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07100067 CITY OF CUPERTINO � � " 7� 7�,� ' BUILDI�IG DIVIS,�N PERMIT 4 ��?��`�� #Y ��' ,. >. ,. _ _:: ..: ,: .:.::.; PERM(T NO. BUIL q�r��.��xesMINETTE DR iJNIVERS��L CONSTRUCTION 07100067 • PERMIT ISSUE DATE OWNER'S NAME: YONG B WON 188 B� �RNHART AVE 10 08 2007 SANITARY NO. CONTROL NO. �NE: (408) 25::-8894 BUILDING PERMiTINFO ARCHTCECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 ; o a LICENSED CONTRACTOR'S DECLARATION JOU DESCi1pUOf1 : V� t hercby afCcm that [ am liccnscd undcr pravisions oC Chapicr 9(commrncing ; x� wim Sccuon 7o00) oroivision 3 of thc Business and Profcssions Codc, and my liceme is TEMP PO[ JER POLE :� y in full focce and cfCec� ��` � v� Z Licensc Clus � Lic. # : F O Datc ConUactor � ARCHITECI'S DECLARATION i a a 1 undcnwnd my plans shall bc used as public rccorcis )qU ° w y Liccnscd Pcofcssional � y � OWNER-BUILDER DECLARATION T hcreby alTirm �hat 1 am excmpt Gom thc Contractars Liccnsc Law Cor Uie � p O follawing r; ason. (Sccdon �(131.5, Busincss and Profacsions Cafc: Any ciry ar caunty <°„ � which requires a pc�mic to cnnswc4 altcr. impmvc. dcmolish. or repair any swcm�c � Z y prior w i�s iscuancc, alsu rcquires ihc applicant for such pertnit to filc a signcd sta�cmrnt , Ft. FlOOi ACCa Valuation a �hat hc is liccnscd pucwant ta thc provisions of U�c Conuactur's Liccnsc Law (Quptcr 9 �q � 4 O O r t �(commcncing with Scction 7000) M Division 3 oC ihc Busincss and Profcssions Code) w y�� that he is ezempt the�cfmm and the bazis !or the allcgcd exemption. Any violatian at SecGon 7031.5 by airy applicant tor a pertnit subjccu ihe applicant to a civil pan4y of Number Occupancy Type noc more ihan fivc hundred dollars (5500). 3 7 5 3 2 � 5. 3�� ❑ 1, u owncr o[ tlie property, a my cmployces with waga u their sotc compenvtiaa. willdothewvrk.andthesttucturcisnotintendcdoroReredforsalc(Sec. Required Inspections and Professions Codc: The Conuacmr's License Law dors not spp�Y a m awrc� of property who builds or impcoves thereon, and wha does such wark himself or Ihmagh his own employces, providcd that such improvements are noc in�ended or o[fered Ca sale. If. however, the building or impmvement is soid within one year of wmplction, �he owrcr- builder witl have the burden o[ proving tlwt he did nat build or improvc far pu�pnse of salc.). ❑ I, ss owner of the property, am exclusively conuacting wiih licenud rnnuactars w constnxt U�e pcoject (Sec. 7044. Businus and Pro[cssians Code:) The Conuaetors Li- • cenx Law does not apply to an ownu of propeny who builds or improves �heRan. and . who contracls Cor such projects with a conuaaot{s) licensed pursuant to �he Coouaanfs License Law. ❑ I am exempt under Sec. , B& P C far t6is �swn Ownv � Date � c��(j_/ _ .. _. I ^R COMPENSATION DECLARATION � � I hercb un r penalty of perjury one o[ �he following decfazations �] I hsve and 'ntain a Cenifiwte of Conscnt to xlf-insurc (or Warlccr'sCompen- sation, as providc for by Section 3700 of the Labor Code, for �he performance af We work for which this permit is issued. ❑ I havc and will maintain Workcr's CampensaUon Insurance, u required by Scaion , 3700 of �he Labor Cade, for �he performance of the worlc for which �his pecmit is issued. My Worker's Compensarian Insurance carricr and Policy number azc: Carrier. Policy No.: CERTIF7CA7'E OF EXEMP770N FEtOM WORKERS' COMPENSATION 1HSURANCE (Chis scttion necd not bc completed if tYrc pecmit is for onc hundced dollars (510� nr Icss.) 1 cenify that in thc performancc of thc work for which ihis permii is issucd. I sha11 not nmploy any person in any manner so as�o{n� 14c1 p orkcrs' Compes�sation Laws of Cali ia. Datc � �� Applicant NOTICE CA : If, afur making Ihis Ccniticatc of Excmpuon, you s4auld become sub Worker's Compcnsation provisians of the Labor Codc, you must � O foMwith co y such provisions ar this pccmii shall bc dccmcd mvolced. z "" CONSTRUCTION LENDING AGENCY (.~.� r�-� ! hereby affirtn Uut therc is a conswction knding agency far the pertwmana of . p� � thc work for which this pertnit is issued (Scc. 3097. Civ. C.) W� A Lendcr's Namc � z [.cnder's Address (� � 1 certify tha� I havc rcad this application and siatc thai thc abovc inComwtiw is �� cortect. 1 agree to comply with all city and county ordinances and state laws relating a , Q U building conswction, and hercby autAome rcprescntativcs of �his ciry to cnter upnn Ux � W aAovc-mcntioncd properly for inspccuon purposes. a (Wc) agrce to save, indcm�ity and kccp harmless the City o( Cuperuno against �� liabiliuu, judgmcn�s, costs and expenscs which may in any way accruc againsl said City 'n U z in consequence af thc granting of this permi� Date / �/ ►-+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by ' U' SOUR REGULATION Re-roofs � Sign ure pp �canUConuxtor �� T of R oof HAZARDOUS MATERIALS DISCLOSURE }�� . II applicant or futurc building occupan� storc or handlc ha•rscdous marc�ial u �nc b thc Cupertino Municipal Codc. Chap�cr 9.t2. and �hc Hcslth and SaCetr c� s� uo 25532(a)? � All roofs shall be inspected prior to any roofing material being installed. Ycs Will ihc applicant or future building occupan� usc cyuipmcm or dcvioes w6ieh If a roof is installed without first obtaining an inspection, I agree to remove cmit ha•rardous air contaminan�s az dcfincd by the Bay Area Air Quality Mm all new rr aterials for inspecrion. �;s��a ,.,,,,,[/ ❑Ycs �U 1 havc read the ha�ardcws ma�crials rcquircmcn�s undcr Chap�cr 6.95 of iAc Cali[or- nia Hcalth & Safcty Codc, Sections 25505.25533 and 25534. I undcrstand ihu iCihe building Jocs not c rten�ly have a tcnan4 �t it is my responsiAiliry to notil'y �hc occupmt of �he rcyuirc must bc met prior to issuancc oCa Ccnifica�c of Occupanry. S1gi1StUIe Of APpI1C3IlI Date All roof coverings to be Class "B" or better Owncr o a th '�cd agent �,� �. . . CITY OF C'UPERTINO � � �� '��.� �?�� '��. CUPEI�TlN� PERMIT APPL=[CATION FORNI �PN# �� C�.�3� �U Date: �� 6B�C?� Building Address: � c.tq5 Mi vt�}�f E' db- Owner's Name: Phone #: `�p�� W oVl �3 � b --�� --_--- - --- — ---- - --- ------- - - - - - Cantractor: Phone: License #: � �l (3 Cov� S�".�U i� l v ei C�vt �-f - .3 ( t� — I 2� � � S� 5UU Contact: Phone: � Cupertino Business License #: ��,t6 Building Permit Info: i i Elect L� Job Description: T ,�� PO w e V- �,�t� Residential �/ Commercial ❑ Cost of Project: �� Qty. if A licable Fee ID Fee Descri tion Fee Grou BTEMP Tem orary Power ELECTRICAL EPERMITFEE El�,ct. Permit Issuance ELECTRICAL BUSLIC Bi�siness License BUILDING CITY OF CUPERTINO 2 ITEMS OF 2 PERMI7' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN ......... 37`�32053.00 DATE ISSUED.......: 10�08/2007 RECEIPT #.........: BS(i00002929 REFERENCE ID # ...: 07�.00067 SITE ADDRESS .....: 10�.'95 MINETTE DR SUBDIVISION ....... CITY .............. CUI'ERTINO IMPACT AREA ....... OWNER ............. YOPJG B WON ADDRESS ..........: 43_. EL CAMINO REAL #4774 CITY/STATE/ZIP ...: SATdTA CLAR.A, CA 95050 RECEIVED FROM ....: YOTdG S WON CONTRACTOR .......: WOTd, SIJNG NAM LIC # 21242 COMPANY ..........: LTN_:VERSAL CONSTRUCTION ADDRESS ..........: 18f370 BARNHART AVE CITY/STATE/ZIP ...: CU]�ERTINO, CA 95014 TELEPHONE ........: (4()8)252 FEE ID UNIT QUANTITY i1MOUNT 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 ----------------- --------------- -------------------- CREDIT CARD 102.89 VISA --------------- TOTAL RECEIPT : 102.89 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL �. = *, Community Development � 10300 Torre Avenue �� ' � ` Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 �UPEt�TINO Buildi:n De artment jOB ADDRESS: PERMIT # ld�as M� �e� c��- ,� a � � � � � OWNER'S NAME: � e�nc _ v� PHONE #_� � 6- 2t GENERAL CONTRACTOR: FAX # 2� � - ?;�2� I am not using any subcontractors � 1��— �c o$ c� . S �;nature Date Please check a licable subcontractors an c ►lete the followin information: SUBCONTRACTOR BUSIl�fESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing IIectrical 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 c� 0� 0 er/Contractor Signature Date �;