following mason.permit
t 703 1.5,Business and Improve,
de Professions Code:Any airy structure$ which rtqulmts,permit re cansWe4 pWn I t for such
h penaft i or repair any ttemum
_ZSa pdarbits cenedpursuantrequires Previsions for,vhpcnni'to Nese Law Inapaxt
F < Ihuhculiccnsedpurwanuo(hepmvis(ovafNeCanuacmr'sLkensclawfChep¢r9 Sq.Ft. Floor Area Valuation
y $ (commencing with Section 7008)of Division 3 of Ne Businessand Professions Cade)tar �^15
`< Net he u exempt therefrom and the lines for the alleged eaemptian.Any vulatiun of
Section 701.5 by arty applicant for a permit objects the applicant to a Civil penalty of Number Occupancy e
not mare men five hundred delars(MM). 31633081 .w p y Typ
❑I.u owner of me PmpenY•m mY wployees wich wage u Nees rale rompensation,
will do thewmL and On swmum is oat intended m oRerd fovale(S«.1044,Business
and P,cfesslan Cade:The C.mswmr.Lt..�,.Law does rat appy to..owuer or Required Inspections
property who Wilds m i m proves themon.and who dma amh work himself or Through his
Own employees,provided that such improvements are notinended oraRered formic.If,
however,the building or Improvement is sold within ane year of compledan,the owner.
builder NR(uve than burden of proving that M did not Mold at Improve for purpose of
sale.).
1eI.u owner of Ba Property.am exelmively conmcift with licensed enneaamm te-
vtmet the project(See.7x144,Business and Professions Cade:)The Con nnewes Lt.
cave Law don riot apply to an owner of property who Wilds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Christmas's
'LicmAx law.
�J l am exempt under See ,B&PCfo flus meson
Owner Q'.y_Doe 7,i/70 d
W KERS COMPENSATION DECLARATION
1 mm under penalty of perjury one of the following decimations:
I have and will maintain a Cardfown of Consent 0 self-insure for Workers Compen-
on,n provided for by Section 3700 of the Labor Cade,far the perfannmec of dm
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,an required by Schon
37W of the labor Code.for the performance niche work for which this permit Is issued.
My Worke(s Comosmamon Insurance artier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPITON FROM WORKERS'
COMPENSATION INSURANCE
(Dtusectlon need not be complexed if the permit in faros.hundred dollen(SIM)
or less.)
1«nify that in the performance of the work for which this permit is tamed,I shall not
emplaywypenan Iran manncrso to «orae b'«u a Warlord Compevadon
Laws of California.Dam
Applicant 54.a ekn-
NOTICE TO APPI :If, making this Cenificae a Exemption.you should
become subject b 'orkces Compensation previsions of the Labor Coda you min
.J O forthwith cemPly Willa such m
eh provisions u permit shall be damned revoked.
z` CONSTRUCTION LENDING AGENCY
[-n 4 1 hemhy affirm that them lea conmuctinn lending agency for iho and.....I
C> the work for which Wer Permit is Wood(Sec.3097,Civ.C.)
IM Landers Name
z [enders Address
UQ 1 certify that I haw mad this applieadon arta state that the above infommadun is
UU r'. corrin I agree to comply with all city and county ordinances and ante laws relating to
C) SV' building construction,and hereby ALOICHm mpracnutivn of this city to enter uponthe
alwve-mcnduncd property for Inspection purposes.
(Wa)agree to save,indemnify and keep h rmlaw 0e City of Cupertino against
rex
liabilities.judgments.cots and espouses which may in any way accrue again,said City
U,Z in consequence of the ranting of this permit. r Z
" APPLICANT UNDERSTANDS D W OMPLY WITH ALL NON-POINT Issued by: Date
SOUR RE ULATIONS.
` > >O o° Re-roofs
Sig rt f pp' (/Cammmur Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant art future building occ'upameme ver handle Murdan material
an defined by the Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety
Code.ca006 25532(a)? VN. All roofs shall be inspected prior to any roofing material being installed.
❑tics
Will the applicant or rune building oceupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hmordov air cememirunts an defined by the Bay Area Air Quality Management all new.materials for inspection.
strict? ``��'' .
❑Yes pdno
I have marl the bnaNuv matodalsrequintrom m under Chaper6.95 ofthc Califon
nu HOW&Safety Cade,Sections 25505,25533 and 25334.1 underaraid des ifone Wilding
doe not cumentiy bow.en.nt ones it u my povibili,Y nodfy the o«upent of the
rtquimmcn whit ast be at pilar aura .eof Omopmm. Signature of Applicant Date
owns ortu-044nned, ' D,e All roof coverings to be Class"B" or better
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31633081.00
DATE ISSUED. . . . . . . : 03/20/2008
RECEIPT #. . . . . . . . . : BS000004215
REFERENCE ID # . . . : 08030113
SITE ADDRESS . . . . . : 10438 PRUNE TREE LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LIU TSUNG-TIEN, YOUNG-CHI TAN
ADDRESS . . . . . . . . . . : 10438 PRUNE TREE LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5263
_ RECEIVED FROM . . . . : YOUNG-CHI TAN
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 150, 000 . 00 15 . 00 0. 00 15 . 00 0. 00
1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
1ERT<200 UNITS 1. 00 40.79 0. 00 40.79 0. 00
ITRAVDOC FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 137 .37 0. 00 137 .37 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 137 .37 VISA
---------------
TOTAL RECEIPT 137 .37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402 TEMPORARY POWER -
003013
CITY OF CUPERTINO
ga, TEMP POWER
• CUPERTINO PERMIT APPLICATION FORM .
APN # Date:
81 0 � 3 � � C)
Building Address:
104-3 ? ( y-
Owner's Name: I Phone #:
plan Cl 7Av\
Co4ctor:Q Phone #:
a(e
vi V., (c6-ak_) 6 6
Fax #:
Contact: Phone #:
Oin^ C� , Za,^ ( 4 as )
ContraMr Lic se #:
Cupertino Business License #:
Job Description:
Residential Commercial ❑
Valuation (cost of project):
'0 000
Quantity Fee ID Fee Description Fee Group Permit Type
1ERT>IK Res. Temp Power>1K E 1REAP14
Amps
1 ERT<200 Res. Temp Power<200 E
Amps
IERT2001K Res. Temp Power 200-1K E
Amps
IEPERMITFE Electric Permit Issuance E
IELCPLNCK Electric Plan Check E
1BSEISMICR Seismic Residential B
CITY OF CUPERTINO
RI TEMP POWER
CITY OF
• CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
IECT<200 Commercial.Temp Power E
<200 Amps
IECT>1K Commercial Temp Power E
>1K Amps
1ECT2001K Commercial Temp Power E
100-1K Amps
I' ITRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
•
r
1
Community Development
10300 Torre Avenue
. ' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
*UPEPTINO
Building Department
JOBDA 3 & r
SS: Jb tw pa4-.-? k-, ev/ PERMIT # 08 3 0//2
OWNER'S NAME: _ Ta PHONE # (4o8)4e3 —4 3
GENERAL CONTRACT FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
60 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
er/Contractor Signature Date