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08100185 CITY OF CUPERTINOt> � 3 zz;4 > '-' - BUILDING DIVISION PE MIT fiCONT'RA, T0Rj'NF01RMATI0N, BUILDING ADDRESS:• PERMIT NO. 10475 MADERA DR Y G' OWNER'S NAME: PERMIT ISSUE DATA ON 5 CONTROL NO. ARCHTIECT(ENGINEER: BUILDING PERM"'INFO PLUMB CHANGE TEH MAIN ELECTRICAL Bp t O D tatZ' LICENSED CONTRACTORS DECLARATION SERVICE PANEL TO 200 Job Description U 1 bwby affirm WI I w Iimse.sed under Provisimu of Chapter 9 mummerNng with Section 7r(K))ofDivislon 3 of flue Business and Profeuiona Code,and my license is n I.full face and rlfut>> ,c License Clue Lk.N G�— Dau Cmnlrmlef e �TTICIS DECLARPTION e I understand my plans admit x used u public mentis s W Licmmd Professimnal SO OWNEm osempt Ron the C ATION mmem 1 hereby&(Erse that 1 am exempt from the Cmuamoru Ucmm city or for IK p O following mason.(Saito 7031.7.B beer. and Ps,dcroli Code:Any oily ser county C Em which its i su a permit ruptures;cnnwthe Wer.improve h per W,ri¢pair any samclurt EO thatrNIL41cosedp oe t,te dC applicant(m mehpermilmflea Law(ed Napter9 tcommecing with Section 70M of Dislmmml thea,But. ndprofsaw(Chapter9 Sq.Ft.Floor Area Valuation tement yts-� (commenef.jwith Satirom and trassm nl afdmeged me pion.Any Cade)of 3 that he u emmpt therefrom and Ne baso for Uu alleged eampUoa Any violatirn of Semon 70IJ by nary applicant four a permit subjects the applicant to a civil penalty of APN Number Occupancy Type nos mese Nan five hundred dollen(S.50)). ❑I.u ownm of Ilie prepmly,a my wpbyces Nth wage u Neo role cefnpewUan, will do the.,it.and da muctum 4notimended oroRwd for side(Sec.7044,13uaimss and Professions Cotl The Contractor'I.iaua Law does tet apply to owner Of owof Required Inspections property who solids or improves thereon,and who dousuchwmkhivuelf or Wough his own employers,provided that web improvements art ref intended oroRemA for sale If. however.the Welding or improvement 4mld widum one year Nmmpktlon.dm mvmer- Wilder will have that burden of proving that M did not Build or improve for purpose of tale.). ❑1,as owner of the property am exclusively contracting with lla.setl comadora Is ceftstnet the pmjea(See 7064,Business aM Profestiau Code:)M Conuacmrs U, come law dont not apply m an owner of Property who builds or improves Neuron,ad . who convects for such projects with a contractors)licensed pursuant to psi Consman ues Line.Lsw. ❑Iw memPt under Sea ,B B P C for this mason Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally or perjury,one of the following declamations: I kve and will maintain a CerdRPm of Consent to re f-ivuse for Wasters Cwprn ion,as provided for by Sado.3700 of the Labor Code.for the Performance of the worK for which Nu Permit is issued. ' ❑I bare and will maintain Worters Compensation Insurance.as required by Section 3700 of the labor Code.1.tic pcRorm sure of Ne wort for which Nu permit u Issued. My W.ster wp &Umar lnsurma .er and Polley umber are: ' Cartier. _Pcd. No.: OZ CER FICATEOF EJ MON FROM WO ERS' COMPENSATION INSURANCE (This sections need not be complcmd If the permit is reform hundred dollar(5100) or lea) 1 mrtify the,in the performance of the work for which this Permit u issued.I Wail out employ any person in my manner an u at baane subject to the worlxn'CompemWon Laws of California.Dam Applicant NOTICE TO APPLICANT:IL after malting this Ocrtlftuu Of Exemption.you should become subject to the Workers Compensation provisions of the lahm Cede you most ,JO forthwith comply with such Providem Or this permit WW be deemed muted. Z"' CONSTRUCTION LENDING AGENCY Ihereby al..Nu Nese is.romuucts.lending agency for the perfumanmuf ai .mow Ne wort for which this Permit Is issued(Sec.3097,Civ.C.) Q lenders Name , 0z Lenders Address U O 1 certify that 1 have read Ibis application and sure that the above information ts Il. carsect 1&gra to comply with JI city and county onlismaef and sum laws relating to .O building comminution.and hemby mthanae mpteunuuves of this city to enter upon the W ahOM-IOCn4UMd property for Y6peedm puryaCi gy (We)agree to can.indemnify and gap harmless the City of Cupertino against r/) IiabiliUea,jWgmenu.cosas and expenseswhich may in my way mouse against aid Cly na V 7 in csome of the granting of this permit. L1• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCEGULATIONS. expenses !'� a _� 0S2--a7S 1 —)— Re-roofs Signa of Applian✓Cenu&cmf ��' Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Use applicant or torose Wilding ecmpml same m haMlc hater me,materia as de0md by the Cupertinotpal Code,Chapter 9.13,and the Health and Safely Code.Sectio.M532(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes nmNo Will Ne applicant cur future building aavWnt sic equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove it hmaN.us air m.umina ss defined by the Bay Arm Air Quality Management all new materials for inspection. avict7 ❑Yu u I have mad the hvaNtus mauria6sequirtlrcw underC ipar6.95 of the CJifef- nuHmllhksafetyCede.Sccu.25%5.25531 and 11114*I understand thellthc Wilding does not cmrendy Mw a terrane Nu it is my responsibility to notify the=Want of the requimme w- bmusxmetpriormiso aaapsbcy. Signature of Applicant Date Oumcr.r mthon.d.,tru / �y�DOW � All roof coverings to be Class';W'or better CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 32635046 . 00 DATE ISSUED. . . . . . . : 10/29/2008 RECEIPT # . . . . . . . . . : BS000006488 REFERENCE ID # . . . : 08100185 SITE ADDRESS . . . . . : 10475 MADERA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHENG JUNG HUANG ADDRESS . . . . . . . . . . : 10475 MADERA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1133 RECEIVED FROM . . . . : BURTON YOUNG CONTRACTOR . . . . . . . : BARTON YOUNG LIC # 22763 - COMPANY . . . . . . . . . . : YOUNG' S CONSTRUCTION ADDRESS . . . . . . . . . . : 14839 CONWAY AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 TELEPHONE . . . . . . . . : (408) 377-6839 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 1, 000 . 00 0 . 50 0 . 00 0 . 50 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 BELEC200 METERS 1 . 00 29 .43 0 . 00 29 . 43 0 . 00 TOTAL PERMIT 111 . 51 0 . 00 111 . 51 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 111 . 51 MASTER CARD --------------- TOTAL RECEIPT 111. 51 Community Development � , 10300 Torre Avenue i -s Cupertino CA 95014 Telephone(408) 777-3228 mI CITY OF Fax(408)777-3333 *UPEkTINO Building De artment JOB ADDRESS: PERMJ' # O R'S NAME: PHONE # " q GENERAL CONTRACTOR: FAX # pp I am not using any subcontractors: � — o� L0 Signature Date Please check applicable subcontractors and complete the following ' ormation: 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 «G J CITY OF CUPERTINO CITY OF • CUPER1INO GENERAL BUILDING PERMIT APPLICATION FORM APN # 1 Date: C Building Address: t� 4r Mairing Address (if different from building address): Owner's Names�++ Phone#: bs 2-3 l Contractor: on�( ' �>q g - F / . / -6" h Fax: v,0 — b Contractor License#: b-2-? 6 e1 9' Cupertino Business License#: 2-2:-W5 Contact: Phone: _ I b/\. (-� t) vLA Fax: A/vy)k- • Residential Commercial Job Description: C� Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/I11 B, IV-HT, V-B ©� `L- Valuation: 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 www.builditlZreen.org Revised 10/20/08