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10040132 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:HOMESTEAD PERMIT NO: 10040132 BUILDING ADDRESS: 10620 MORENGO DR CONSTRUCTION INC 10080 STERN AVE DATE ISSUED:04/21/2010 WNER'S NAME: BEN LU rhereby HONE: 7148721196 CUPERTINO,CA 95014 PHONE NO:(408)255-8999 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL LICENSED CONTRACTOR'S DECLARATION B TEMP POWER POLE Lic.# U lJ v 3 �thatl Datensed under the provisions of Chapter 9 g with Section 7000)of Division 3 of the Business&Professions at 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 Sq Ft Floor Area: Valuation:$150 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this APN Number:37534062.00 permit is issued. APPLICANT CERTIFICATION ove information is PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and state that the abWITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 N. upon the above mentioned property for inspection opurposes. li(We)ies judgments, ISO DAYS FROM LAST CALLED INSPECTIO indemnify and keep harmless the City of Cupertm g st said City in consequence of the Issued by Date: costs,and expenses which may accrue again 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. RE-ROOFS: Date e l7 All roofs shall be inspected prior to any roofing material being installed.If a roof is ;nature installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to Chapter construct the project(Sec.7044,Business&Professions Code). California a Health&Safety Code,aSections 25505,ls 2553,, 9he I have read the hazardous and 25534. 1 will l I hereby affirm under penalty of perjury one of the following three maintaHealth,n compliance with the Cupertino Municial&Safety Code,Section 25532(a)should Istore oor handlthazardoud the declarations: onsent to t hazardous I have and will maintain a CertificateSection 3700 of thelLaborrCodee for for the Worker's air tcontaminants as defined by the Bay uAreaeAir Quality Management District I Compensation,as provided for y will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and performance of the work for which this permit is issued. the Health&Safety Code,Sections 25505,25533,and 25534. 1 have and will maintain Worker's Compensation Insurance,as provided for by Date: Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I sation provisions of the Labor Code,I must worsforwhich thispermit is i sued(Sec.3 97rm that there CrveC)ffor the performance of become subject to the Worker's Compenk' forthwith comply with such provisions or this permit shall be deemed revoked. 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 state laws relating t�building construction,and hereby authorize representatives of this city to enter ARCHITECT'S DECLARATION in the above mentioned property for inspection purposes.(We)agree to save —demnify and keep harmless the City of Cupertino against liabilities,judgments, 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 ti 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: PERMIT# n) U 2— OWNER'S NAME: PHONE# t'714 GENERAL CONTRACT R: — BUSINESS LICENSE# 77 L 3 ADDRESS: ,v� CITY *Our municipal code requires all businesses 4orking 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: Date ignature Please check applicable subcontractors and complete the following information: t/ 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 OAL(0 Date Own r/Contractor Signature CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec : Twp: Rng: Sub: Blk: Lot: APN 37534062 . 00 DATE ISSUED. . . . . . . : 04/21/2010 RECEIPT #. . . . . . . . . BS000010233 REFERENCE ID # . . . : 10040132 SITE ADDRESS . . . . . : 10620 MORENGO DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BEN LU ADDRESS 1574 RIORDEN TER CITY/STATE/ZIP SUNNYVALE, CA 94087 RECEIVED FROM . . . . : VEYTZE SU CONTRACTOR JONATHAN WEI-CHIN SU LIC # 27723 COMPANY HOMESTEAD CONSTRUCTION INC ADDRESS 10080 STERN AVE CITY/STATE/ZIP CUPERTINO, CA 95014 TELEPHONE (408) 255-8999 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- -------- 1BCBSC VALUATION 150 . 00 1 . 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 150 . 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 ----------------- --------------- -------- CHECK 127 . 50 1050 --------------- TOTAL RECEIPT 127.50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- ----- 402 TEMPORARY POWER CITY OF CUPERTINO TEMP POWER CUPEkTINO PERMIT APPLICATION FORM �6/3Z APN # Date: Building Address: Owner's Name: jgm, ti► L,'u Phone #:C?/f�) $9z,/ q� Contractor: -f tOR6 —I rwo C0/V5 Uo,J Phone # S P F Fax #: Contact: Q-25/i S U Phone #: Contractor License #: $ 6 9 1 6 3 3 Cupertino Business License Job Description: Residential Commercial Valuation (cost of project): Type of Constructio Qtt= Fee Description Fee Group Permit Type K Res. Temp Power>IK E 1REAP14 Amps IERT<200 Res. Temp Power<200 E / Am s 1 ERT2001 K Res. Temp Power 200-1 K E Amps / 1 EPERMITFE Electric Permit Issuance E 1 ELCPLNCK Electric Plan Check E r 113CBSC Cal Bldg Standards B ALL PERMIT I Commission Fee TYPES 1BSEISMICR Seismic Residential B 1TRAVDOC Travel & Documentation B Fee Revised 01/07/09