The URL can be used to link to this page

07020082 7777777777777.77 CITE'OF CUPERTINO BUILDING DIVISION PERMIT C�1 L�CgOR I46um. ATI��1' BUILDING ADDRESS: PERMIT NO. 20889 FARGO DR ALIVE ELECTRIC AND 07020082 OWNER'S NAME: C E PERMIT ISSUE DATE ALEX LIM 41447 C1,RMEN ST DNE: SANITARY NO. CONTROL NO. (510) 57-': -3790 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION ;cur I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is TEMPORAF:Y POWER r 0- in full force and effect. j j? License Class Lic.# t wDate Contractor a ARCHITECTS DECLARATION i C< 1 understand my plans shall be used as public records )yU U.HLicensed Professional O� OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county $ which requires a permit to construct,alter,improve,demolish,or repair any structure U;- prior to its issuance,also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation t✓ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $350 L 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 N Number Occupancy Type V.t more than five hundred dollars($500). 3 2 6 3 018 E (Wt,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 forsale(Sec.7044.Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P 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 Contractor's Li- cense 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. 0 lam exemSee B&Y.Uor this reason Owner WORK COMPENSATION DECLARATiO I hereby affirm under penalty of perjury one of the following declarations: 0 1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 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 am: Cartier. 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 manner so as to become subject to the Workers'Compensation Caws of California.Date 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY F-h►�•+ I hereby affirm that there is a construction lending agency for the performance of <Yi> the work for which this permit is issued(Sec.3097,Civ.C.) ALender's Name z Lender's Address U Q 1 certify that 1 have read this application and state that the above information is - correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes. (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. U �^ Date APPLICANT UN STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE R ATIONS. —/ e-roofs Signature of Applicant/Contracto 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 Cotte,Section 25532(a)7 All roofs:;hall be inspected prior to any roofing material being installed. ❑Yes 4�lfo Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new in 3terials for inspection. District? 0 Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth&Safcty Code,Sections 25505,25533 and 25534.1 understand that if the building does not cu Ely have a tenant,that it is my responsibility to notify the occupant of the rcyuirc is which must be me nor to issuance of a Certificate of u cy. G � � GjF�'r'� Z -nature of Applicant Date All roof coverings to be Class"B"or better Owner or authori-zc agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMI`I RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . . 32E30188. 00 DATE ISSUED. . . . . . . : 02/15/2007 RECEIPT #. . . . . . . . . : BSC00000471 REFERENCE ID # . . . : 07C20082 SITE ADDRESS . . . . . : 20E89 FARGO DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUEERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : ALEX LIM ADDRESS . . . . . . . . . . : 20E00 HOMESTEAD RD #90 CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : DAIDIEL OH LIC # 28075 COMPANY . . . . . . . . . . : ALIVE ELECTRIC AND MAINTENANCE ADDRESS . . . . . . . . . . : 41447 CARMEN ST CITY/STATE/ZIP . . . : FRE'MONT, CA 94539 TELEPHONE . . . . . . . . : (510) 573-3790 FEE ID UNIT QUANTITY IMOUNT 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 REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 100.47 VISA --------------- TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL µ:µt Community Development � M 10300 Torre Avenue n;, ✓•- Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -,UPEkTINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAMY-. PHONEWCrl e3 36 7 GENERAL CONTRACTOR: FAX# — I am not using any subcontractors: Si;nature Date Please check applicable subcontractors and complete 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/Contractor Signature Date CITY OF CUPERTINO EMP POWER 011 CUPEf�TINO PERMIT APPLICATION FORM APN# 3 6 - `& Date: Building Address: C Owner's Name: / D �l Phone #: Contractor: Phone: License #: Contact. Phone: c, Cupertino Business License#: Building Permit Info: Elect ❑ Job Description: Residential Ll- Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BTEMP T(,mporary Power ELECTRICAL EPERMITFEE E:ect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING