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08100206 CITY OF CUPERTINO �a�2��as •,/�x�r- BUILDING DIVISION PERMIT kXA'./ TRAC"°TV1k�� BUILDING ADDRESS: PERMIT NO. 21044 HAZELBROOK DR JL CONSTRUCTION ENTERPRISE OWNER'S NAME: PERMIT ISSUE DATE ONE: SA CONTROL NO, ARCHITECT,ENGINEER: BUILDING PERMIT INFO INSTALL NEW LIGHT FIXTURE BLDG ELECT PLUMB MECH O O O O ��p LICENSED CONfRACi'OR9DECLVtATON UNDERNEATH NEW DECK wZ 1 bemby affirm Wr 1 sem licensed under provisions of Chapter 9(commencing lob Description nen with Section 7")of Division 3 ofd.Business and Profnsium Codc,and my licensee < in full force and effect _ uewe an. Us.g . L, Dam contremr, ARCHITECTS DECLARATION 1 cauk numl my plans Nall W used as public...'a I U g C r Licensed professional 3 OWNER-BUILDER DECLARATION to y I hereby alarm that I an exempt from the Contractors license Law for the ZOO following moron.(Section 7831.5,Bessiseu and Prefeuiuv Code:Any city or county $ which requires a permit to censwcL alar,improve,dcmolkvh,or repair any structure prior aits issuance.also requires the applicant forsuch permit to file a signed Ratemem < ton lm is licensed purmam to we pmnsiomnr the conuacmr's uecom Law(Chapter 9 Sq.Ft. Floor Area Valuation x�$ (commaming with section 700M.f Division 3 oftic Bummossand Preferment;Coca)or Q`< thus he a exempt therefrom and the buss for the alleged esemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Oe morn mare than five bundmd dollars(IW. Occupancy Y TYP 0 LumwncroftWprapmy.amymploycmwithwagesudiscmlemmp don, will do the work,and the suuctum enotinuended oroffbom forma e,(Sere.7066,Business and Profession Cndc:The Contractors Licene,Law don set apply m an owner of Required Inspections property wine builds nimpmw Bnrcon.and whodoessuchwarkhimself or through he mmemployen,provided that such improvements are not intended worn nd fmaale If. however,the building or improvement a sold within arc year of eempleu.n.that owrcr. Wilder will have rte Makes of proving Nat W did an Mid or improve for purpose,or sale 1.es sonar of the property arm exclusively consoling with licemed commissars m construct the pmjea(Seo.7016,Bviness and Professors Cede:)The Comrano(s U. cove Law does not apply to an manor of property who MIs;or improm domen.and. whommuracs forsuch projectswithacontrxmrts)Iie:. dpunmammthe Comraetoh License sono IwrmXeJWPL.dnddser See._ ,B&PCfmth ns ✓^ e n Ow • `'`-'—— Date �O WORKERS COMPENSATION DECLARATION 1 WrebY an under pcvlty of perjury onc mf tin following declanuone , I ham and will..low.a certificae,mf(.vent m relr-iume raworkera C.mpen- "on,u providnd fm by Se'euon 3700 mf de Labor Code,for drat pcRormw of the work for which this,Pamir is issued. 0 I have and will maintain Workers Compensation Insunnce,as required by Section 37M of the fault Code.for the performance ofthe work,for which this Penni,is issued. ' My Workers Compensation insurance carrier and policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (The section rad!w W completed ifsec peanut Is Were hundred d.11an(SIM) ser leu) 1 ersufy imt in the performarce of the work for which this permit is issued.l shall set employ any Person in my mannan as to become subject to the wmkm'Compewtion Lasso mf Califomia D NOTICE E TO APe the Work IL after making this vW mof the Later on.you should become subject m the Workers t'ampcwtimn ermit o i of de,demand Code,you mew .J Z fwNWidi comply with tnCM1 proviuom or me permit shall W damrA mrptcd. , Z OCONSTRUCTION LENDING AGENCY [•« I Wreby affirm than them is a commuted t lcndineagenry for the performance of C este work for which this Permit a issued(Sec.3097,Civ.C.) ip Lsndeh Name z Lenders Adams U 0 1 certify that I have reed this application and son that Ne aWw information is LL F' corm 1 agree in comply with all city and county ordinances and state laws relating be 0 U Wilding conduction,and hereby audience mpresenutim of the city in enter upon the [17 above.memo mi property,for inspection purposes 0. (Wc)agree to eve,indemnify and keep humless the City of Cupertino moot pn liabilities,jWgments.costs and expenses which may in my way ocean against mid City U Z in covequcmc of the Swung of this permit / '—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR GU ONL�77 5. 14121 dl X14`k Re-roofs Signature of AppliunUConmctor Dam �y HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding asupuntnmc or handle baasadov material as dented by the Cupertino Mumrip 1 Code.Chapter 9.11,and the Health and Safety Code.Section 15531(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yue o Will the applicant or future Wilding occupant are equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove B hums us air cmromemm�m tncd by use Bay AreaAir Quality Management all new materials for inspection. c17 ❑Yn o 1 hew mad die hmardons m=daemquim=m under Chapw6.95 of the Califw- ne)csith&Safety Cod0.Secuom15505.75533and25534.1undrsmundthatifdc building dors not curmnuy have a count.than it is my responsibility m notify the occupant of the requite which W sect odor In issuance mf a Cetir, of Occup Signature of Applicant Date !� ownerm.nmmr�<eagem g R All roof coverings to be Class' a'or better Date" CITY OF CUPERTINO • 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32655034 . 01 DATE ISSUED. . . . . . . : 10/31/2008 RECEIPT #. . . . . . . . . : BS000006518 REFERENCE ID # . . . : 08100206 SITE ADDRESS . . : 21044 HAZELBROOK DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : REGNER CUNANAN ADDRESS 21044 HAZELBROOK DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : REGNER CUNANAN CONTRACTOR . . . . . . . : MOO POK LEE LIC # 27642 COMPANY . . . . . . . . . . : JL CONSTRUCTION ENTERPRISES ADDRESS . . . . . . . . . . : 1070 TERRA BELLA AVE CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043 TELEPHONE . . . . . . . . : (408) 318-1531 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BREMFIXT NO. FIXTURES 1 . 00 61 .19 0 . 00 61 . 19 0 . 00 - 1BSEISMICR VALUATION 100 . 00 0. 50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 . 40 .79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- TOTAL PERMIT • 102 .48 0 . 00 102 . 48 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER --------------- - ------------ CHECK 102 .48 124 --------------- TOTAL RECEIPT 102 .48 O , 'gym, CITY OF CUPERTINO CITY Of • CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM O�6 I b0 20Lp APN # Date: ( v ^ ? G u Building Address: 2I.9yY /�� Lgy gFtorll� Gu �E�i iNo / cA- 9So/Y Mailing Address (if different from building address): Owner's Name: Phone#: iV Contractor: Phone:��a, �_ $�/3 /,ov PC9-- GES, L GD^�S j Qc�cTrp� Fax: [6Ct>) 768 — 932`t Contractor License#: Sy/pg, Cupertino Business License#: Contact: AG Phone:C4/�g • Fax: Residential Commercial Job Description: Ai5hr 6/ !mow Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ I1/III/V-A ❑ II/VI B, IV-HT, V-B 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.builditgreen.org Revised 10/20/08