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07080073 CITY OF CUPERTINO y�� BUILDING DIVISION PERMIT PERMIT NO. BUILDiiJCy.(b SS�ERRIMAN RD C&S CONSTRUCTION SERVICES, 07080073 U PERMIT ISSUE DATE OWNER'S NAME: 43575 MISSION BL ZHIHONG LILT SANITARY NO. CONTROL NO. E: (510) 4( 2-8422 BUILDING PERMIT INFO BELECT PLUMB M ARCHITECTIENGINEER: Job Description zz LICENSED CONiRACTORs DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing withScction70(1U)ofDivision3ofthcBusincssandProfcssiunsCode,andmylicenseis TEMP POWER POLE FOR NEW CONSTRUCTION. o in full force and effect. z License Class contractor p Date _ ARCHITECT-S DECLARATION u� I understand my plans shall be used as public records U Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm That 1 am exempt from the Contractors License Law for the r county lo following reason-(Section 7(131.5,Business a P Professions Code:repair any structure Valuation ti which requires a pahniI to construct,alter,im rove,demolish,or rep r , Ft.Floor Area w prior to its issuance,also requires the applicant far such permit to Glc a sigtrcct statement $5000 0 0 0 a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q o (commencing with Section 70D0)of Division 3 of the Business and Professions Codc)or Occupancy Type that he is exempt therefrom and the basis for the alleged exemption.Any violation of 3 4 216 0 31 AEV Number Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty o[ not more than five hundred dollars(M)- 0 1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale(Sec.t7o044. rs an mvne� of and Professions Code:The Contractor's License Law docs not apply property who builds or improves thereon,and who does such work himself or through his o own employees,provided that such improvements are not intended or offered for sale.l[, 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 s .). 1,as owner of the property,am exclusively contracting with licensed comntors to truct the project(Sec.7044,Business and Professions o feessi gilds deor improves D-AL nSand. Li- ense Law does not apply to an owner of property who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. e&PvC,fpr °n i am exempt under Sec ,_ eS'j' � Date Ownerrt en WORKER'S COMPENSATION DECLARATION ATION 1 hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a Certificate of Consent to self-insure for Wrf rrmance of kces the cation,as provided for by Section 3700 of the Labor Code,for the pe 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 Workers Compensation insurance carrier and Policy number ate: Carrier. Policy No.: CERTIFICATE OF EXEl ON NSUROM WORKERS' (This section need not he completed if the permit is for one hundred dollars(5100) or less.) i certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Dale Applicant NOTICE TO'APPLICA :If,after making this Certificate of Exemption,you should become subject to the Workcr's Compensation provisions of the Labor Code,you must z forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY r-. f hercby.afftrm that there is a construction lending agency for the performance of te > the work for which this permit is issued(Sec.3097,Civ.C.) Lender's Name +Q. Lendeet.Address ,z 0 I certify that I have read this application and state that the above information rs '-a ctirrccI UU g construction,and hereby authorize representatives of this city to enter upon the building . y above-inenuoned property for inspection purposes. of Cup (We)agree to save,indemnify and keep harmless the City Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City Date Z in consequence of the granting of this permit. ) -4 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ISSlle y: SOURCE REGULA� s. JS�/D1FAA111 fs Date f Roof Signature of ApplicanUContrator HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Codc,Chapter 9.12,and the Health and Safety c°de,Section z5532(a)? ofs shall be inspected prior to any roofing material being installed. oY� NO If a ro�f is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all nes✓materials for inspection. District? Po 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 Date docs not currently have a tenant.that it is my responsibility to notify the occupant of the Signa ore of Applicant requirements whic ust be met prior to issuance of a Ccrtirrca�(Oe�p�r! J AVI Al]roof coverings to be Class"B" or better "t bloc Owner or authorized agent CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 2 ITEMS OF 2 COPY # 1 Sec: Twp: Rng: Sub: Blk; Lot: APN 342L6031 - 00 DATE ISSUED. . . . . . . ; gS000002007 RECEIPT #• • " ' 07080073 307 REFERENCE ID # • • SITE ADDRESS 10E51 MERRIMAN RD SUBDIVISION • • • . . CUPERTINO CITY . . . . . . . . . . . . IMPACT AREA . . . . . . . OWNER ZH-HONG LIU ADDRESS . . . . . . . . . . CITY/STATE/ZIP RECEIVED FROM JIJG LI CONTRACTOR CARL FUNG, PRESIDENT LIC # 29273 COMPANY C&S CONSTRUCTION SERVICES, INC ADDRESS . . . . . . . . . . : 43575 MISSION BLVD STE 629 CITY/STATE/ZIP . . . : FREMONT, CA 94539 TELEPHONE (510) 402-8422 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC ---------- ---------- ------------- ---------- - ------------- - ----62 .10 0 . 00 62 .10 0 .00 -------- FLAT RATE 1. 00 0 . 00 38 .37 0 .00 BTEMP 1.00 38 .37 _ EPERMITFEE FLAT RATE ----100 .4 ---------- 0 .00 100 .47 0 .00 100 .47 TOTAL PERMIT AMOUNT REFERENCE NUMBER -- METHOD OF PAYMENT ---- ----- 47 CREDIT CARD ---------------VISA 100 .47 TOTAL RECEIPT VOICE IDDEDESCRIPTION VOICE ID DESCRIPTION ------------------- --------- ----------- __ ---------------- - 304 ROUGH ELECTRICAL 103 UFER CITY OF C UPERTINO TEMP POWER CUPEKTiNO PERMIT APPLICATION FORM APN# Date: Building Address: r� AV0 j lit Owner's Name: Phone#;4-: -------�Y Contractor: / PhoLicense ise Contact: Phone: Cupertino B ea Li m #: V,4v 1 Building Permit Info: � - Elect Job Description: Residential �q— Commercial ❑ Cost of Project: i Qty.. f A 1f Fee ID Fee Description Fee Group BTENT Tem orary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 m CIV OF Fax(408)777-3333 '-UPEkTINO Build.-'On De artment JOB ADDRESS: PERMIT # !06s- �A 1 OWNER'S NAME: 2 (, 04� L( PHONE # "L N - 3 12- GENERAL 2GENERAL CONTRACTOR: FAX # 4 -�k-S'3 - 3,-Kr I am not using any subcontractors: Signature Date Please check applicable subcontractors and coni 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/Contractor Signature Date