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09070134 CITY OF CUPERTINO BUILDING DI.ISION PERMIT BUILDING ADDRESS: PERMIT NO. 10460 S FOOTHILL BLVD LAW CON;' OWNER'S NAME: PERMIT ISSUE DATE —r'-P T I C Isas )NE: c mIL, 1 00 S A CONTROL NO. (4 08) 99 3-2353 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u0p LICENSED CONTRACTOR'S DECLARATION Job Description Lu C I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z tE with Section 7000)of Division 3 of the Business and Pro ons Code,and my license is 4 o y in full force and effect ' Q� POWER POLE =Z [icenac Clas Lic•N n M Date Contractor RCHITECTS DECLARATION < I understand my s shall be used as public records �ul i CH Licensed Professional y 3 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county c m,8! which requires a permit to construct,alter.improve,demolish,or mpair any structure ZW prior to its issuance.also requires the applicant for such permit to rile a signed statement < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 iq.Ft.Floor Area Valuation Yt=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 5 0 0 0 O 0 f 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 APN Number Occupancy Type not more than rive hundred dollars MOM. 3 5 7 0 4 01 ) . 00 ❑I,u owner of the property.or my employees with wages as their sole compensation, will do the work,and the structure is notintended or offered rorsale(Sec.7044.Business ns 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 sale.). ❑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 LL- ccnse 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 Sex. B&P C for this mason OwnerDate 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. My Worker' ore nsatig,insurance carrier Wil Policy number �� Cartier: cY No.: CERTIFICATFyOF 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 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 Coda you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. z 0"4CONSTRUCTION LENDING AGENCY [~i C.43 I hereby afr=that there is a construction lending agency for the performance of lye 5 the work for which this permit is issued(Sec.3097,Civ.C.) Wfs.Q Lender's Name — z Lender's Address U 0 I certify that 1 have read this application and state that the above information is V.11''* corm 1 agree to comply with all city and county ordinances and state laws relating to OV building construction,and hereby authorise representatives of this city w enter upon the U above-mentioned property for inspection purposes LL (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the f this it. Date /1", h" APPLICANT U RSTAND A D WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REG ATIONS. 7i' Re-roofs Signature of Apoickicklowker Data Type of R sof HAZARDOUS MATERIALS DISCLOSURE 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 Cole,Section 25532(a)? All roofs!-hall be inspected prior to any roofing material being installed. ❑Yam 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 .:.nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection. District? El Yes Ale 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Saf d 505.25533 and 25534.1 understand that if the building does not c tly have ten t. it is my responsibility to notify the occupant of the requirements n;cn et or toissranc�cmracertir tear cupancy. Signature if Applicant Date All roof coverings to be Class" ``or better Owner or authori� ge Dam CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN 35704010 . 00 DATE ISSUED. . . . . . . : 07/17/2009 RECEIPT #. . . . . . . . . BSC00008214 REFERENCE ID # . . . : 09C70134 SITE ADDRESS . . . . . : 10460 S FOOTHILL BLVD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER FELICIA CHOW ADDRESS 10460 S FOOTHILL BLVD CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2605 RECEIVED FROM . . . . : SU LAW CONTRACTOR FRFNKIE LAW LIC # 25316 COMPANY LAS CONSTRUCTION LLC ADDRESS 20E60 STEVENS CREEK BLVD STE 1 CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE (4C8) 996-2353 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 500, 000 . 00 20 . 00 0 .00 20 . 00 0 . 00 1BSEISMICR VALUATION 500, 000 .00 50 . 00 0 . 00 50 . 00 0 . 00 1EPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00 1ERT<200 UNITS 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 196 . 00 0 . 00 196 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 196 . 00 VISA --------------- TOTAL RECEIPT 196 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO 0� 7 TEMPPOWER CUPEkTINO PERMIT APPLICATION FORM APN # G�/ , r p Date: Building Address: Owner's Name: Phone #: )- 719--7s-37 Contractor: Phone 4rr14>,y - 31 Fax #: � Contact: / Phone ##: 1e, l�aeo Contractor License #: g,21,S2�,,6 Cupertino Business License Job Description: Residential Commercial ❑ Valuation (cost of project): Type of Constructio N/` Quantity Fee ID Fee Description Fee Group Permit Type IERT>1K Res. Temp Poi ver>IK E 1REAP14 Amps I ERT<200 Res. Temp Power<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps 1 EPERMITFE Electric Permit Issuance E 1 ELCPLNCK Electric Plan Check E / 1BCBSC Cal Bldg Standards B ALL PERMIT Commission F-e TYPES 1BSEISMICR Seismic Residential B 1 TRAVDOC Travel & Documentation B Fee Revised 01/07/09 Pacific Gas and Electric Company' 10900 No. Blaney Avenue Cupertino, CA 95014 City of Cupertino 10300 Torre Avenue Cupertino, Ca. 95014 To Whom It May Concern: SUBJECT REMOVAL OF GAS AND / OR ELECTRIC FACILITIES The gas and electric facilities have be-In removed and / or abandoned at: W460 S Po4b'11 Slued on6ig�c� If you have any further questions, ple ase contact me at (4080725-3325 Sincerely, v4;C1(-V �+ Service Planning