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07090137 CITY OF CUPERTINO BUILDING DIVISION PERMITPERMIT NO. �1Rt� fl xEMitTI�k�1� :' BUILDIAJG,ADAbHIL LN T" & R M%NAGEMENT & 07090137 OWNER'S NAME: Y PERMIT ISSUE DATE RWEI—CHENG LO 6172 BO__JLINGER RD STE 151 09/21/2007 NE: (408) 329-2831 SANITARY NO. CONTROL NO. ABUILDING PERMIT INFO RCHITECT/ENGINEER: BLDG ELECT PLUMB MECH a 0 a a p p LICENSED CONTRACTOR'S DECLARATION Job Description V CI hereby affirm that I am licensed under provisions of Chapter 9(commencing :z m with Section 7000)of Division 3 of the Business and Pr fessions`Code,and my license is TEMP POWER j y in full force and effect. rnS ��r 8 S t ? License Class v Lic. F Date Contractor ARCHITECTS DECLARATION i a 4 l understand my plans shall be used as public records :0. OI- Licensed Professional n OWNER-BUILDER DECLARATION '> I hereby affirm that I am exempt from the Contractors License Law for the jp oa following reason.(Section 7031.5,Business and Professions Code:Any city or county <$ti which requires a permit to construct,alter,improve.demolish,or repair any structure Z y 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 3 O O Valuation uF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 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 of3750502 7 . Number Occupancy Type not more than five hundred dollars(5500). ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure isnot intended oroffered for sale(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 fru purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed con wAcwm to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- ccnse 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 Coalractoes License Law. ❑I 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 declarafions: ❑I have and will maintain a Certificate of Consent to self-insure for WorkeesCompen- 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 thispermit is issued. My Worker's Com�penns nce-aad I suracrier and Policy num l Gr 1;!:_0 [ 00 S) Cartier. Policy No.: V 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 Workers'Compensation Laws 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 Q forthwith 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 ai•� the work for which this permit is issued(Sec.3097,Civ.C.) aQ Lendcr's Name Z Lender's Address U O 1 certify that I have read this application and state that the above information is —d correct.I agree to comply with all city and county ordinances and stale laws relating to Ubuilding construction,and hereby authorize representatives of this City to enter upon the W ahovc-menuuned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,toss and expenses which may in any way accrue against said City �J U Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. q U �l /�L�� Re-roofs Signature of Applicant/Cularactor Date HAZARDOUS MATERIALS DISCLOSURE Type of F Loof 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)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ❑No , If a roof:s 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 new materials for inspection. District? ❑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 dos not currently have a tenant,that it is my responsibility to notify Use occupant of the requirements whichfir be met r to issuan f a Certificate of pante Signature of Applicant Date �Q Owner or author'.cd agent t>,re_ All roof coverings to be Class"B"or better _, CITY OF C'UPERTINO TEMP POWER CUPEkTINO PERMIT APPLICATION FORM CPN# � O � O � Date: Building Address: V33 PA � L`a�� . Owner's Name: , � � � Phone #: Contractor: i Phone: r License Vit:h 4 Contact: L � hone. Cupertino Business License #: Building Permit Info: - Elect ❑ Job Description: kS vz 4-e� pD ,.f,Pi` - fc-LQ- Residential E)( Commercial ❑ Cost of Project: a}. Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE El,ct. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING CITY OF CUPERTINO ITEM 1 OF 1 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 37505027 .00 DATE ISSUED. . . . . . . : 09/21/2007 RECEIPT #. . . . . . . . . : BSC00002707 REFERENCE ID # . . . : 07C90137 SITE ADDRESS . . . . . : 19-37 PHIL LN SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER RWEI-CHENG LO ADDRESS . . . . . . . . . . : 19= 37 PHIL LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2756 RECEIVED FROM . . . . : TR DEVLPMENT & CONS CONTRACTOR . . . . . . . : PAUL YANG LIC # 29369 COMPANY . . . . . . . . . . : T S: R MANAGEMENT & CONSTRUCTIO ADDRESS . . . . . . . . . . : 61; 2 BOLLINGER RD STE 151 CITY/STATE/ZIP . . . : SAN JOSE, CA 95129 TELEPHONE . . . . . . . . : (408) 329-2831 FEE ID UNIT QUANTITY 114OUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BTEMP FLAT RATE 1. 00 62 .100. 00 62 .10 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 62 .10 0. 00 62 .10 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 62 .10 #1040 --------------- TOTAL RECEIPT 62 .10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: patg Sec: Twp: Rng: Sub: Blk: Lot: APN 37505027 . 00 INVOICE DATE. . . . . . : 09/21/2007 REFERENCE ID # . . . : 07C90137 SITE ADDRESS . . . . . : 19337 PHIL LN SUBDIVISION . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . : OWNER RWE,I-CHENG LO ADDRESS 19337 PHIL LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2756 CONTRACTOR PAUL YANG LIC # 29369 COMPANY T S R MANAGEMENT & CONSTRUCTION ADDRESS . . . . . . . . . . : 61-12 BOLLINGER RD STE 151 CITY/STATE/ZIP . . . : SMI JOSE, CA 95129 TELEPHONE . . . . . . . . : (4( 8) 329-2831 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID .--`'$ALANCE --------------------------- ---------- ------ ---------- --------- ------ 0 . 00 0.'Vo 0. 00 TEMPORARY POWER PRINTING PERMIT 62 .10 (y: 00 62 .10 ---------- 62 .10 0. 00 62 .10 VOICE ID DESCRIPTION VOICE ID DE CRIPTION -------- ---------------------------- -------- ---------- ----------------- 103 UFER 304 ROUGH ELEC ICAL Community Development 10300 Torre Avenue ¢ Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEkTINO Building Department JOB ADDRESS:� � /�� L�e . (' , PERMIT 7 O OWNER'S NAME: ? C7 PHONE # GENERAL CONTRACTOR: PAV( __4,,17A,) C FAX # ck 61 3 Y 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 Ov/her/Contractor Signature D to