08100091 CITY OF CUPERTINO 77,= �7f'
BUILDING DIVIciON PERMIT acoftk&e__'To INFQRMATION
PERMIT N0.
BUa.q�ricp4DgEsSTEVENS CREEK BLVD WONG ELECTRIC INC 08100091 .
OW NEWSS NAME:
PERMIT ISSUE DATE
INTERNATION BAPTIST CHURCH 4067 TRANSPORT ST 10/16/2008
NE: - SANITARY NO. CONTROL N0.
(650) 813-9999
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u o p LICENSED CONTRACTOR'S DECLARATION
U I hereby affirm that 1 see licensed under provisions of Chapter 9(commencing Job Description
�ZW with Secdon]0(IB)of Division Sof the Business and Professions Cade,sad my li.san is INSTL 3 GFCI RCPTCLS ON ROOF
<< l
Lt...j = Lt run asss nse ClCasartesv
LLle,g
M
g,, Data.Contractor
W ARCHITECTS DECLARATION
LL 7 1 undersand any plans shall he used as public records
;yU
g o In Licensed Pmfessleaal
OWNER-BUILDER DECLARATION
1 knob,vGom Nat I am seem,[from the Contractors License Law far the
p O following mason.(Section 9031.5.Bananas and Profcssm.Code:Any city or county
which.,aims a permit to com,4 alter,improve,demnli h.or.pair any structure
_Z< prior m its isswnce,also toqtes uimheapphieant farsuch permit W file.signed statement -
DetheislicensedpursuanttothepmvisioaoftheContractor'sLicensalsw(Chapm9 Sq.Ft. Floor Area Valuation
gn (commencing with Bassam 100o)at Divuion3oT the Businrss and Professiem Cede)er _ $1497
y that In,is exempt therefrom and the basis for the alleged esempdon.Any violation of
Section 9031.5 by airy applicant for a permit.mbjects the applicant to a civil penalty of �,pp�Number Occupancy Type
nate.than five handled dollars(SSW). 3 4 2 14101:t7 V'
El Las ownu of tic pmpmy.of my employees with wages at theradie compar ation,
will Pr thewon,ands: he Comunet License
Law
duces
to 14,Bnerof
and Profession Cade:The ve ntrutah License Law dose tort apply lf an owmr of Required Inspections
Own erty who builds orietprovesch Improvements
ved who doessmh ework nded cmself arthmugh his _
awn employees,provided that such improsold wit are not ear Otic conflicted for sale.s-
Wilder Nebuilding orImprovement usoldwithinom year of mmpvf.,theowner-
Wilder will love the burtico of proving that k did not build or improve far purpore of
salcJ.
❑I.as owmr of the property am tentatively contracting with licensed contractors W
construct the project(Sec.1014,Business and Professions Cade:)The ConmcWrs Li-
cense law does not apply to an owner of property who Wilds or improves theater,and
who comencts for such pmjeoy with a cormo clods)Related!pursuant W the cm u m es
License Law.
or tae nodal .BBPCpar this moon
O Dam
P. S OMP gSAT10N DECIARATIO
I km reby under penalty of perjury aof dor fallowing dechndona:
1 its ve and will malnam a Cmifmesaaf Consent to self-insure far WmkcrsCamper.
sadon,as provided for by Section 3700 of the Labor Code.for the performance of the
won for which this permit is issued.
71 1 have and will maintain Warkers Compensation Insurance,as requited by Section
3700 of the labor Cede.for the performance of the won for which this permit is lssurd.
My Worker's Compensation Iruuranm carrier and Policy numkr art:
Cartier. Policy No.: -
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThBsection need not kcomplemd![the permit is faros,hundred dollars($100)
or inert)
I cenify that in the p Carrolton of the work far which this Parmil Is issued,I"I not
employ any person i ymannor obceoma subjutte Work ono m
laws am
NOTICE TO a t ANT:If.Compensation
ung this Corniest,of Exemption you rha=
become womp y the Worker Orthis
p.visiom of se labor Code you muse
,Jz forthwith comply with snob visiansorNis permit shallkdacmetl revoked.
z CONSTRUCTION LENDING AGENCY
[-t mew Thereby affirm that then is a comuwctinn lending agency far the,performance of
!Yi> the won for which this permit is issmd(Sac.31197,Civ.C.)
QLenders Name
J z Lenders Address '
C)p 1 earth that 1 have read this application and sum that the above information is
W E" co.ecL 1&gran W empty with ell city and county ardinances and sum laws relating W
pU Wilding consuucdon,and hereby autharim representatives of this city W enter upon the
U akve-mentioned property for inspection purposes
G (We)agree to rave,indemnify and keep heretical the City of Cupertino against
mFs fA liabilities,judgments,coda and expenses which may in any way amue against mid City
U'z A eonsegmnee of th con as of this permit. y
m cafe UNDE ANDS AND WILL COMPLY WITH ALL NON-POINT Issued b Date t/
SOUR GULATIO
Re-roofs r�
ignat oA _HAZARDOUSMATERIALSDISCLOSURE Dam Type of Roof
sillppliamor future Wilding ocupantstore or handle Wandous manorial
es defined by Cupertino Municipal Code.Chapter 9.13.and time Health and Safety
Cade.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye No
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t haparMus air contaminants as dc0red by the Bay Arab Air Quality Management all new materials for inspection.
uh 0
Oyer
I have mad the ha.sdnusmamrials requirements under ChapW 6.95 orthe Califor-
aiaHcalth@ altoy C ,Scui.u25505,25533vW25534.1undersundthatifdx Wilding
dors not rely he moan that It u my responsibility W notify the occupant Of Ne
require whichmust met pdortoissuameafaCertificatef0cmp cyte Signature of Applicant Date
wnerm thorn agcn Dow
All roof coverings to be Class'A!'or better
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34214101. 00
DATE ISSUED. . . . . . . : 10/16/2008
RECEIPT # . . . . . . . . . : BS000006367
REFERENCE ID # . . . : 08100091
SITE ADDRESS 22638 STEVENS CREEK BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : INTERNATION BAPTIST CHURCH
ADDRESS . . . . . . . . . . : 22638 STEVENS CREEK BLVD
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5627
RECEIVED FROM . . . . : STANLEY K YAMAICHI
CONTRACTOR . . . . . . . : WONG, STEVEN L LIC # 20368
COMPANY . . . . . . . . . . : WONG ELECTRIC INC '
ADDRESS . . . . . . . . . . : 4067 TRANSPORT ST
CITY/STATE/ZIP . . . : PALO ALTO, CA 94303
TELEPHONE . . . . . . . . : (650) 813-9999
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ----- ----------
1BREMRECEP NO. OUTLETS 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1BSEISMICO VALUATION 1, 497 . 00 0 . 63 0 . 00 0 . 63 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---- ---------- -
TOTAL PERMIT 123 . 00 0 . 00 123 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ------- ----------
CREDIT CARD 123 . 00 MC
---------------
TOTAL RECEIPT 123 . 00
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#,UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE # m_a,5'3-7s d
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: /C,�7' / (e,
Si tune Date
Please check applicable subcontractors and corn lete the followinginformation:
66 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
� n er/C ntractor i� Date
vel 00CV/
Cupertino permit application
•
aCITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# 2V�/ L v / Date:
Building Address: 2263Q vTCVCNS _tZcE)< rj�1/p
CU)°E:nTlhlO, CFS 756/4
Mailing Address (if different from building address):
Owner's Name: (;;fZ c4.; DAWN Phone#:
INCE aNA( SAeT5� tN V12W <`f 6 �{
Contractor: Wp/{6 ELcCrnIC ItiIG Phone:
C(.,Sv , 3 -�jgg9
Fax: 813 - 76(3q
Contractor License#: C _I p 37-q I c, -
Cupertino Business License#:
Contact: S I A14 AMA KH 1 Phone( j pg� Z q S _ I
. Fax:
Residential Commercial
TH2�E C3)
Job Description: Ta r12L->U1t36 AW) /Ni5-TAU
G��T YLcCi`( a(CLcS DN tftC Kvof VE{Z C/JDc
Building Permit Info:
Bldg ❑ Elect Cl' Plumb ❑ Mech❑
Type of Construction(Usage Class): Occupancy Type:
1-A, 1-13 ❑ II/III/V-A ❑ 11/11113,IV-HT,V-B M -t" 2-
Valuation:
Valuation: p� Square Footage:
Project Size: Express[ Standard ❑ Large❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable,include in plan set&the sheet index.
Points Achieved: _
For help,contact Build it Green at",w.buildi[ reen.or
Revised 7/01/08