06050085 (2) CITY OF CUPERTINO +' T'S'
• BUILD'AVCDIVISION PERMIT i'� ONTRACT ,R�INT''RORMAT.IO
BUILDING ADDRESS: s HERITAGE CONSTRUCTION AND PERMITNO.06050085
10270 TULA LN
OWNER'S NAME: PERMIT ISSUE DATE
Aak CAROLINE HUANG 13622 SARAVIEW DR 05/10/2006
E: SANITARY NO. CONTROL NO.
(408) 867-6881
ARCHr1ECT7ENGINEER: BUILDING PERMIT INFO
BLDG EIFCT PLUMB MECH
0 0 0 0
moo LICENSED CONTRACTOR'S DECLARATION
i C 1 ibotchyon7fi arm inti I am licensed under provisions of CtAoa 9(commencingMis Job Descriptio' 1
G iiia Seaman and
of Division Sof NC Businccs and Profcssium Cade,aMm license is
±Lq„ m Tau rues,Ctruns Irma TEMPORARY POWER POLE
>y,Jg Dow Class Conti
Dau Contractor
ARCHITECTS DECLARATION MAY zs7— i
I understand my plans snail W .N u rt
public enrde
Sa.
,O 1; Licensed encs Tonal1500
a h
OWNER-BUILDER DECLARATION
ac I hereby.(Sect Nes 1 1. uusin from the Contractors License Anyc Law for Orc •p rsdp
O O following reason.(Section]0310 Business and Pm.demod Code:Any city or county t
<m which rryussu a permit mums the
alar.ht forst h Permitsbut,Or repair any statement 50 0
prior 0.s its issuance.also requires the applicant for such Permit tilt asigned aumment
r< MatWkslicensedpursuanttoNcpmMaionsofNcconmetur'sIi¢nxlaw(chapmr9 Sq.Ft.Floor Area Valuation
(commencing with Section 70D0)of Division 3 of Ne Businessand Professions Codc)or
y — thathe u eumpt uniform.and the basis for the alleged exmnption Any violation of
Section 7031.5 by any appliam for a permit subjectsthe applicant m a civil penalty of r Occupancy Type
not mart dun firs hundred dollars
❑Lo he woulk the themuy,mmy employees withwaguasate(role 044.Bum.
will Prthework,and taeswuum unots License
uouded erawdetffeoul f,notapplyi in Bum.
and Pro who W code The improves
do Contractor's ulw1h.Law sou not apply lf an owner is Required Inspections
propertywhobuildsorimprovech improvements
m rove who aressmhwork hiroxVelthrough his
awn employees,providedNalsuchnLis mimmuartnos inuMedmpkd .the ow.B,
However,the Wilding orimprovementusoldwithinorayear at impo efor due purpose
of
builder wi0 bare the WNcn of proving that W did rot build at improve for pogo¢of
sale.).
❑1.as owner of the property am exclusively connecting with licensed commuters to
construct the project(Sec.70x4,Business and Pmfesdau Code:)The ConmcmrS U.
coax taw does not apply an an owner of pmpeny who W R43 or imports thermn.and.
who conmcu for such projects with a cmmimr(s)licensed pursuant in the COrmsemes
Lice.law.
❑lam tempterSm ,B&P C for this naw9.
�U u
Owner - Dau
WORKER' C h t]93ATION RATION
1 Mrtby arfum under penalty of perjury n of fallowing dedaratimse
I hem and will mdnuin a CcrdBm¢of Conant m self-inmrt faaWalls Counter.
satim,asprovided for by Section 3700 of dme LaWr Code.for me performe en of the
work far Molest
permit is issued.
❑1 Mvr and will maintain Workers Compensation Insurance,as required by Section
37011 of the labor Cade.for the performance of dte work for which this permit u issued. '
My Workers Compensation Imm.carrier and Polity number are
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thin section need notal completed if the Permit is Intone hundred dollars($100) v
Or leu)
1 cenify that in the performance of the work for which this permit is issued,1 shall not
e.^.mpioyanypersoninanymarma, bed me subject US Workers'Compensation
laws of California,
April nt
NOTICE TO APPLICANT:If, no making this CeniOcas Exemption,you should
been mbject to me Warkcrf mperuation pmvisia of c Labor Codr,you muss
.J O forthwith comply with me
such pmvitiom or that permit N deed rvo
eked.
Z` CONSTRUCTION LENDING AGENCY
I-+•�— 1 Mreby aMon that mere is a construction lending agency for the Nor...of
(Yi> Ute work for which thus permit u ksaued cite 3097,Civ.c.)
QLenders Name
7 z tenders Address
U0 I certify that 1 have read this application and sum mm the above information is
ly r comet 1 agree to comply with all city and county Ordinances and state laws relating in
0 Wilding construction,and hereby authorise mpfesentadws of this city to enter upon the
r W habili es,judncdpmpersy for inspection purposes.
L4 (We)agree to sass,indemnify and keep harmless the City of Cupertino against
U h iiaconsacquence cnu coauand ofthisasthey in any way stereo egduasdd City
UZ APLIC mtena afore Bandagalma permit.I ^/O
'--' APPLICANT UNDERSTANDS,AND WILL COMPLY WITH ALL NON-POINT Issued by: Date J —
SOURCEREO ONS.
"cl —fo--06 Re-roofs
Sigruureof ApplinMCon Dau
HAZAR MATERIALSDI L SURE Type of Roof
Will the appliantor future Wilding acvpmtm orlundlchvardou material
u doilm d by the Cu,onino Municipal Code.Chapter 9.12.and the Health and Safety
taut. y.zss3z(a)7 ❑No
❑ All roofs shall be inspected prior to any roofing material being installed.
41 Yu
wn thea tieant Or future Wilding occupant Ott If a roof is installed without first obtainingan inspection,I agree to remove
Ire g W ea Air
P g
emittel? nu air cmuminants as JcOncd by Na Bay Area Air Quality Management all new materials for inspection.
Disnica?
E]Yes 0 N
1 harts mad the hosinkrrs materials requirements under Chapter 6.95 Or the Califon
nice Health&Safety Code.Seetiou 255(35.25533 and 25534.1 understand that if the Wilding
does not currently haw a unml ShilL it is my respouiaility m notify de occupant Of Ne
requiremcntswhich tWmel ri `.cman aCcruRcateOffkcupuncy. / Signature of Applicant Date
Owner or authorized a Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT#
C) Z 7 a-k Come-
o6as6o�s
OWNER'S NAME: kO L/n1( 11U11AMr PHONE # 6
GENERAL CONTRACTOR: danq FAX #
I am not using any subcontractors: S /o - D�
S' toreDate
Please check a licable subcontractors and com Tete the fo win information:
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
Own etor ' ture 67 Date
CITY OF CUPERTINO
em 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35913122 . 00
DATE ISSUED. . . . . . . : 05/10/2006
RECEIPT 4 . . . . . . . . . : 34334
REFERENCE ID # . . . : 06050085
SITE ADDRESS . . . . . : 10270 TULA LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CAROLINE HUANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CAROLINE HUANG
CONTRACTOR . . . . . . . : HUNG VAN .TRAN LIC # 25516
COMPANY . . . . . . . . . . : HERITAGE CONSTRUCTION AND
ADDRESS . . . . . . . . . . : 13622 SARAVIEW DR
CITY/STATE/ZIP . . . : SARATOGA, CA 95070
TELEPHONE . . . . . . . . : (408) 867-6881
•FEE 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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO (D(oCF)DD95
TlENIP POWER
CITY OF
SCUPERTINO PERMIT APPLICATION FORM
APN # C 19/ /d a Date: —
Building Address: ( 9 2 7 O
Owner's Name: Phone #:
CAka L1AJ F f UAI' IC7- i6- zzo - 9FF
Contractor: Phone: License
� #:
fie Tran vk- 3/s- zsoZ cen. sco51 59Q
Contact: Phone: Cupertino Business License#:
Building Permit Info: ( �»� P0k--a.f �OlaZ
Elect 0—
Job
Job Description:
Residential .e Commercial ❑
Cost of Project: Sbd
•
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
•