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09070195 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10600 JOHANSEN DR CONTRACTOR:S I S CONSTRUCTION INC PERMIT NO:09070195 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 ❑ LI U NSED CONTRACTOR'S DECLARATION 3UILDING PERMIT INFO: BLDG� ELECT PLUMB � License Class ` Lic.# S � � �'- ,�^ ry� MECH RESIDENTIAL COMMERCIAL Contractor SC iolhs�'IMA*y% -_ Date �%/Z9�� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTIOMTEMPORARY POWER OFF MAIN PANEL; S 1 S (commencing with Section 7000)of Division 3 of the Business&Professions -ONSTRUCTION Code and that my license is in full force and effect. 2ENEWED BUSINESS LICENSE 7/29/8-PER JEFF GREEF 1)N 7/29/9 HE REVIEWED LOCATION&FOUND SAFE ENOUGH 1 hereby affirm under penalty of perjury one of the following two declarations: 1 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 Sq,Ft Floor Area: Valuation:$275 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. 1 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 re lations per the Cupertino Municipal Code,Section 9.18. Signature Date Issued by: _ Date: OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: dl roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, i istalled without first obtaining an inspection,I agree to remove all new materials for i ispection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I ignature 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: 1 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 I 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 `afety 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 performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will r raintain 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 ::wneAthorgent:forthwith ealth& fety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I S become subject to the Worker's Compensation provisions of the Labor Code,I must comply with such provisions or this permit shall be deemed revoked. On. ate: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I 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 t)r which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter bender's Name upon the above mentioned property for inspection purposes.(We)agree to save it iffy and keep harmless the City of Cupertino against liabilities,judgments, bender's Address ca 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• 1 understand my plans shall be used as public records. Signature Date_ I icensed Professional CITY OF CUPERTINO 6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk . Lot : APN 37E36013 . 00 DATE ISSUED. . . . . . . : 07/29/2009 RECEIPT #. . . . . . . . . BSC00008301 REFERENCE ID # . • . : 09C70195 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 . . . . : SPFCIALTY INSURANCE CONTRACTOR ALIN FLANAGIN LIC # 24660 COMPANY S ] S CONSTRUCTION INC ADDRESS 18E8 STONE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE (4( 8) 293-1285 FEE ID UNIT QUANTITY 1,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 275 .00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 275 . 00 0 .50 0 . 00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 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 241 . 50 0 .00 241 . 50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 241 .50 #25771 --------------- TOTAL RECEIPT 241. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 402 TEMPORARY POWER CITY OF CUPERTINO oq 0-7 G I cl ,S-' TEMP POWER CUPEkTINO PERMIT APPLICATION FORM APN # Date: Bui/i�, 0Address: 100�ef� �� D Owner's Name: Phone #: r/ vn.�v H r v v 08' 'r9'5 �Y?7 Contractor: Phone #: yam ag3 /a G-S S �C✓ Fax #: L/D V\ 8'0293 /02j' 7 Conry t: Phone #: Contractor License #: $' 3 3 7,57 Cupertino Business License #: G v Job Description: Y--e PY\0 �0 V,,e- Residential Commercial Valuation (cost of project): c� Type of Construction: N/A a7s Quantity Fee ID Fee Descriptic n Fee Group Permit Type IERT>1K Res. Temp Povier>1K E 1REAP14 Amps IERT<200 Res. Temp Poorer<200 E Amps 1 ERT2001 K Res. Temp Power 200-1 K E Amps 1 EPERMITFE Electric Permit Issuance E IELCPLNCK Electric Plan Check E ' 1BCBSC Cal Bldg Standards B ALL PERMIT Commission Foe TYPES 1BSEISMICR Seismic Residential B 1TRAVDOC Travel & Documentation B Fee 43 9J Revised 01/07/09 Community Development 10300 Torre Avenue as ` Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEf�TINO Building Department JOB ADDRESS: PERMIT # /QG D ' A 0 L 1-D? ,v OWNER'S NAME: ,nAAjdhitft PHONE 4W S9 GENERAL CONTRACTO : S FAX # jige .Z f,3 .2S- I am not using any subcontractors: D Signature/9, Date Please check applicable subcontractors and com-Aete 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 �& - 7a4' Owner/Contractor Signature ate