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07030063 --77-7777777 CITY OF CUPERTINO *�T � ( !!! BUISDING DIVISION PERMIT PERMIT NO. BUILD Nor DDREss: TBD - TO BE DETERMI07030063 ��987 GREENLEAFT DR — PERMIT ISSUE DATE OWNER'S NAME: 03/0 /2QQ7 SUPING CHEUNG SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ARCHITECTIENGINEER: c� o 0 0 i a a LICENSED CONTRACTOR'S DECLARATION Job Description 1 W� I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z U with Section 7000)of Division 3 of dtc Business and Professions Code,and my license is DEMO SW II I NG POOL <y in full force and effect. ? License Class�---L� d Contractor F w Date ARCHITECTS DECLARATION j a< I understand my plans shall be used as public records )aU U. Licensed Professional D a OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the a 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 Valuation u- H prior to its issuance,also requires the applicant for such permit o file a signed statement $ Ft.Floor Area ::: $7000 =Z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 1 Fs-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or Occupancy Type i r that he is exempt titemtrom and the basis for the alleged exemption.Any violation of Number Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 32609 01 i not more than five hundred dollars(5500). ❑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 oroffered for sale(Sec.700.Business Required Inspections and Professions Code:The Contractor's License Law does rat 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 We.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 project(Sec.7044,Business and Professions Code:)The Contractor's u- rty reon,and who contracLaw does or such projects with a contractnot apply to an owner of toor(s)who pursuant o the roves Contractor's License Law. B&P C for this reason -- ❑I am exempt undf Sec. OwnerDate 3 WORKER'S COMPENSAnO pZE uKATION I hereby affirm under penalty of perjury one of the following declarations: J I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn- 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 any person in any manner so as to become subject to the Workers'Compensation Laws of Cali mia.D Applicant NOTICE A CANT:If,after making this Cc ficatc of Ezcmptian,you should become subject to the Worker's Compensation provisions of the labor Cade,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z� CONSTRUCTION LENDING AGENCY H rte. I hereby affirm that there is a construction lending agency for the performance of Cd.> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name aLtndees Address V (certify that I have read this application and state that the above information is Li+ correct.I agree to comply with all city and county ordinances and state laws relating to V building construction,and hereby authorizt representatives of this city to enter upon the above-mentioned property for inspection purposes. >" Ow against said(we)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue agaiid City Date U Z in consequence of the granting of this permit. -rRe-roofs APPLI NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Id b SOUR REGULA NS. J Signature of App icant/ContractorDate roof HAZARDOUS MATERIALS ISCLOSURE 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. C]Yes PN. If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment orevi swhicn all new 1 materials for inspection. emit hazardous air contaminants as defined by the Bay Area Air QualityManagement District? ❑Yes 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 have a tenant,that it is my responsibility to notify the occupant of the Date rcqui cnts w must be met prior to issuance of a Certificate of Occup% Signatul e of Applicant All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32609017. 00 DATE ISSUED. . . . . . . : 03/09/2007 RECEIPT #. . . . . . . . . BE000000651 REFERENCE ID # . . . : 07030063 SITE ADDRESS . . . . . : 2C987 GREENLEAFT DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SUPING CHEUNG ADDRESS . . . . . . . . . . : 2C987 GREENLEAFT DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : TED - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TED - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 7, 000 .00 137.16 0.00 137.16 0.00 BSEISMICRE VALUATION 7, 000 .00 0.70 0.00 0 .70 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 137. 86 0.00 137. 86 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 137. 86 VISA --------------- TOTAL RECEIPT 137.86 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO CITY OF CUPERTINO t :DEMO CUPS TING PERMIT APPLICATION FORM C APN# �f � i� Date: /,y / Building Address: i 19 Owner's Name: Phone#: ��w 402 - -Aga* -J- Contractor: License#: Contact: Phone#: Applicant/Contractor: Building Permit Info: 1 &Ie�cMech escription: Residential: J�'y' ` S`"""y" / '`'�� Commercial: Sq.Ft. Floor Area: $/Sq.Ft.: � a Architect/Engineer: Valuation: Type of Construction: Occupancy Group: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILIDNG BSEISMICOM Seismic Commercial BUILIDNG BSEISMICRE Seismic Residential BUILIDNG BPLANCHK Plan Check Fee BUILIDNG BUSLIC Business License BUILIDNG Community Development 10300 Torre Avenue ~` a Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Buildirl De artment JOB ADDRESS: oJ'� 7 �r / �� PERMIT #a � C� ti•,v �'� Sa t OWNER'S N S i'-7 �' C� PHONE # -;e o� -s - y'�-`f GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and comp lete the following information: SUBCONTRAC'T'OR 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 Date Owner/Contractor S' ature