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07090126 CITY OF CVPERTINO BUILDING DIVISION PERMIT � ` , � RMAT�Ol�° PERMIT NO. BUILDi(JIf}pJ�Ij 14C CLELLAN RD NATIONFL CONSTRUCTION 07090126 OWNER'S NAME: PERMIT ISSUE DATE ROGER & JIN LING LOW 15319 CHATSWORTH ST 09/19/2007 NE: SANITARY NO. CONTROL NO. (818) 21-6057 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 p LICENSED CONTRACTOR'S DECLARATION Job Description UJ 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing U with Section 70(10)of Division 3 of the Business and Professions Code.and my license is TEMP PC WE R POLE H in full force and effect. License CI s Lic.# F vAi Date— 1L Contractor' b RCHITECTS DECLARATION i a a I understand my plans shall be used as public records jaU u Licensed Professional OWNER-BUILDER DECLARATION > 1 hereby affirm that I am exempt from the Contractor's License Law for the po following reason.(Section 7031.5,Business and Professions Code:Any city or county < Pi which requires a permit to construct,alter,improve,demolish,or repair any structure Z prior to its issuance,also requires the applicant for such permit to rile a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area e.tz-• (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $350 4 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 of3 5 6 0 8 0 7 �Number Occupancy Type not more than five hundred dollars($500). ❑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 Required Inspections and Professions Code:The Comuactoes 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 hie 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.). ❑I,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 Contractors License Law. ❑1 am exempt under Sec B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations ❑I have and will maintain a Certificate of Consent to self-insure for WorkeesCompem- 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,az 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: � L,,) Cartier: icy No.:-re c1/L-,d �1 6 CERTIFIC E OF CEM ON FROM WORKERS'3�/f- b COMPENSATIO INSURANCE /J (This section need not be completed if the permit is for one hundred dollars C$10D) 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 Workers'Compensation Laws of Califomia.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you most Oforthwith comply with such provisions or this permit shall be deemed revoked. z" CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of a> the work for which this permit is issued(Sec.3097,Civ.C.) Wei.A Lender's Name z Lender's Address U 0 1 certify that I 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 rJ U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspccuon purposes. fL (We)agree to save,indemnify and keep harmless the City of Cupertino against fn liabilities,judgments,costs and expenses which may in any way accrue against said City (�Z in consequence of the granting of this permit. Date �. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b) SOURCEREGULA NS 211 �l�� Re-roofs Signature of Applicant ontractor Dale T Of Roof 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(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes �[]No , Will the applicant or future building occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes V/15 No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth&Safety Code,Sections 25505.25533 and 25534.1 understand that if the bmlding does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met priorto issuance of a Certificate of OccaPaney. ignature of Appl icant Date r _ All roof coverings to be Class"B"or better Owner .or authorized agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMI`L� RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35608027 . 00 DATE ISSUED. . . . . . . : 09,'19/2007 RECEIPT #. . . . . . . . . . BS000002690 REFERENCE ID # . . . : 07090126 SITE ADDRESS . . . . . : 21088 MC CLELLAN RD SUBDIVISION . . . . . . . CITY CUIERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ROGER & JIN LING LOW ADDRESS . . . . . . . . . . : 21SI88 MCCLELLAN RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95015-2273 RECEIVED FROM . . . . : D D GROUP LLC CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537 COMPANY NATIONAL CONSTRUCTION RENTALS ADDRESS . . . . . . . . . . : 15-719 CHATSWORTH ST CITY/STATE/ZIP . . . : MI::SION HILLS, CA 91345 TELEPHONE . . . . . . . . : (818)221-6057 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 40.79 0. 00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 102 .89 0. 00 102 .89 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 102 . 89 #1020 --------------- TOTAL RECEIPT 102 . 89 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------ ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blh: Lot: APN . . . . . . . . . 35608027 .00 DATE ISSUED. . . . . . . : 0919/2007 RECEIPT #. . . . . . . . . : BS000002690 REFERENCE ID # . . . : 07090126 SITE ADDRESS . . . . . : 21S88 MC CLELLAN RD SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ROGER & JIN LING LOW ADDRESS . . . . . . . . . . : 21S88 MCCLELLAN RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95015-2273 RECEIVED FROM . . . . : D L GROUP LLC CONTRACTOR . . . . . . . : NA'T'IONAL CONSTRUCTION RENTALS LIC # 22537 COMPANY . . . . . . . . . . : NA'T'IONAL CONSTRUCTION RENTALS ADDRESS . . . . . . . . . . : 15-19 CHATSWORTH ST CITY/STATE/ZIP . . . : MIESION HILLS, CA 91345 TELEPHONE . . . . . . . . : (818)221-6057 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 40.79 0. 00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 102 . 89 0. 00 102 .89 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 102 . 89 #1020 --------------- TOTAL RECEIPT 102 .89 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF CrUPERTINO ` ` IP POWER CITY OF CUPEI.TINO PERMIT APPLICATION FORM APN# Date: Building Address: Elf Owner's Name: qq I / Phone #: ? Z I Contractor: . Phone.- -----License 4- — ZcL� Lc� ave Contact: Phone: Cupertino Business License #: Building Permit Info: Elect EJ Job Description: , 1 �i cp y'�F2�'-e,v �� L Residential Commercial ❑ Cost of Project: a Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Bu3iness License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -'UPEkTINO Building Department JOB ADDRESS: PERMIT # .2- 11 �k �'�-�lr "—;W. 6 7 O a� 2-6, OWNER'S NAME: r J(1,141/,)C PHONE # off'- S 3-- e 15 e' GENERAL CONTRAC OR: FAX # I am not using any subcontractors: Signature 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 l 1-Y Owner/contract3r Signature Date