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07050020 CITY OF CUPERTINO 77777.777 BUILDING DIVISION PERMIT �1 ' `RC1R } MATI3N: BUILDING ADDRESS: PERMIT NO. 20818 GREENLEAF DR ATLANT% CONSTRUCTION INC 07050020 OWNER'S NAME: PERMIT ISSUE DATE WILLIE LU 342 DAISY DR. 05/03/2007 ONE: SANITARY NO. CONTROL NO. ARCHTTECT/ENGINEER: BUILDING PERMIT INFO TEMPORkRY POWER POLE BLDG ELECT PLUMB MECH i p zo LICENSED CONTRACTOR'S DECLARATION Job Description V ): I hereby affirm that I am licensed under provisions of Chapter 9(commencing j z M with Section 7000)of Divi ion 3 of the Business and Profession Codg,and tfty license is I�y in full force and effect �f-Ll(7� j v�z License CI Lic,if 3 t-a Date Conttacwr ARCHITECTS]DECLARATION 7 a a I understand my plans shall be used as public records )qU u y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the pO following reason.(Section 7031.5,Business and Professions Code:Any city or county $ which requires a permit to construct,alter,improve,demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement Valuation _G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area t- (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or ythat he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of AP Number Occupancy Type 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 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 sok.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 Contractoes U- 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. ❑i 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. My Workers Compensation Insurance carrier and Policy number am: 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,1 shall not employ any person in any in cr a o bject to the Workers'Compensation Laws of Cali(oraia Aate Applicant � NOTICE OAP CAM:ff.after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be dcemed revoked. Z RCONSTRUCTION LENDING AGENCY [-r CA I hereby affirm that dare is a construction lending agency for the performance of _ tY > the work for which this permit is issued(Sec.3097,Civ.C.) Wfs.A Lender's Name r7 z Lender's Address U C-) I certify that I have read this application and state that the above information is CL.► correct.I agree to comply with all city and county ordinances and stale laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned properly for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against ,E"y to 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 AND WILL COMPLY WITH ALL NON-POINT Issued by: so U REGULATIONS. V Re-roofs I n o pplcan it/Contracl r Date HAZARDOUS MATERIALS DISCLOSURE Type of 1:oof 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 roofs shall be inspected prior to any roofing material being installed. Q Yes Q No If a roof s 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 Q Nu 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 does not currently have a tenant,that it is my responsibility to notify the occupant of the req' ents which mist be t r w issuance of a Certificate or 9ccup Signature of Applicant Date All roof coverings to be Class"B"or better O cr or authorized agent Da CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: B1<-: Lot: APN . . . . . . . . : 32530173 .00 DATE ISSUED. . . . . . . : 05/03/2007 RECEIPT #. . . . . . . . . : BS)00001190 REFERENCE ID # . . . : 07)50020 SITE ADDRESS . . . . . : 20318 GREENLEAF DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WILLIE LU ADDRESS . . . . . . . . . . : 20318 GREENLEAF DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RE=PT INTERFACE CONTRACTOR . . . . . . . : FRkNCIS HO LIC # 24120 COMPANY . . . . . . . . . . : ATLANTA CONSTRUCTION INC ADDRESS . . . . . . . . . . : 342 DAISY DR. CITY/STATE/ZIP . . . : SAV JOSE, CA 95123 TELEPHONE . . . . . . . . : (438) 205-5520 FEE ID UNIT QUANTITY kMOUNT 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 ----------------- --------------- -------------------- CREDIT CARD 100 .47 AMEX --------------- TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF CUPERTINO TEMP POWER CITY OF ' CUPERTINO PERMIT APPLICATION FORM l� APN# Date: S- Building Address. Owner's Name:( A , ' +"� 1 � � Phone #� / n vV t u �s� 3v n d Co tractor: I Phone: icense #: Cn ��r;oma, j ��-zJ C ntact: Phone: Cupertino Business License #: B ilding Permit Info: / Elect ❑ I 4 Job Description: Residential Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BTEMP T ower ELECTRICAL EPERMITFEE E sect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING