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09070196 CITY OF CUPERTINO BUILDING PERMIT S � BUILDING ADDRESS: 21871 DOLORES AVE(LOT2) CONTRACTOR:NICE&RIGHT PERMIT NO:09070196 CONSTRUCTION INC O"'NER'S NAME: TRACY HSU 1'0 BOX 2285 DATE ISSUED:07/29/2009 (r.,PER'S PHONE: 4084645030 CUPERTINO,CA 95015 PHONE NO:(408)861-0928 ❑ LICENSED CONTRACTOR'S DECLARATION ]WILDING PERMIT INFO: BLDG ELECT PLUMB License Class _ Lic.# _ MECH r RESIDENTIAL� COMMERCIAL Contractor_ Date _ 1 hereby affirm that 1 am licensed under the provisions ot'Chapter 9 OB DESCRIPTION:TEMPORARY POWER POLE (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 'q,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 Section 3700 of the Labor Code,for the performance of the work for which this f kPN Number:35714026.00 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 relating 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 save 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 comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section �2Cl�S 9.18. Si ._gture Date RE-ROOFS: Y ill roofs shall be inspected prior to any roofing material being installed.If a roof is OWNER-BUILDER DECLARATION i istalled without first obtaining an inspection,I agree to remove all new materials for i ispection. 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: `ignature of Applicant: Date: 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.7044, Business&Professions Code) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,am exclusively contracting with licensed contractors to – construct the project(Sec 7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the declarations: California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Compensation,as provided for by Section 3700 of the Labor Code,for the `safety Code,Section 25532(a)should 1 store or handle hazardous material. performance of the work for which this permit is issued. ikdditionally,should I use equipment or devices which emit hazardous air I have and will maintain Worker's Compensation Insurance,as provided for by c ontaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this I lealth&Safety Code,Sections 25505,25533,and 25534. permit is issued. 1 certify that in the performance of the work for which this permit is issued,I shall Owner or uthorized a n J not employ any person in any manner so as to become subject to the Worker's Date: 2 67 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 CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. 1 hereby affirm that there is a construction lending agency for the performance of work's Ior which this permit is issued(Sec.3097,Civ C.) APPLICANT CERTIFICATION Lender's Name 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 Lender's Address to building construction,and hereby authorize representatives of this city to enter V he above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION i, mly and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 1 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. q Signature Date -7—a/ CITY OF CUPERTINO 5 ITEMS OF 13 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk : Lot : APN 35-/14026 . 00 DATE ISSUED. . . . . . . : 07/29/2009 RECEIPT #. . . . . . . . . BSC00008302 REFERENCE ID # . . . : 09C70196 SITE ADDRESS . . . . . : 21E71 DOLORES AVE (LOT2) SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER TRF.CY HSU ADDRESS 10365 PALO VISTA RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : TRT.CY S HSU CONTRACTOR . . . . . . . : JIF. HUO YU LIC # 23446 COMPANY NICE & RIGHT CONSTRUCTION INC ADDRESS . . . . . . . . . . : P C, BOX 2285 CITY/STATE/ZIP . . . : CUPERTINO, CA 95015 TELEPHONE (4C8) 861-0928 FEE ID UNIT QUANTITY 7,MOUNT 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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO { TEMP POWER CUPEkTiNO PERMIT APPLICATION FORM APN # 3 _ /�- 0 (P � v C-2, Date: r Building Address: Owner's Name: —/ 3 s f-- Phone #: q-a� - Contractor: Phone #: (� _ Z ff�S—qZ 2-- A//,v --` V/,v i` �o-�S�}7dCJ719�n .Zi7 C . Fax #: 4-t /° 12 Contact: Larr u Phone #: 4( v — o Contractor License #: 2- Cupertino Cu ertino Business License#: Job Description: T I e-hp POW'er PD/,c Residential Commercial El Valuation (cost of project) .. Type of Constructio�N/A Quantity Fee ID Fee Description Fee Group Permit Type IERT>1K Res. Temp Poi ver>lK E 1REAP14 Amps / l ERT<200 Res. Temp Power<200 E Amps 1 ERT2001 K Res. Temp Polver 200-1 K E Amps 1 EPERMITFE Electric Permi-: Issuance E 1 ELCPLNCK Electric Plan Check E 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Fee TYPES 1BSEISMICR Seismic Resid1;ntial B 1TRAVDOC Travel & Documentation B Fee Revised 01/07/09 : \ Community Development ' 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF �UPE�TINO Fax(408)777-3333 Building Department JOBADDRESS: PERMIT # r 7 Uolow s r,49SV OWNER'S NAME: 7 PHONE # !ZS-63 a GENERAL CONTRACTOR: # e�-o —6Z Z I am not using any subcontractors: °S Si;ma a 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 16" vq o S e'rl codxdcior Signature Date