08110077 CITY OF CUPERTINO �
BUIL+VG DIV'SION PE T "1.0
BUILDING ADDRESS: PERMIT NO.
21124 GREENLEAF DR RFRTTAGF
OWNER'S NAME: PF1thDT ISSUE DATE
ALAN & 149 T�i 13622 SARAVIEW BR
ONE:
A CONTROL NO,
408) 867-6881
ARCHITECTIENGtNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
• 0 0 0 0
up0 LICENSED CONTRACTOR'S DECLARATION lob Description
F 1 hvcby affirm that 1 w licensed under provisions of Chapter 9(commencing
111
with
fournesoodeaddle)effect. TEMP
3 o NC Business;Nd PrOfelGOm COaC,slid myllcenSCY TEMP POWER FOR HOME REMODELING
1q: Class Lk.a
2v,q Donee Da¢ Contractorqq7W ARCHITECT'S DECLARATION
�WV I understand my pWta andl h used u public records
g C Licensed professional
u
OWNER-BUILDER DECLARATION
y I hereby.Ram that i am eacmpt from the Conuact.ls license Law for be
D o following mason.(Sectio 7031.5.Business and professional Code:My city or county
Ym which tarpons,.permit m condnteL alter,improve.dentrubb.m repay any structure
Zy
0.to its LSWa
LOLS. Bo mg01rm;dC applKLn(.1 such permit W file a signed slooment
—M
four hulicensed PmwatIndteprovisions ofdue Com
vecfslicenslaw(Ch+ptm9 Sq.Ft.Floor Area Valuation
ym-a (cernmeming wird Smion70DO)N Division 3 of Ne Business and Professions Code)or 400
y — dirt W u emmmpt therefrom W the basis for the alleged esempdm.My violation of
Section 10316 by amy applicant for.Permit subjects the applicant o.civil Fertility of APN Number Occupancy Type
not mom tau Ow huMrea collas($5001
32628097 . 00
C]1,u.wnerof NeprW=y.mmyemploymu LhwaguuN:bwkeompenudon.
winmNewprk.sod NeawOtme i.notinteneeamnrterw rma+m(s«.la..Bua�aa
Required Inspections
and Professions Cade The Contrasures ss rotoner
Ys License law doapply m a wof q P
property who bAYMs or Impaw s NerNn.Yid wlm dou such work himself Or through his
owe emPlaym,provided NY such imyrow eenn=ran intended or offered for role U.
however,the building or improwncot u sold within one yens of completions.the owner-
builder will have the burden Of proving that k did rot build or Improve for purpose of
sale.).
1,as Owner of the property,am emluawly contracting with liceraed conuactars m
comtmm the project(Sec.7W.Business and Professions Cade:)The COnuxbfs LS-
anse Law dos not apply to so owner of Property who builds or improves theaean.ad.
who concocts for such pmjcm wits a conuamoRs)licensed pursuant on rah contracmYs
Liem.law.
❑lamueroptunderSec �-I .B&PCf.rthsrc.m
d 5 COMPENSATION DECLARATION
1 hereby affirm under peulty of perjury arc of Ne following deelNil.ns
1 haw and will maintain aCatificam of Consent in selyinsum for Workels Compcn-
on,u proided for by Section 37M of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have ad will maintain Wmkce.Compensation Instincts,as refound by Section
3700.1 the Labor Cede,for the pedormaee pf due work for which Nu permit is Issued.
My Workees Compensation Insurance carrier and Policy number K:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu section need athcomplemd if the permit is form hundred dollen(5100)
or lass)
1 certify Net in Ne performance of Ne work for which this Permit is issued.l shall not
employ any person 1.any mannerst be c bject to dol Workm
Workers'Conpcadon -
Laws of California.Date
Applicant Q¢�/�-A
NOTICE TO APPLICA L after making this Certificate.f Exemption,you should
become subject b site WorkeYs Compensation provisions of the labor Code,you muss
,J z forthwith comply wird such provisions of this permit shall h dccmed revoked.
'Zz y CONSTRUCTION LENDING AGENCY
[—m I hereby affom dist Nem is a construction lending agency for Ne performance of
fYw w7 the work for which this Peron u issued(Sec.3097,Civ.C.)
W Q
Landes Name ,
z Lenders Md.
U Q 1 certify that 1 hale mad this application and state thY the&hove informatiun is
Ii correct-I agree in comply with all city and county ordinances and rate lave nesting m
-C) building construction,and hereby adoption nProscnudws of this city in enter upon the
r W aha-mentioned property for inspection purposes
y
(Wo)agree to taw•indemnify ad keep harmless the City of Cupertino against
.F,uy Imbilitiu.judgments,costs ad cape-...which may in any way aceruc Mats said City
V z In comectaXe of dm grating of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU ONS.
�V 11�10�08 Re-roofs
Siauurt of Applin ovonuamm Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building=opal sort or handle huardom materia ,
as defined by the Cupertino Muni'rot Code.Chapor 9.11.ad the Health ad Safety
cwe.semi.n2553u+1? All roofs shall be inspected nor to an roofing material beim installed.
❑m No P P Y g g
Will Ne applicat or Tamm waaing.cepp.nt.se wapmat m mmem which If a roof is installed without first obtaining an inspection,I agree to remove
it haurdmm ser contamim ns u defined by the Bay Area Air Quality Management all new materials for inspection.
Wet?
❑Yue 41.
I haus real the huaNws muedau nequlmmentsumler Chapieri95 of he Califor.
nice Hcalth&S+IctyCade.Scctiats 25505,25533 and 75534.I undcmma NYifthe Wilding
docs not curmndY ha team,dm it is my responsibility to notiq the ocevpa,or the
mqumm m mo,:somnce.f.0 r f.tc.faap+.y Signature of Applicant Date
T�^ZOL
Ownermw .recd+gcnl All roof coverings to be Class'"or better
CITY OF CUPERTINO
. 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 32628097 . 00
DATE ISSUED. . . . . . . : 11/20/2008
RECEIPT # . . . . . . . . . : BS000006663
REFERENCE ID # . . . : 08110077
SITE ADDRESS . . . . . : 21124 GREENLEAF DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ALAN & MU LI
ADDRESS . . . . . . . . . . : 21124 GREENLEAF DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1622
RECEIVED FROM . . . . : MU Y LI
CONTRACTOR . . . . . . . : HUNG VAN TRAN LIC # 25516
COMPANY . . . . . . . . . . : HERITAGE CONSTRUCTION AND
ADDRESS . . . . . . . . . . : 13622 SARAVIEW DR
CITY/STATE/ZIP . . . : SARATOGA, CA 95070
TELEPHONE . . . . . . . . : (408) 867-6881
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ --- ---------- ---------- ----- -------
1BSEISMICR VALUATION 400 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
1ERT<200 UNITS 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 122 . 87 0 . 00 122 . 87 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 122 . 87 AMEX
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------- ----- --------- -------- ----------------------------
402 TEMPORARY POWER
•
OPi1 0077
CITY OF CUPERTINO
' TEMP POWER
I* CUPERTINO PERMIT APPLICATION FORM
APN# � d U 7• � � Date:
Building Address:
dWA 6T9ewI.0o+f 060- , &Jert ✓w , CA '1J-` /X
Owner's Name: Phone #:
G�IaM lqvL Z409--"4 -J-J-1S-/
Contractor: r/ Phone #: 4 U
I qUeA,`47nn 2 Guru h'ut.'I7 j, ('H2 K r7 ran
Fax#:
Contact: Phone #:
He niirate
Contractor License #:
Cupertino Business License #: d
Job Description:
-kvvfoal� po,v2-./- fov- f4"e. rQ k,
Residential Commercial LJ
Valuation (cost of project): c� � Type of Cons`ruucSipn: N/A
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>1K Res. Temp Power>1K E 1REAP14
Amps
/ IERT<200 Res. Temp Power<200 E
Am s
1ERT2001K Res. Temp Power 200-1K E
Amps
IEPERMITFE Electric Permit Issuance E
IELCPLNCK Electric Plan Check E
/ 1BSEISMICR Seismic Residential B
/ 1TRAVDOC Travel & Documentation B
Fee
®
CITY OF CUPERTINO
TEMP POWER
CUPEkTiNO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
IECT<200 Commercial Temp Power E
<200 Amps
IECT>IK Commercial Temp Power E
>1KAm s
1ECT2001K Commercial Temp Power E
100-1K Amps
ITRAVDOC Travel & Documentation B
Fee
IBUSLIC Business License B
Revised 6/16/08 •
•