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07030087 77. 77 CITY OF CUPERTIN0 I BUILDIN=G DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 19328 GREENWOOD DR QUAN' S ELECTRICAL 07030087 PERMIT ISSUE DATE PER'S NAME: 10 LAI, YI—FANG 628 RANDY LN 03/13/2007 SANITARY NO. CONTROL NO. JNE: BUILDING PERMIT INFO ARCHITECT7ENGINEER: REPLACE, FURNACE AND ADD A/C BLDG ELECT PLUMB MECH CJ G7 O D p C LICENSED CONTRACTOR'S DECLARATION Job Description LI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is I a a in full force and effect. v�Z License Class L'c•S - p Date Contractor E v� ARCHITECTS DECLARATION j C< I understand my plans shall be used as public records >aU 'u.i- Licensed Professional o e OWNER-BUILDER DECLARATION 1N.J I hereby affirm that I am exempt from the Contractors License Law for the p Op� following reason.(Section 7031.5,Business and Professions Code:Any city or county ,,�,Ii which requires a permit to conswct,alter,improve.demolish,or repair any structure Valuation prior to its issuance,also requires the applicant for such permit to file a signed statement ; ,Ft.Floor Area -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q _- (commencing with Section 7000)of Division 3 of the Business and Professions Codor 14 _ that he is exempt therefrom and the basis for the alleged exemption.Any violation of OCCU Section 7031.5 baraC y any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work.and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees.provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. "SA�ibN -B&P C for this reason -]Lam exemp under Se owner Date WOS CE COMIANON 1 hereby affirm under penalty of perjury one of the following declarations: ❑f haft and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.I shall not employ an4p�rTso.nin man so as to me subject to the Workers'Compensation Laws of CApplicantNOTICE TIf, r making this Certificate of Exemption,you shouldbecome sur Compensation provisions of the Labor Code,you must ,J. Z forthwith comply with such ovisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY Fr Cn I hereby affirm that there is a construction lending agency for the performance of ^„( > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name a+ Lender's Address U C) 1 certify that I have read this application and state that the above information is - correct.1 agree to comply with all city and county ordinances and state laws relating to n Jbuilding construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against r� rpt fA liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date r APPLICANT UNDERSTNDS AND ILL COMPLY WITH ALL NON-POINT Issued b.i: SOURCE REtRi LA lj Re-roofs Signature ppli C9pactor Date Type Of Zoof H RDOUS MATERIALS DISCLOSURE YP Will the applicant or future building occupant store of handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof:;shall be inspected prior to any roofing material being installed. C:]Yes o If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Disaict? _/ ❑Yes u I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building docs notcurrently have a tenant,that it is my responsibility to notify the occupant of the Date rcqui w ' ust be met pr=o issuance of a Certificate of occupancy. SignatuI a of Applicant 3/f3 All roof coverings to be Class"B"or better Own or autlidlized cnt Dodo, CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37543031. 00 DATE ISSUED. . . . . . . : 03/13/2007 RECEIPT #. . . . . . . . . BS000000674 REFERENCE ID # . . . : 07030087 SITE ADDRESS 19328 GREENWOOD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LAI, YI-FANG ADDRESS CITY/STATE/ZIP . . . : CUEERTINO CA, . CA 95014-3454 RECEIVED FROM . . . . : REC'EIPT INTERFACE CONTRACTOR . . . . . . . : HIEN Q TRUONG LIC # 23332 COMPANY . . . . . . . . . . : QUIN'S ELECTRICAL ADDRESS 10E28 RANDY LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE (4(18) 366-1823 FEE ID UNIT QUANTITY INOUNT PD-TO-DT THIS REC NEW BAL -- ---------- -- -------- ---- BENERGY PERMIT FEE 1.00 34 .86 0 .00 34 .86 0.00 BREMAIRHAN NO.UNITS 1.00 10.26 0 .00 10 .26 0.00 BREMFURN NO UNIT 1.00 14 .31 0.00 14 .31 0. 00 BREMRECEPT NO. OUTLETS 1.00 1.20 0 .00 1 .20 0. 00 BSEISMICRE VALUATION 5, 000.00 0 .50 0 .00 0.50 0.00 MPERMITFEE FLAT RATE 1.00 38.37 0.00 38 .37 0.00 PPERMITFEE FLAT RATE 1.00 38 .37 0 .00 ----- - ------ -- -- TOTAL PERMIT - --- 137. 87 ------0 .00 137 . 87 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------- CHECK 137.87 5775 --------------- TOTAL RECEIPT 137.87 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ----------- 204 UNDERFLOOR FRAME 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS CITY OF C UPERTINO FST NA.CE/AC :UPEiZTINO PERMIT APPLICATION FORM APN # Date: Building Address: Owner's Name: Phone#: 7 -�aY CC �1+14 ( ) --.��-31 I (N) Phone: License 4: Contractor: �j (44, )S- �f-/U 70 Cupertino Business License#: Contact: Phone: / - 141 Cd, <�/--0,N76i Building Permit Info: H D,-'- Plumb M' Mech Bldg ❑ Elect ❑ Job Description: � /t►�nti[fL- e%1/N-<�C ��i.e!CCX. C�iY C-�:1G1'7a1 Residential Commercial ❑ For Residential Insta ations: Attic ❑ I' floor LT 2nd floor❑ 'Where to min set back requirement[� ,or Commercial Installations: _eplacement same weight ❑ Additional weight (st-uctural calcs)❑ Structural Calculations required for new installation New installation Planning Approval Required ❑ Cost of Project- -6 CO / Type of Construction: Occupancy grou . �s Strapped ❑ On Platform 13' Bonded ❑ Sq.Ft. Floor Area: New Location Replacement Qty. if Fee Description Fee Group Ap licable Fee ID BENERGY Energy BUILDING BREMFURN F amace MECHANICAL BREMACOVER AJC Unit> 10,000 cfm MECHANICAL BREMAIRHAN AJC Units<= 10, 000 cfm MECHANICAL / BREMRECEPT F.ec tl, Switch& Outlets ELECTRICAL BSEISMICRE S eismic Fee Res BUILDING BSEISMICOM eismic Commercial BUILIDNG EPERMITFEE Elec Permit Issuance ELECTRICAL ( MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE F lumbing Permit Issue PLUMBING BPERMFEE F;ldg PermBUILDING Permit Fees BPLANCHK F Ian Check Fee BUILDING BPGAS Gas Piping System Fee PLUMBING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTIN0 Buildi:n De artment JOB ADDRESS: PERMIT# 0324- 41-eeW46tw p OWNER'S NAME: 1 ' a Ldr PHONE# GENERAL CONTRACTOR cq FAX# I am not using any subcontractors: Si;;nature Date Please check apphcable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating ti Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile (V x I- /-,-,-�� Date Owner/Contractor Signature