07010157 CITY OF CUPERTINO *�
BUILDING DIVISION PERMIT �R INFQRh;i AT lY�
2.
BUILDING ADDRESS: PERMITNO.
10319 MENHART TJ9 -MM CM 0-7 O O l
OWNER'S NAME:PANG p IT UE DATE 1
-PING PANG 5 IJP P , \ O�
ONE: (408) 6._5-1508 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
NO CONDITIONS * BLDG EO PLUM MO
0 z LICENSED CONTRACTOR'S DECLARATION
G u p I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
=z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is TEMPORA tRY POWER POLE
H in full force and effect
? License Class Lic.#
t wo Date Contractor
ARCHITECTS DECLARATION
W U 1 understand my plans shall be used as public records
a
4 O H Licensed Professional
n y OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
i
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
e m which requires a permit to construct,alter,improve,demolish,or repair any structure
y Z} prior to its issuance,also requires the applicant for such permit to file a signed statement
F_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
X(– (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $40
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 r VbN Number Occupancy Type
not more than rive hundred dollars s500). 3 7 515 0_ ,
❑1,as 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
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
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,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to the Contractor's
License Law.
C3 I am exemptttunder Sec B&P C for this reason
Owner -?--7 Date 7
WORKER'S COMPENSATION DECLARATION /
1 hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insurc 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.
❑I have and will maintain Worker's 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 forone hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workcrs'Compensation
Laws of Califo�
Applicant �,�[�E art
NOTICE TO AP LICANT:If,after makin is Ccrti(icatc of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
E" I hereby affirm that there is a construction lending agency for the performance of
pC the work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name
Z Lender's Address
U Q I certify that I have read this application and state that the above information is
(y " correct.I agree to comply with all city and county ordinances and state laws relating to
J building construction,and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes.
H 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
V Z in consequence of the granting of this permit.
t" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date L y'!✓^1
SOURCE RECy[1LATIONS.
04Ar 02 5' 0-7 Re-roofs
Signature of ApplicanUContractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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)?
❑Yes AN. All roofs:;hall be inspected prior to any roofing material being installed.
If a roof i:;installed without first obtaining an inspection,I
Will the applicant or future building occupant use equipment or devices which g agree to remove P
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection.
District?
❑Yes o
I 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
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
requiremenwb hf ust be met prior to issuance of certificate or Occupancy. Signature AApplicant Date
Owner or authorized agent Date g
b� � -=>I., All roof coverings to be Class 'B or better
-
Sz..
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Buildf.rig Department
JOB ADDRESS: PERMIT #
03 Viz,e441 LJ") 070C O
OWNS S NAME: r _ PHONE #
GENERAL CONTRALTO : i�Jk' Ge�'�{26�7! FAX #
I am not using any subcontractors:
Sig nature Date
Please check applicable subcontractors and corn lete the following 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
Owner/Contra or Signature Date
CITY OF irL.-'UPERTINO
TEMP POWER
�UPEkTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
031 el)orf �h .
Owne�'s Nam Phone #:
Contractoi Phone: _ License 0�7
ContactPhone: S Cupertino Business License
�D �`,` #:
40$
Building Permit Info:
Elect
Job Description:
EMP Pvw-E� t e
Residential X, Commercial ❑
Cost of Project:
,r
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE :?lect. Permit Issuance ELECTRICAL
BUSLIC 3usiness License BUILDING