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07030092 CITY OF CUPERTINo BUILDING DIVISION PERMIT GT:® INFQJ,M -- PERMIT NO. BUILDING ADDRESS: 1028 NOVEMBER DR SUNBRO BUILDERS INC 07030092 PERMIT ISSUE DATE OWNER'S NAME: JANICE LI 1285 TOLRNAMENT DR SANITARY NO. CONTROL NO. LONE: (408) 483-2637 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 00 LICENSED CONTRACT'OR'S DECLARATION Job Description I 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 mylicense is TEMP POWER POLE t=y in full force and effect. z License Class Lic.1 Contractor w DateIT ARCHECTS DECLA ATION j a .t < 1 understand my plans shall he used as public records >aU U.y Licensed Professional OWNER-BUILDER DECLARATION aI hereby affirm that I am exempt from the Contractor's License Law for the p o following mason-(Section 7(731.5,Business and Professions Code:Any city or county e which requires a permit to construct,alter.improve,demolish,or repair any structure o—w prior to its issuance.also requires the applicant for such permit to rile a signed statement > Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $500 Y Fs-G (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of tiff Number P Y YP not more than five hundred dollars(5500). 3621500 1 V V ❑I,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 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.). I,as owner of the property.am exclusively contracting with licensed contractors to construct the projen(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. C3I 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: U[have and will maintain a Certificate of Consent to self-insure for Workces Compen- icin,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 coompe on Insu carrier and Policy number are.- Carrier: te:Cartier: ' ?� Policy No.: � CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (chis 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 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of (Y+> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name z Lender's Address I certify that I have read this application and state that the above information is LUfr O correct.1 agree to comply with all city and county ordinances and state laws relating to rJ building construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against 914 rte- fn liabilities,judgments,costs and expenses which may in any way accmc against said City Cl� U Z in consequence of the granting of this permit. Date ►-r APPLICANT UNDERSTANDS L COMPLY WITH ALL NON-POINT Issued b; SOURCE REGULATION � Re-roofs Signaturcof Ap ' t/ tractor Dare Type of Roof DOUS MATERIALS DISCLOSURE YP Will the applicant or future building occupant store or 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. fi ❑Yes JOL"° 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. District? ❑Yes Qf�01_ I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently ha.�Licnarnt that it is my responsibility to notify the occupant of the Date requirements w nor to issuance of a Certificate of up!r. Signatur of Applicant 3 All roof coverings to be Class"B"or better Owner or 6&h&'7-dT9MTr Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 aft Of Fax(408)777-3333 r,UPEkTINO Buildin De artment JOB ADDRESS: PE OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX# (�u ✓ <� �-�/ I am not using any subcontractors: Si;nature Date Please check applicable 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 Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile -,///47 der/Contractor Signature Date INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: christya Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36215007 . 00 INVOICE DATE. . . . . . : 03/ 13/2007 REFERENCE ID # . . . : 07030092 SITE ADDRESS 1028 NOVEMBER DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JAN ICE LI ADDRESS . . . . . . . . . . CITY/STATE/ZIP CONTRACTOR KAN: LI LIC # 27378 COMPANY SUI�BRO BUILDERS INC ADDRESS 12E5 TOURNAMENT DR. CITY/STATE/ZIP . . . : HILLSBOROUGH, CA 94010 TELEPHONE . . . . . . . . : (4(18) 483-2637 FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE ----------;------ TEMPORARY POWER PRINTING PERMIT 62 . 10 0. 00 62 .10 ELEC PERMIT ISSUANCE PRINTING P?ERMIT 38. 37 0.00 -----38_37 ---------- ---------- 100.47 0 .00 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---------------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: christya COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 3E215007 . 00 DATE ISSUED. . . . . . . : 03/13/2007 RECEIPT #. . . . . . . . . . BE000000678 REFERENCE ID # 0%030092 SITE ADDRESS . . . . . : 1C28 NOVEMBER DR SUBDIVISION . . . . . . CITY CC PERTINO IMPACT AREA . . . . . . OWNER JINICE LI ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR KIM LI LIC # 27378 COMPANY SINBRO BUILDERS INC ADDRESS 1285 TOURNAMENT DR. CITY/STATE/ZIP . . . : HILLSBOROUGH, CA 94010 TELEPHONE . . . . . . . . . (408) 483-2637 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- BTEMP FLAT RATE 1. 00 62 . 10 0 .00 62 . 10 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0.00 - --------- ---------- ---------- ---------- TOTAL PERMIT 100.47 0 . 00 100.47 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 100.47 JOHN CAREY JR --------------- TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ----------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL