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09070197 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10600 JOHANSEN DR CONTRACTOR:S I S CONSTRUCTION INC PERMIT NO:09070197 OWNER'S NAME: KUNLUG HSIANO&CHIEN HUI LIAO 1868 STONE AVE DATE ISSUED:07/29/2009 ER'S PHONE: 4085952484 iAN JOSE,CA 95125 PHONE NO:(408)293-1285 ❑ LICENSED CONTRACTOR'S DECLARATIONf— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. ,317-5 r>.- r ) 7 � MECH RESIDENTIAL COMMERCIAL Contractor CphS�n�lTer .�i� Date 1 hereby affirm that I am licensed under the provisions of Chapter 9 IOB DESCRIPTION:DEMOLITION INTERIOR OF WALLS(PHASE 1); (commencing with Section 7000)of Division 3 of the Business&Professions kDDITIONAL Code and that my license is in full force and effect. HALLS REMOVED(PHASE 2); S I S CONSTRUCTION RENEWD 3US LIC 7/29/9 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 ;q,Ft Floor Area: Valuation:$1200 permit is issued. APPLICANT CERTIFICATION CPN Number:37536013.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-poi t source reg lations per the Cupertino Municipal Code,Section 9.18. y 77 a Signature Date / /\q (/ . Issued by: ate: {d OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: klI roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: nstalled without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, nspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this :iafety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the perfonnance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District 1 will naintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's lealt &Safety ode,Sections 25505,25533,and 25534. 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 ) ora o .zed agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: 1 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating or which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter ,ender's Name upon the above mentioned property for inspection purposes.(We)agree to save i iify and keep harmless the City of Cupertino against liabilities,judgments, ,ender's Address c,_ ,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 ARCHITECT'S DECLARATION 9.18• understand my plans shall be used as public records. Signature Date .icensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIZ RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk . Lot : APN 37536013 . 00 DATE ISSUED. . . . . . . : 07/29/2009 RECEIPT # . . . . . . . . . : BSC00008303 REFERENCE ID # . . . 09C70197 SITE ADDRESS . . . . . : 10E00 JOHANSEN DR SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . OWNER KUYLUG HSIANO & CHIEN HUI LIAO ADDRESS 10E00 JOHANSEN DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SPECIALTY INSURANCE CONTRACTOR . . . . . . . : ALIN FLANAGIN LIC # 24660 COMPANY S ] S CONSTRUCTION INC ADDRESS 18E8 STONE AVE CITY/STATE/ZIP . . . : SAII JOSE, CA 95125 TELEPHONE (4(,8) 293-1285 FEE ID UNIT QUANTITY 1,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 200 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 1, 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1DEMORES SQ FEET 2 , 500 . 00 507 . 00 0 . 00 507 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 508 .50 0 . 00 508 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 508 . 50 #25772 --------------- TOTAL RECEIPT 508 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO QC107 0! t CITY OF CUPERTINO DEMO CUPEi�TfNO PERMIT APPIACATION FORM APN# Date: Buildm* Address: Co c Y C L v-C,• Mailing Address (if different from building addr-Iss): Owner's Name: II'' Phone: / Vft )CON J� S 14%^6 C1 tr 4v t 60 1/�fl' cS S Contractor: Phone : yar a 93 /-Z P5 SX- Giro �'l vGFt ,�rlC, Fax: -x Contractor License #: SG 3 3 7 Cupertino Business License #: Contact: Alec [AAV-t5 y,, Phone: prWf a g Fax: Residential Sq Footage aV U Commercial ❑ Sq Footage J } Job Desction: / 44, �,V-M0 '�lTIrNC ( i n 41 a �XGr T' Valuation: t o0 Qh4Sc 2 r%�A D `Foq 1 ;7C Project Size: Express ❑ Standard ElLa-ge F1 major F-1 g a 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 1SFDWL-DEM 1DEMOPRES Pool Denio Residential B 1SFP00L-DEM- / 1BCBSC Cal Bldg Standards B ALL PERMIT Commis ion Fee TYPES 1BSEISMICRE Seismic Residential B Revised 01/07/09 Community Development ;y^ 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ...MkTINO Building Department JOB ADDRESS: PERMIT # 16000 'D# �a -r et v--* -- O q O -7 61c/ 7 OWNER'S NAME: ftlan JL 3 4 o PHONE # 11if8' SfS o7le GENERAL CONTRACTOR: ,$ �,,,c FAX # IA.Y- I am not using any subcontractors: Signature Date Please check applicable subcontractors and com plete 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 740 Owner/Contractor Signature Date