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06100031 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � } M�kT�© ' BUILDING ADDRESS: PERMIT No.0 610 0035 7635 ORANGE BLOSSOM DR OWNER'S NAME: PERMIT ISSUE DATE CHIA-LAU FERNG 10/06/2006 jNE: SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH !0p LICENSED CONTRACTOR'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 my license is ?-y in full force and effect. TEMPORARY POWER ?n? License Class Lic.# l ❑ Date Contractor ARCHITECTS DECLARATION W U I understand my plans shall be used as public records ,a yU.in Licensed Professional y OWNER-BUILDER DECLARATION < 1 hereby affirm that I am exempt from the Contractors License Law for the COO following reason.(Section 7031.5,Business and Professions Code:Any city or county ,Q,ff which requires a permit to construct,alter,improve•demolish,or repair any structure 0 z w prior to its issuance,also requires the applicant for such permit to file a signed statement e_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation i t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 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 the applicant to a civil penalty of 3XIIN MMR-r Occupancy Type not more than five hundred dollars($500). ❑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 q p 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 sate.). ❑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 mot 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. ❑[am exempt unde Se! B&P C for this reason Owner _Date r RI SCO ENSATION DECLARATION I hereby affirm tindVaertifly of perjury one of the following declarations: ❑1 have and will maimed iate of Consent to self-insure for Workers 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 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 6 be c su 7i-to the Workcrs'Compensation Laws of California.Date Applicant 0it NOTICE TO APPLICANT: f,after ma ting this ttertificatc of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or�thi permit shall be deemed revoked. z" CONSTRUCT\ION LENDING AGENCY 1 hereby affirm that there is a canswdion lending enry for the pe ante of �+> the for which this permit is' (Sec.3097,Civ. .) W A Lend is a �- a+ Len rs A a z- U 0 1 certify that I have read this application and state that the above information is w correct.I agree to comply with all city and county ordinances and state laws relating to Vbuilding 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 to liabilities,judgments,costs and expenses which may in anyway accrue against said City U Z in consequence of the granting of this permit. r"t APPLICANT UNDERSTANpS AND W OMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULA N Re-roofs Signature of Ahli#n#e6nt1f&iF Gate, AZARDO SMVfMALS DISCLOSURE Type Of Roof Will the appli t or future b 'ding occupant store or handle hazardous material as defined by the Cope ' Muni' al Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? v All roofs shall be inspected prior to any roofing material being installed. ❑Yes y�Nu Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? El Yes ��(u 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 255.25533 and 25534.1 understand that if the building does not currently have a5mgrt is sponsibilhy to notify the occupant of the rcyuircmcnts whit or to c of a Certificate of Occupancy Signature of Applicant Date �J All roof coverings to be Class"B"or better Owner or uth . ag f Date ' CITY OF CUPERTINO n 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36611080.00 DATE ISSUED. . . . . . . : 10/06/2006 RECEIPT #. . . . . . . . . : 36331 REFERENCE ID # . . . : 06100035 SITE ADDRESS . . . . . : 7635 ORANGE BLOSSOM DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CHIA-LAU FERNG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5250 RECEIVED FROM . . . . : FERNG CHIA CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : r'EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -TEMP 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 NUMBER ----------------- ------------ ------------------ OTHER 100.47 VISA TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF CUPERTINO E TEM P POWER T CUPS OF PERMIT APPLICATION FORM APN # � / f.� (� ` D Date: Building Address: / Owner's Name: Phone #: Contractor:- hone: License #: , Z) Contact: Phone: Cupertino Business License#: Building Permit Info: Job Description: Residential Commercial ❑ Cost of Project: Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING