07100004 CITY OF CUPERTINO ' ` �?
BUiLDi+�lGDIVIS�9N PERMIT ��������� :
s <.: ,::: , :............. ...: _ .
PERMIT NO.
BU[LD NG ADDRESS:
�0535 CYPRESS CT HAN JAY CONSTRUCTION 07100004 .
PERMTT LSSUE DATE
OWNER'S NAME:
STEVEN LIAO 190 TI LSON AVE 10/01/2007
SANITARY NO. CONTROL NO.
)NE:
(408) 2C5-8020
BUILDING PERMITINFO
ARCHITECT/ENGINEER:
BLDG EI.ECT PLUMB MECH
� � 0 0
i p � LICENSED CONTRAGTOR'S DECLARATION JOU DeSCClptlOfl
� V� I hcrcby affirm �hat [ am iiccnscd unJcr provisions oC Chapicr 9(commencing
; Z, � wi�h Section 7IXlU) of Division 3 of Ihc Busincss and Pro cssianq Code � my licensc is T EMP POV IER
�� y in full Corce and effec� �
� � z Licenx Class �. X �
� F p Datc ` � ConUactor .
� RCHITECTS DECLA A N •
i a e I undcrstanJ my plans shall bc used as puhlic rccords
>yU
° u. F' Liccnscd Pmfcssional
' � < OWNER-BUILDER DECLARATION
j<� 1 hcrcby alTirm Uiat 1 am cxcmp� Crom �hc Convacwr's Liccnsc Law far thc
. p O (ollowing rcason. (Scction 7031.5, Busincss and Profccsions Calc: Any city or county
�,°, � which rcquires a permit �o cnnswct, altcr, improvc, dcmolish, or repair any suucturc
�,Z � prior �o i�s issuancc, also rcquires thc applican� Cor such pertnit to file a signed sia�ement �' Ft. Floor Area Valuation
;= a ihai he is liccnscd pursuant to thc provisions oC thc Contracmr's Liccnsc Law (Chaptcr 9 `' • $10 0 0
u t- �(commenring wiih Section 7000) of Division 3 0( thc Busincss and Profcssions Cadc) ur
��� that he is exempt thcrcfrom and t�e basis for t6e allcgcd exempdon. Any violarion o(
SecUon 7031.5 by any applicant for a permit subjects ihe applicant to a civil pcnalty of �� Number Oceupaney Type
not morc than five hund�td dollars (5500). 3 1 6 3 0 � 6� �.
❑ I, u owncr o[ the propecty. or my cmployces with wages az the'v salc campensaUon,
willdothework.andtheswcwceisnotintendedorof[ecedforsale(Sec.7044.Business Re(lUII'Cd TIiSPCCU0i1S
and Professions Code: 'R�e Conuacmr's License Law does nat apply to an owner of
propeny wAo builds or improves thereon, and who does such work himseiCor ttwugh dis
own emplayces. providcd that such improvements are not iNended or o[Lered for sala If,
however, ihe building or improvement is sotd within one year of campletion, ihe owner-
builder will have the burden o[ proving �hat he did not build ar improvc for purpose of
sale.).
❑ I, u owner of the property, am eacclusively conuac�ing with licensed rnnvutors w
wnsuuct the project (Sec. 7044. Business and ProCessions Code:) The Conuacwr's Li-
cense Law docs not apply to an owner of propeny who builds or improves ihaeon, and ,
w6o conuac�s for such pmjecu wiU� a conuactor(s) licensed pursuant to the Convactor's
License Law.
0 1 am ezempt undu Sec , B& P C for ihis reason
Owner ��
WORKER'S COMPENSA'fION DECLARATION
I 6ereby aflirm under penalty ot perjury one o[ �he following deciaraGons:
„J t h:ve and will maimain a CertiGcale of Consent to sclf-insure for Workcrs Compen-
sation, as providcd for by Section 3700 of ehe Iabor Code, for thc performancc o( the
work for which this permit is issucd.
❑ I Aave and will maintain Workcr's Compensation Insurance, as �cyuired by Section ,
3700 oC thc Labor Codc, fw thc pedormance oC the work for which this permit is issued.
My Worke�s Com{xnsation Insurance cartier and Palicy number are:
Camer. Policy No.:
CERTIFICATE OF EXEMP7'[ON FROM WORKERS'
COMPENSAT[ON INSURANCE '
(ihis sectlon necd not be completed it the pccmit is for anc hundrcd dollars (S 100)
nr Icss)
I cenify that in thc performancc of tdc work for which this permit is issucd. I shall not
e�nploy any person in any manncr so as w bccome subject w the Workcrs' Compcnsation
Laws ot Cali(omia. Datc
ApPlicant �
NOTICE TO APPLICAM: If, a r ing �his CcrtiGcatc of Exemplion, you should
become subject to �hc Workcr's Compensadon provisions of Uic Latxu Codc, yau must
� O forthwi�h comply with such provisions ar this permit shall bc dccmcd revokcd.
Z '"'" CONSTRUCTION LENDING AGENCY
[-~-� ►�-� I hercby a(]irm that thcre is a constnxtion Icnding agcnry Cor thc perfortna�rcc of
(Y., � ihc work for which �his permit is issucd (Scc. 3097, Civ. C.)
W Q Lendcr's Narnc '
? z C.ender's Address
V � 1 certify �hat I havc rcad this application and staic Ihat tpc abovc informauon is
w ► - � cortcct. I agree to comply with all city and county onlinances and s�a�e laws relating to
rJ U building conswction, and hereby authoriie representalives of this city to enter u{mn the
� a abovc-mcntioncd property for inspccuon purposes. .
(Wc) agrce �o save, indemni(y and keep hartnless thc City of Cupertino against
�„F'',� � liabiliva, judgmrnts, costs and expenses which may in any way accruc against said City
(� z in consequcncc oC tAc granung of this pertnit. D3LC
"'� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P rrr Issued by:
SOURCE EGULATIONS.' � l � ` '
�],,`v�.. � � 4 � Re-roofs
Signatu Applican� °ac T e of R�of
HAZARDOUS MATERIALS DISCLOSURE }
Will 1hc applicant or Cuwrc building occupantstorc or handlc ha•rardous matcrial
u dcfincd by lhe Cupertino Municipal Codc. Chaptcr 9.12. and thc HcaIIA and Sa[ety
CoJc, Scction 25532(a)? All roofs : hall be inspected prior to any roofing material being installed.
� Ycs �o
Will the applicant or fu urc building occupant use equipmenl or dcvices which
If a roof i: installed without first obtaining an inspection, I agree to remove •
..nit ha•rardous air contamina�ig.�s dcfined by the Bay Arca Air Qualily Managcmcnt all new m�terials for inspec*ion.
Disvict?
❑ Ycs ❑ Nu
1 havc read U�e ha�ardous maierials requircmcnts un�icr Chap�er 6.45 of thc Califor-
nia Hcalth & Safcty Codc, Scctions 25505, 25533 aruf 25534. t undcrsund thaz iC �hc building
docs not curtc ly h a tcnan4 �at it is my responsibility lo noufy lhc occupant of �
myuircmcna hicti ustbcmetpriort issu oCaCcruficaicofOccup Signature �fApplicant Date
`� �`� All roof coverings to be Class "B" or better
Owncr or authorizcd a cnt D�� -
��7 r c� � o c� �--�
� . CITY OF C UPERTINO
��-.- � � �` �, I�� � : � ��%� �.
CUPEI�TI�10 PERMIT APPLI CATION FORIVI
_�PN # � � �� �C� �p� � �C� Date: i f� . � � � ��
Building Address: � � � � � � �� s S �.�
Owner's Naine: �� � �, �� Phon�O � 6� zs q �
� - �-°- ��--- �
------ -- - ---- --- -- -- - ---- ,
� Co�7tractol�: ' l�ho�ze: Liceilse #: '
�-I u� C�y � �� s� �.C�: � 4�r � 2�� ��z o g � �a �� �G
Contact: Phone: Cupertino Bu ness License #:
��� � � �� � �C� ��Q ����
Building Permit Info:
Elect ❑
Job Description: �� ��,� �-� �� ��
Residential Commercial ❑
Cost of Project:
� b�;''L'' �0
Qty. if
Ap licable Fee ID Fee Description Fee Group
BTEMP Te nporary Power ELECTRICAL
EPERMITFEE Ele:ct. Permit Issuance ELECTRICAL
BUSLIC Bu siness License BUILDING
CITY OF �UPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 31630060.00
DATE ISSUED.......: 10/01/2007
RECEIPT #.........: B5000002829
REFERENCE ID # ...: 07100004
SITE ADDRESS .....: 10535 CYPRESS CT
SUBDIVISION .......
CITY .............. CUFERTINO
IMPACT AREA .......
OWNER ............. STEVEN LIAO
ADDRESS ..........: 10�35 CYPRESS CT
CITY/STATE/ZIP ...: CUFERTINO CA, 95014-2423
RECEIVED FROM ....: HAD JAY CONSTRUCTN
CONTRACTOR .......: HAI�' CHIEH LIN LIC # 28954
COMPANY ..........: HArf JAY CONSTRUCTION
ADDRESS ..........: 19C98 TILSON AVE
CITY/STATE/ZIP ...: CUF'ERTINO, CA 95014
TELEPHONE ........: (4C�8) 205
FEE ID UNIT QUANTITY ��MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- -----
BTEMP FLAT RATE 1.00 62.10 0.00 62.10 0.00
EPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00
----------- ---------- ---------- ----------
TOTAL PERMIT : 102.89 0.00 102.89 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 102.89 #1108
---------------
TOTAL RECEIPT : 102.89
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -----------
103 UFER 304 ROUGH ELECTRICAL