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07090171 777777777777 CITE'OF CUPERTINO BUILDING DIVISION PERMIT + �1TlE�t�CTQZ� ��A� 'ps PERMIT NO. BUILI]I1��L2T'z UGGLE AVE T & R M%%AGEMENT & 07090171 �j PERMIT ISSUE DATE OWNER'S NAME: CHIN, GINA 6172 BO__iLINGER RD STE 151 09/25/2007 SANITARY NO. CONTROL NO. )NE: (408) 329-2831 BUILDING PERMIT INFO ARCHI7ECTIENGINEER: BLDG ELECT PLUMB MECH 1m, LICENSED CONTRACTOR'S DECLARATION Job Description W 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing y m with Section 7000)of Division 3 of the Business and Professions Code,and my license is TEMP PO n1ER FOR S FDW REBUILD � y in full force and effect. )n? License Class Lic.M 0 Dam Contractor ARCHITECTS DECLARATION i < 1 understand my plans shall be used as public records )yU u.l- Licensed Professional OWNER-BUILDER DECLARATION o}� 1 hereby affirm that 1 am exempt from the Contractor's License Law for the jp O following reason.(Section 7031.5,Business and Professions Code:Any city or county <.ff 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 Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $400 O e.is (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 37533 061W Number Occupancy Type not more than five hundred dollars($500). ❑I,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 forsak(Sec.7044,Business Required Inspections 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 Vs as owner of the property,am exclusively contracting with licensed contractors auct the project(Sec.7044,Business and Professions Code)The Contractors 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 u e Se B&P C for this reason OwnerDate WO CONIMNSAWBECLARAMON 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 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. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Cade.for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: 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 Workcrs'Compensation Laws of California.Dai�f Applicantj � e�(� 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. z ' CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of pl> the work for which this permit is issued(See.3097.Civ.C.) W Q Lender's Name a2 Lenders Address U 0 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 W above-mentioned property for inspection purposes. L3. (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way accrue against said City z V Z in consequence of the granting of this rmit. Date APPLICANT UNDERSTANDS ND ILL COMPLY WITH ALL NON-POINT Issued b SOURCE U NS r �1 'l• Re-roofs Signature of ApplicantlConD Type of]roof HAZARDOUS MATERIALS DISCLOSURE yP 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 Cale.Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed. ❑Yes /0140 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 Area Air Quality Management all newt materials for inspection. District? ❑Yes Nu I 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 ant,that i ' my ponsibility to notify the occupant of the requirements w 'ch st be et 'o to issuan of a Certificate of Occugancy, Signature°of Applicant Date All roof coverings to be Class"B"or better Owner or u or .cd agent cfatc F CITY OF C'UPERTINO M vd 01 - t V EMPOWER CUPERTINO PERMIT APPLICATION FORINT APN# 3Date: � `� � �� t � � Building Address: I IV Owner's Name: Phone #: V Contractor: Phone: License _-V -- - - Contact: 'r DG�V� ? A �:Gl"ui'rP%,CT, (� Phone: Cupertino Bu iness License #: US AUL- Building Permit Info: *� � CCM Elect n___ Job Description: Residential ""- Commercial ❑ Cost of Project: O Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN 37533061. 00 DATE ISSUED. . . . . . . : 09,'25/2007 RECEIPT #. . . . . . . . . : BS000002759 REFERENCE ID # . . . : 07090171 SITE ADDRESS . . . . . : 18381 TUGGLE AVE SUBDIVISION . . . . . . . CITY CUERTINO IMPACT AREA . . . . . . . OWNER CHCN, GINA ADDRESS . . . . . . . . . . : 18381 TUGGLE AVE CITY/STATE/ZIP . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : GENA S CHEN CONTRACTOR PAJL YANG LIC # 29369 COMPANY T x R MANAGEMENT & CONSTRUCTIO ADDRESS 6172 BOLLINGER RD STE 151 CITY/STATE/ZIP SAV JOSE, CA 95129 TELEPHONE (438) 329-2831 FEE ID UNIT QUANTITY z1MOUNT 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 CREDIT CARD 102 . 89 MC --------------- TOTAL RECEIPT 102 . 89 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ------ 103 UFER 304 ROUGH ELECTRICAL Community Development - 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 r,UPEkTINO Buildin De artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: 74L41- FAX# I am not using any subcontractors: Si,;nature Date Please check applicable subcontractors and com Mete 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