08110081 CITY OF CUPERTINO r° �r'� P �}�,/'��{ �1'¢,�
6UILDI NG DIVISION PERT ,r,Rco1`I°,� RCT fflNFORMAT��i\„fid
BUILDING ADDRESS: PERMrT NO.
10370 MENHART LN DWK CONSTRU T -
OW NEWS NAME: PERMIT ISSUE DATE
A CONTROL NO.
ONE:
(408) 615-1508
BUILDING
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
upp LICENSED CONMACIOR'S DECLARATION lob Description
U I hereby allmn that 1 con IkmsnM under provisions of ChaPou 9 memmeming
with S«tian 70110)of Division l of tha Busneas and Professions Code,and my license is
in fall—andefTecs �f Z,�py/� TEMP POWER POLE
j i License Class Lk.g w
�—a Dam I 0 Comedo
` ARCHITECTS DECLARATION -
tl 1 understand my plans shall M used at Public records
C� Licensed Professional
3 OWNER-BUILDER DECLARATION
s� E I Wre1y 0B.Nal I am sumpt from the COnuanor's Lic.nm Law for the
p O followingo
mon.(Section 703I.S.Business and Professions Conk:Any City or county
which requites a permit on...k alcor.improve,ci maluh,Or$pair any a=[..
prior at a«e.alsumqukesthe applicant for such permit to file asigned suumem Ft.Floor Area Valuation
< thuWulicensed Forms,totheprovisions ofticContrumn'sLlseos.Law(Chap=9 Sq.
y1- (commencing with Section 7000)ofDivision 3 or the Business and Professions Code)of
du oO
dist W attempt th
empt erefrom and the basis for the Ocpd excerption Any violation of
Section 7031.5 by any applicant For.Pnmit wbjeca tha applicant to a civil PmagY of APN Number Occupancy Type
was$ort dun five hundred dallars ISM 37516012 . 00
❑I.u awry of Ila pmputY•«my wplayees with wage u the'vank compewdon,
wad do rwwons and ma TWO
Chanteuses
I bare Law does
apply Tan.Business Required Inspections
and Pro,who Cade Tbe Conbecur's Lierme law does oat apply If rt owner Of tl P
property,who ,provirimpmveschImprve wad..1 ihwdedOrOelfar We W his
awaemplayeWiping a,improvement
suchimpmveremtsin not intended«aQerad the iL
however,the Wilding odamromnent k cold within au year Or I.,.fn.ar the own«-
builder win luso Ne WNrn of proving that W did cot disk«improve fm purpose of '
sakJ.
❑1,as owner of the Property am achemely...$scant with Bcumnd ecnuxron to
cootmet the project(See.7044.Business and Professions Code)The Conmamor's U.
ecue Law does not apply m an owner m property who Wilds or improves thereon,and,
who contracts for such projects with a conmactar(s)licensed parental m the Conusenoh
License law.
❑I am a.mpt under Sen ,B&PC far this reason
Owner
Data
WORKER'S COMPENSATION DECLARATION
1 hereby drum under penalty of Perjury aro of the fallowing detimar ons:
1 ave and will minuin a Cadtammof Co.,w self-imuum far Worker's Campcm -
an,u provided f«by Section 3700 of IW labor Cade.for the perfmmwce of the
work for which this permit is issued.
❑I Mee and will maintain Worker's Compensation Insurance,u required by Section .
)71100(the labor Cede,for the performance of tad w«k for which tau Permit is Issued,
My Worker's Compeuadon Insurance cerin and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EKEMP ION FROM WORKERS' -
COMPENSATION INSURANCE
(ndsmetion reed cot be completed Btk permit is f«one hundred dallars(SIM)
or less)
1 certify don in the perform.Or the work f«which this permit u Laud.l shill n«
employ anyperson in my manne�rLLasttOhe r subject w Neworlmd Compensation
Laws of UliroMa.Dau4�, /aa-- SOA ,
App0cvmt TTlr// .s -n
NOTICE TO APPLICANT.If.aftcrInaking Nu CeNncam of Exemption,you would
became subjem to the Worlear's Compensation provisions of the labor Cade.you muu
.�Z mMwith comply with such provisions or thin Permit shall be dermad revoked.
zi O CONSfRUCT10N LENDING AGENCY
[-. I hamhy.from that Nem u a couwcunn lending agency for dm pvformance of
CL m7 the work for which this permit u issued lSec.3097,Civ,C.)
W�~n- lender's Nam.
z Lcnde's Addma
V Q 1 crucify Nat I haw red this applieuion and sum that the show information is
V.H toren.I agree to comply with all city and county orninanas and sum use$lading to
0U building consuuction,and hereby auNoria mprosenmivcs of this city to enter upon ftU aW.-mentioned property r«iupenion purpeaes
le (We,)ague to taw.indemnify and keep hannleu the City of Cupertino agiut
rjj liabilities.judgments.cam and expenses which may in my way amuse against said City
UZ Inconsequence,or the grading of this permit. / }.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. 9
Z/-o R Re-roofs
Slgeunma A licanr/Coatramer No
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dx applicant or future Wilding occupant vare or handle hamndons material
as defined by the Cupertino Municipal Code.Chapter 9.12.and Ne Halth and Safety
Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu f?j Na
Will the applicant or mire wilding Occupant mc equipment or aevica which If a roof is installed without firs[obtaining an inspection,I agree to remove
it huardous air contaminants u defined by the Bay Ara Air Quality Management all new materials for inspection.
suicm7
❑Yns WN.
I have mal the buvdnus materials reqummuntsunde,Chapter6.95 orthe Califor.
nia Hca[ &SafelYC.d..Sadou25505,25533and25534.1undermudiMifNc Wilding
docs not currently have a mnam,the,it is my responsibility u notify the occupant of the
roquwmcdtswhich ast be met Prior mismarce of a Ccrdfmcam of GccupamT. Signature of Applicant Date
Owner or mthorifsd agent 40
~L Dam 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 . . . . . . . . : 37516012 . 00
DATE ISSUED. . . . . . . : 11/21/2008
RECEIPT # . . . . . . . . . : BS000006671
REFERENCE ID # . . . : 08110081
SITE ADDRESS 10370 MENHART LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PEI-FEE SHU
ADDRESS . . . . . . . . . . : 10370 MENHART .LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM PEIK FEE SHU
CONTRACTOR . . . . . . . : JULIE LI HE LIC # 24852
COMPANY . . . . . . . . . . : DWK CONSTRUCTION
ADDRESS . . . . . . . . . . : 18665 LOREE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 615-1508
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- --- ---------- --- --------
1BSEISMICR VALUATION 300 . 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
------------ --- -----
CHECK 122 . 87 #885
---------------
TOTAL RECEIPT 122 . 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-- ---------------------------- ------------- ----
402 TEMPORARY POWER
0 p l I ooPI
- CITY OF CUPERTINO
C' TEMP POWER
• CUPERTINO PERMIT APPLICATION FORM
APN # Date:
X75 i C� dna. vv ✓off
Building Address: 103`f0 1144-h Lsi
Owner's Name: Rik e S � Phone #:
dog- 4.z - 682bl
Contractor: v A 1 K Q N r Phone #:
V V 1 Fax#:
Contact: Phone #:
7`h`a1-iAS
Contractor License #: g
Cupertino Business License #:
Job Description:
P le
Residential Commercial El
Valuation (cost of project): 3 w Type of Construction: N/A
ao.
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>lK Res. Temp Power>1K E 1REAP14
Amps
/ 1 ERT<200 Res. Temp Power<200 E
Amps
IERT2001K Res. Temp Power 200-1K E
raps
/ IEPERMITFE Electric Permit Issuance E
IELCPLNCK Electric Plan Check E
/ 1BSEISMICR Seismic Residential B
ITRAVDOC Travel & Documentation B
Fee
w CITY OF CUPERTINO
TEMP POWER
CUPEI,TINO 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>lK Commercial Temp Power E
>1K Ams
IECT2001K Commercial Temp Power E
100-1K Amps
1TRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
Revised 6/16/08 •