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10050213 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21900 ALCAZAR AVE CONTRACTOR:NICE&RIGHT PERMIT NO: 10050213 CONSTRUCTION INC VNER'S NAME: STEPHEN FUNG&LILING WANG P O BOX 2285 DATE ISSUED:05/28/2010 OWNER'S PHONE: 4088610928 CUPERTINO,CA 95015 PHONE NO:(408)861-0928 6 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL E] License Class Li+c.# Z J �,F S TEMP POWER POLE Contractor N/67 1 6 r Date �3 I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$200 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35714034.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws re ating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to sw,e 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comely Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. C. RE-ROOFS: na[gr, C% Date /�d /f '� All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law fir one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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."044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed cone actors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and th declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self-insure for Work,r's material. Additionally,should I use equipment or devices which emit hazards Compensation,as provided for by Section 3700 of the Labor Code,for t ie air contaminants as defined by the Bay Area Air Quality Management Distric performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 a I have and will maintain Worker's Compensation Insurance,as provide-I for by the Health&Safety Code,Sections 25505,25'5933,and �25534. Owner or authorized a Section 3700 of the Labor Code,for the performance of the work for w rich this g d �V �1 l�'�6k7 Dater permit is issued. I certify that in the performance of the work for which this permit is ist ued,I shall not employ any person in any manner so as to become subject to the V•orker's Compensation laws of California. If,after making this certificate of a:emption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance o forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and st:ite laws relating t^building construction,and hereby authorize representatives of thi! city to enter -i the above mentioned property for inspection purposes.(We)agree to save ..Iamnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: B11: Lot: APN 35 7'14034 . 00 DATE ISSUED. . . . . . . : 05/28/2010 RECEIPT #. . . . . . . . . BS000010517 REFERENCE ID # • • • 10050213 SITE ADDRESS . . . . . : 21900 ALCAZAR AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER STEPHEN FUNG & LILING WANG ADDRESS 21900 ALCAZAR AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SHnRLEY NG CONTRACTOR . . . . . . . : JIA HUO YU LIC # 23446 COMPANY NICE & RIGHT CONSTRUCTION INC ADDRESS P 0 BOX 2285 CITY/STATE/ZIP . . . : CUPERTINO, CA 95015 TELEPHONE . . . . . . . . : (408) 861-0928 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- 1BCBSC VALUATION 200 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 200 . 00 0 . 50 0 . 00 0 . 50 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 127 . 50 0 . 00 127 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 127 . 50 me --------------- TOTAL RECEIPT 127.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER a, CITY OF CUPERTINO TEMP POWER CUPEkTINO PERMIT APPLICATION FORM APN # Date: Buildin Address- 0 O /� �iGL�`'tw Owner s Name: Phone #: L Contractoy (f' Phone #:4 V YO 2 ^ ps 9 Il no-4-a /' -7-41C , #! Orf lice- Contact: . Phone #: @ Contractor LicenAe #: Q l �-- Cupertino Business License #: c)- 3 4�,6 Job Description: ` T "'f' // Residential �' Commercial ❑ Valuation (cost of project): Type of Construction: N/A V tea; ".0- Quantity Fee ID Fee Description Fee Group Permit Type IERT>IK Res. Temp Power>1K E 1REAP14 Amps 1 ERT<200 Res. Temp Po`ver<200 E Amps 1 ERT2001 K Res. Temp PoNver 200-1 K E Amps t 1 EPERMITFE Electric Permil Issuance E 1 ELCPLNCK Electric Plan Check E I IBCBSC Cal Bldg Standards B ALL PERMIT Commission F-le TYPES 1BSEISMICR Seismic Residential B 1 TRAVDOC Travel & Doct mentation B / Fee Revised 01/07/09 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: a&00 mil-LC V PERMIT# OWNER'S NAME: /j(/�rj �,J/�3-, V(57 PHONE # �D� �G/— D (7Zp GENERAL CONTRACTOR: /t//C S- Qj(5z-&T BUSINESS LICENSE# ADDRESS: ,,0, p.& C ��, Cu p F�CITY/ZIPCODE: /,-t—*Our muni4al code requires all business(s working it the dy'tRaCe—a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTVACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. �_� �/ I am not using any subcontractors: O C� h Si mature 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 Painting/Wallpaper Paving Plastering l Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date