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07020089 CITY OF CUPERTINO BUILDING DIVISION PERMIT eg g{WTOR I} ( M TIS Y• PERMIT NO. BUILDING ADDRESS: 20775 SCOFIELD DR TBD - TD BE DETERMINED 07020089 PERMIT ISSUE DATE OWNER'S NAME: FUK KWUN SIT & YING WONG 02/16/2007 SANITARY NO. CONTROL NO. JNE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 a p LICENSED CONTRACTOR'S DECLARATION Job Description m F I hereby affirm that I am licensed under provisions of Chapter 9(commencing ';Z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is SW I MMIN J POOL DEMOLITION >>y in full force and effect : ? License Class Lic•8 t p Datc Contractor ARCHITECTS DECLARATION i a< 1 understand my plans shall be used as public records )aU W.y Licensed Professional C< OWNER-BUILDER DECLARATION 2w:<� 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county m which requires a permit to construct.alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation -?< that he is licensed pursuant to the provisions o( the Contractor's License Law(Chapter 9 Sq• 5 O O 0 e.o-= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or Q that he is exempt therefrom and the basis for the alleged exemption.Any violation of �p� Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 35912003 . l7 l T Number Occupancy Type not more than five hundred dollars(5500). owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself or through his /� own employees,provided that such improvements are not intended or offered for sale.if, it t l J_ however,the building or improvement is sold within one year of completion,the owner- 3 ll��//��"" builder will have the burden of proving that he did not build or improve for purpose of Sq r�� sale.). 02,10'as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- ccnse Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. Q] pt under See. In.this Owner ER'S COMPENSA I hereby affirm under penalty of perjury one of the following declarations: (]1 have and will maintain a Certificate of Consent to self-insure for Worker's compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any mamte{somasIon eomcsubiect to the Workers'Compensation Laws of Califo 'a. to l —dv�t- Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must O forthwith comply with such provisions or this permit shall be deemed revoked. Z CA CONSTRUCTION LENDING AGENCY Er I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) L4 Q Lender's Name a z Lender's Address U C) 1 certify that I have read this application and state that the above information is UL " correct.I agree to comply with all city and county ordinances and state laws relating to (DUbuilding construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U,Z in consequence of the granting of this permit. Date / APPLICANT UNDERSTANDS AND WILL C LY WITH ALL NON-POINT Issued by: ' G'v S URCE R ONS. I -t 100Re-roof: Signature of Applicant/Contractor Dam Type of Roof r HAZARDOUS MATERIALS DISCLOSURE yp Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? �(Ne All roof;shall be inspected prior to any roofing material being installed. C:]Yes Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? p Yeso 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requireme which must be met pri issu f a certificate of occupancy. Signatul a of Applicant Date —stn All roof coverings to be Class"B or better Owncr or authorized agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35912003 . 00 DATE ISSUED. . . . . . . : 02/16/2007 RECEIPT #. . . . . . . . . : BS000000479 REFERENCE ID # . . . : 07020089 SITE ADDRESS . . . . . : 20775 SCOFIELD DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER FUK KWUN SIT & YING WONG ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2922 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : TED - TO BE DETERMINED LIC # 00096 COMPANY TED - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 5, 000. 00 115 .56 0. 00 115.56 0. 00 BSEISMICRE VALUATION 5, 000. 00 0.50 0. 00 0.50 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 116 . 06 0. 00 116. 06 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 116. 06 2287 --------------- TOTAL RECEIPT 116 . 06 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 *TPEkTINO Building Department JOB ADDRESS: V(2, . PERMIT # c�P�2r Nb CA 5 0 t -/C92 co c4b�l OWNER'S NAME: F • K-, S iT 4, itN b o PHONE # L10DcWk(O GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI:vESS 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 0? Owner/Contractor Signature Date CITY OF CUPERTINO ]DEMO Q-CCE CUPEkTINO PERMIT APPLICATION FORM APN# r v �_� Date: Building Address: 2D_ `� Dri� �� „r-� 6N::.1 Z) Owner's Name: Phone# ID tb: Contractor: License#: Contact: r2� S p-y i Phone#: LZI Applicant/Contractor: YY U n' Bu- ing Permit Info: C, Bld� ec ec Job Description: Residential: Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: Architect/Engineer: Valuation: J 0 y 1 Type of Construction: Occupancy Group: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG