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07030062 7777777 CITY OF CUPERTINO BUIL:DINGbIVISION PERMIT �'© I U M PERMIT NO. BUILDING ADDRESS: 20142 LAS ONDAS WY TBD - TC BE DETERMINED 07030062 PERMIT ISSUE DATE OWNER'S NAME: ANN CHEN 7 SANITARY NO. CONTROL NO. .)NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p p LICENSED CONTRACTOR'S DECLARATION Job Description iV F`- I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is SEWER L]NE-FOUNDATION CLEAN OUT & PROPERTY LINE r<e in full force and effect. 5 cJ i License C Lie, # CLEAN OUT. GOGO ROOTER #28801 HAS BL F Date h7 Contractor 7n D ARCHITECTS DECLA TATION 7 C< I understand my plans shall be used as public records >qU a Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the c O following reason.(Section 7031.5,Business and Professions Code:Any city or county '.9 which requires a permit to construct,alter,improve,demolish,or repair any structure Q—y prior w its issuance,also requires the applicant for such permit to file a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;>q.Ft.Floor Area $4000 i t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects Ute applicant to a civil penalty of (� Number Occupancy Type not more than five hundred dollars($500)- 3 6 9 3 0 0 2 E 7 , ❑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 does not apply to an owner of property who builds or improves thercon,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 ]7(l/L<<j X J construct the project(Sec.7044,Business and Professions Code:)The Contractor's La- 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. ❑I am exempt under Sec .B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: - ❑1 have 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. M Worj�,es fC mpensation/I"�ranee carrier number are: Cam'enErrlUI��QMC�.^GTI/ oil No.: 1U'LZ�af - v' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ('Kris section need not be completed if the permit is foronc hundred dollars($100) or Icss.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provision or this permit shall be deemed revoked. 7-" CONSTRUCTION LENDING AGENCY [~- rA 1 hereby affirm that there is a construction lending agency for the performance of py> the work for which this permit is issued(Sec.3097,Civ.C.) OW.A Lender's Name a 2 Lender's Address U 0 I certify that I have read this application and state that the above information is LL correct.I agree to comply with all city and county ordinances and state laws relating to rJ Ubuilding construction,and hereby authorize representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rte- cel 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 ►' APPLICANT UNDERSTANDS D WILL COMPLY WITH ALL NON-POINT Issued by: S . � _ y4 g O=ATIQt�Sa Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of F.00f Will the applicant or future building occupanL store or handle hazardous material as defined by the Cupertido Municipal Code.Chapter 9.12,and the Health and Safety Cede,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑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 n.aterials for inspection. District? ❑Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Section 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility t etiFtVa occupant of the require muAbem�+n+orwissuanceoCaCc sate fcupancy SignatureofApplicant Date 4�g All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF (: Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 'UPEkTINO Building Department JOB ADDRESS: b y z �a s o DA'S PERMIT # C )-?O7o0 d2 OWNER'S NAME:an n Che-0 PHONE # VN 29 o Z(o GENERAL CONTRACTOR: FAX# I am not using any subcontractors: �'� `d l0-7 Signature Date Please check applicable subcontractors and co m Lete the following information: 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 0 GD 9t)c4 cr Roofing Septic Tank Sheet Metal Sheet Rock Tile --� Owner/Contractor Signature Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 36930026 . 00 DATE ISSUED. . . . . . . : 03/09/2007 RECEIPT #- - - . . . . . . BSC00000649 REFERENCE ID # . . . : 07C30062 SITE ADDRESS . . . . . : 20142 LAS ONDAS WY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER ANIS CHEN ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUI'ERTINO, 95014 RECEIVED FROM . . . . : REC'EIPT INTERFACE CONTRACTOR . . . . . . . : TBI, - TO BE DETERMINED LIC # 00096 COMPANY TBI, - TO BE DETERMINED ADDRESS CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY ],MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BPSEWER SEWER SYSTEM 1.00 21.58 0.00 21.58 0.00 PPERMITFEE FLAT RATE 1. 00 38 .37 0 .00 38 .37 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 59. 95 0.00 59. 95 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 59. 95 VISA --------------- TOTAL RECEIPT 59.95 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING