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10040074I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20861 DUNBAR DR I CONTRACTOR: TBD - TO BE DETERMINED I PERMIT NO: 10040074 OWNER'S NAME: LEE FON-CHEN AND FRAN NER'S PHONE: 4089962527 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date 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. I 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 permit is issued. APPLICANT CERTIFICATION 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 state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 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 comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date U OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. I 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 permit is issued. 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save unify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. f' DATE ISSUED: 04/12/2010 PHONE NO: BUILDING PERMIT INFO: BLDG r— ELECT f— PLUMB r— MECH I— RESIDENTIAL r— COMMERCIAL r— JOB DESCRIPTION: DEMO 2 STORAGE SHEDS**SEE NOTES Sq. Ft Floor Area: I Valuation: $100 APN Number: 32630159.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYSFROMLAST CALLED INSPECTION. Issued by: /.% Date: —/ 2 -,!!� RE -ROOFS: 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. Signature of Appl Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner.or-authnt•ized agent: �. —"'bate:- j [ f/ C., CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32630159.00 DATE ISSUED.......: 04/12/2010 RECEIPT #......... BS000010158 REFERENCE ID # 10040074 SITE ADDRESS 20861 DUNBAR DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER LEE FON-CHEN AND FRAN ADDRESS 10935 MIRAMONTE RD CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM FRAN W LEE CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBD - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: TELEPHONE ........: FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ---- THIS REC NEW BAL ----------------------- 1BCBSC VALUATION ---------- 100.00 ---------- 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 100.00 0.50 0.00 0.50 0.00 1DEMORES SQ FEET 0.00 507.00 0.00 ---------- 507.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 508.50 0.00 508.50 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 508.50 --------------- 508.50 REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- - 704 DEMO C7Ci �,J C a�. d z_ 79 a K) M /70 O v I I b Z N ?TIF GITY OF IN ACCORL'ANt 1 "'11TH NAES ANf' ORDINANCG CUPERTINO COU = --%/b- DATE_ SIGNEb if,cations MUST This set of plans and spec es and it is the job at be kept on o alterations unlawful to make any rmission from on same without written pe Cupertino. Building Department, City of C ifadons the The stamping of this plan and spec NOT be held to Permit or to be an SHALL approval of the violation of any Provisions or State Law. s " of any City Ordinance r �,J C a�. d z_ 79 a K) M /70 O v a. CM Of CUPEkTINO —7q CITY OF CUPERTINO DEMO PERMIT APPLICATION FORM APN# 01 Fee ID Date: Building Address: Ll r 1DEMORES -A Mailing Address (if different from building address): B f L) cl-,-55- �-/ 1* 1 Owner's Name: Pool Demo Residential Phone: 1SFP00L-DEM 1BCBSC Contractor: B Phone lBSEISMICRE S'eismic Residential B Fax: Contractor License #: Cupertino Business License #: Contact: Phone: <j, r, Fvext,\ L.k. Fax: Residential Sq Footage Commercial E] Sq Footage Job Description: �77�' ,Q Valuation: Project Size: Express 0 Standard 0' Large 0 MajorE:] Please complete relevant portions of the Green Building Checklist & attach it to the application or if applicable, include on the plan set & the sheet index. Quantity Fee ID Fee Description ,.Fee Group._ Permit Type 1DEMORES Demo -Residential B ISFDWL-DEM 1DEMOPRES Pool Demo Residential B 1SFP00L-DEM 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES lBSEISMICRE S'eismic Residential B Revised 01/07/09 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 09: � - )�" . PERMIT # d DU7 OWNER'S NAME: _ _, _`, PHONE # c -r e GENERAL CONTRACTOR: BUSINESS LICENSE # r ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: ne�Xontractor Signature ate 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ne�Xontractor Signature ate