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07080049 7 7777777777777777 clT of cuPERTINO g�7� T B(11LD1NG UiVIS10N PERMIT PERMIT NO. BUILDING A DRESS: 20i�96 ELENDA DR NATIONAL CONSTRUCTION 07080049 ENTAL S PERMIT ISSUE DATE OWNER'S NAME: ALICE TAN 15319 CI. SAN AR CONTROL NO. 'E: (818) 223 -6057 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH ZLICENSED CONTRACTOR'S DECLARATION JOb Description 0 F. 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing TEMPORAF.Y POWER POLE a with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. Z License Class Con p Date Contractor u ARCHITECTS DECLARATION e I understand my plans shall be used as public records V F- Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the opL following mason.(Section 703 1.5,Business and Professions Code:Any city or county {i which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation y prior to its issuance,also requires the applicant for such permit to file a signed statement e Ft.Floor Area othat he is licensed pursuant to the provisions n!the Contractor's License Law(Chapter 9 fl 6 0 0 O 00 e (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of N Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3263002"M Number not more than five hundred dollars(5500). 0 1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections 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 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.). M,I,as owner'of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractofs Li- cens Law does not apply to an owner of property o builds or improves who contracts Of r such projects with a contractor(s)1 ncensed pursuant to Itte Con�vactofs License Law' B&P C for this on 0 I am exempt under Sec Owner Date WO CER' OMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: have and will maintain a Certificate of Conscnt to self-insure for Workees 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 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.I shall not employ any person in any manner so as to become subject to the Wo oaton Laws of California.Date Applicadt NOTICE TO APPLiCA alter making this Certificate of Exenflition.you shoo become subject to the Worker's Compensation provisions of the Labor Codc,you must Qforthwith comply with such provisions or this permit shall be deemed revoked. —+ CONSTRUCTION LENDING AGENCY ��. i hcrcby affirm that there is a construction lending agency for the performance of $> the work for which this permit is issued(Sec.3097,Civ.C.) a Q Lender's Name Z Lender's Address r= I certify that 1 have read this application and state that the above information is r+ correct.1 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 above-mentioned property for inspection purposes. ya (We)agree to save,indemnify and keep harmless the City of Cupertino against ti liabilities,j6d.gmems,costs and expenses which may in anyway accrue against said City Z in consequence of the granting of this permit. Date —G ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATION ,�� Re-roofs Signature o(Ap canU ontractor alt I e of I:oof HAZARDOUS MATERIALS DISCLOSURE Type 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(x)? All roofs shall be inspected prior to any roofing material being installed. 0 Yes No If a roof .s installed without first obtaining an inspection,I agree to remove Will the applicant or forum building occupant use equipment or deviceswhien all new r)aterials for inspection. .mit hazardous air contaminants as defined by the Bay Arca Air QualityManz ement uistrict? C3 Yes No 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 docs not currently have a tenant,that it is my responsibility to notify the occupant of the Date requirements w must be met prior to nce of a Certificate of Occup ignature.of Applicant -- . All roof coverings to be Class"B" or better Owner or author to Community Development -: 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF CUPEkTINO Buildi:n De artment JOB ADDRESS: Zy 6 ��, PERMIT # OWNER'S NAME: U l �� ; PHONE # n 6 f GENERAL CONTRACT ,� FAX # I am not using any subcontractors: Si;;nature Date Please check applicable subcontractors and complete the following information: jZ[] 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 d Date Owner/6 Signature INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMI`I INVOICE OPERATOR: CathyS Sec: Twp: Rng: Sub: Blk: Lot: APN 32630023 .00 INVOICE DATE. . . . . . : 08/06/2007 REFERENCE ID # . . . : 07C80049 SITE ADDRESS 20696 ELENDA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ALICE TAN ADDRESS 26-,2 BAYSHORE PKWY #702 CITY/STATE/ZIP MOUNTAIN VIEW, CA 94043 CONTRACTOR NATIONAL CONSTRUCTION RENTALS LIC # 22537 COMPANY NATIONAL CONSTRUCTION RENTALS ADDRESS . . . . . . . . . . : 15:,19 CHATSWORTH ST CITY/STATE/ZIP . . . : MISSION HILLS, CA 91345 TELEPHONE (8:.8) 221-6057 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ----------------- ---------- ------- TEMPORARY POWER PRINTING PERMIT 62 .10 62 . 10 0.00 ELEC PERMIT ISSUANCE PRINTING PERMIT 38.37 38.37 0.00 ---------- ---------- ---------- 100 .47 100.47 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------------ 103 UFER 304 ROUGH ELECTRICAL CITY OF C+UPERTINO TEMP POWER CITY OF CUPEkTINO PERMIT APPLICATION FORM U CPN# 4 U Date: Z ao o Building Address: 7 C) Q 7 t C--"da d Owner's Naive: ff Phone#: - C'ozltractol: Phone: Z��, License #: Nc�r`e� d Cl -tl'Gte.t� ` "- 6 l sr. C 62 Contact: C Phone: Cupelo�us ness License#: Building Permit Info: Elect ❑ Job Description: Residential A Commercial ❑ Cost of Project: 4600) 000 Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL / EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Bu3iness License BUILDING