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07100223 CITY OF CUPERTINO �+� ' • �t�T BUILE . � DIV:i:ION PERMIT t.�� _ . . .. _ PERMIT NO. BUILD t�r�n��ss�,LORA VISTA AVE WEL;KIN :f.NTERNATIONAL IND 07100223 . PERMIT LSSUE DATE �ER'S NAME: MR XIE 19925ST:� CREEK BLVD 10/31/2007 SANITARY NO. CONTROL NO. PHONE: (408)733-0188 BUILDING PERMIT INFO A RCHI'I'ECTBNGiNEER: � BLDG ELECT PLUMB MECH � 0 � � i p p LICEMSED CONTRACTOR'S DECLARATION JOb DESCI'1pt101] ; V� I hcrcby affirm that I un liccnsed undcr provisions of Chaptcr 9(commcncing ; z� with Section 7IXw) of Division 3 of ihc Business and Protcssions Codc, and my licensc is TEMP P� �TER POLE �� y in full Corec and effect �` y ��? Licensc Class L�. # � c� v ; � r p Datc Conuactor lfni 1fYwG 1�rS0 � ARCHITECI'S DECLARA I N i a a I undcrstand my plans shall Ac uud as public records )yV ' u. y Liccnsed Prufcssional � y � OWNER-BUILDER DECLARA'CION � 1 hcrcby alTirm that 1 am excmpt from ihc Contractofs Liccnsc Law for thc � p o Collowing rouon. (Secdon 7031.5, Busincss and Profcssions Codc: Any cily ar county e°„ ( which rcquires a pcmiit to construc4 altcr, improvc, dcmolixh, or rcpair my strucwrc ? Z y prior to iis issuancc, also rcquires thc applicant Cor such pertnit �o filc a signcd s�atcment ��, Ft. Floor Area Valuation �_ � �ha� hc is liccnscd pursuant to thc provisions of ihc Comractor's Licensc Law (Chaptcr 9 '>q � 1 0 O O u t- �(commcncing wi�h Scction 7000) of Division 3 of ihc Busincss and Profcssinos Codc) or ,, �.. �hat he is exempt Neacfrom and ihe bazis Cor the allegcd exemption. Any violation of Section 703I.5 by arry applicant for a pertnit subjecu the applicant to a civil penalty of 3 2 6 2 8 0 7 a?8� Number Oeeupaney Type not more U�an fivc hundred dollars (5500). ❑ I, ac owner o( the pcoperty. a my cmployces with wages az thc'v sole campensation, wi{l do thc work, and the sttuctuce is not intendcd or oftered for sale (Sec.7Q�4. Bt:siness Required Inspections and Professions Cada The Conuactor's Lianse Law does not apply to an aw�xr of prapeny who builds or improvem thereon, and who dces such work himself or uuong6 his own employccs, providcd �hat such improvemen�t are not intended or oRered for sale. [f. however, the building or improvement is sotd within one year of completion, die owner- builder will have the burden of proving that he did not buiW w improvc [or pwpose of sale.). ❑ I, as awur of the property, am exclusively conuacting with licensed conuactors a conswct the pmject (Sec. 7044. Business and Rofcssions CadeJ The Contrxmrs Li- cense Law docs not apply to an owncr o( propeny who builds or improves �he�eon, and , who convacts tor such projects with a conuactor(s) liansed pursuant m �he Conuactors Liccnse Law. ' am exempt under Sea , B& P C for this mason .ner Date _ . WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one af the follawing declantions: ❑ i hsve and will maintain a Cenificate oC Consem to ulGinsure for Workcts Compen- sation, as provided for 6y Secrion 3700 of �he Labor Code. Cor ihe pedormance o[ the work for which ihis permit is issucd. ❑ I have and will maintain Worker's Compensation Insurance, ac required 6y Sectian . 3700 oC thc Labar Codc, (or thc perfortnance o[ the work for which this pertnit is issued. My Worker's Compensation Insurancc carricr and Poliry number arc: Cartier. �,'�G C t� iM � PaI'�cy No.: CERT1FlCATE F EXEMPI'fON FROM WORKERS' COMPENSATION INSURANCE (This settian nccd not bc completcd i( lhe permit is far onc hundred dollus (S I00) orlcssJ I cenify ihat in thc performancc o[ ihc work fw which �his permit is issucd, l shall not omploy any person in any manncr so as ta bccome subject to the Workcrs' Compcnsa�an Laws o[ Califamia. Datc Applicant NO"I'ICE TO APPLICAM: I!, aftcr making this Ccnifca�c of Ezcmpuon, you shouW bccome subject to �hc Worker's Compcnsaaon provisions of ihc Latwr Codc, you must � z forthwi�h comply wi�h such provisions or this pcanil shall6c dccmcd awokcd. � O CONSTRUCTION LENDING AGENCY H ►�-� ( hcrchy aR'irm U�at thcre is a conswction Icnding agency Ibr �hc performanc� o( - p�., � �hc work for which �his pertnit is issucd (Scc. 3097, Civ. C.) W Q Lendcr's Narnc � z L,cnder's Address U 0 I cenify ihat 1 havc rcad this aPptieation and sta�c ihat �hc abovc infortnauun is w � cortect. 1 agece to comply wi�h all city and county ordinances and state laws relating to � U building conswction, and hcrcby authori�e represcntativcs of ihis city to cntcr upon tAc � a abovc-mcntioncd propcny for inspccuon pur}wses. � (Wc) agree to save, indcmni(y and keep harmless thc City o( Cupcnino agai�s� � �� IiabiliUes, judgmen�s, costs and expenus which may in any way accrue against raid Gty �),"� in conuqucncc oC lhe granling oC lhis permil. Date � �{ //f �'-� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by %� "" � SOURCE REGULATIONS. / �' i� �� 1 1 r�7 Re-roofs � Signaw pplicantl ontrxtor � T e of R oof HAZARDOUS MATERIALS D[SCLOSURE }�P Will ihc applicant or futurc building occupant storc or handlc harardous marcrial fincd by thc Cupertino Municipal Codc. Chap�r 9.12, and thc Hcalth and SaCcty ,�, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Ycs �o . Will the applicant or future building occupant use eyuipment or devices which If a roof i� installed without first obtaining an inspection, I agree to remove cmit harardous air conuminan�s as dcfincd by the Bay Arca Air Quality Mmagcmcm all new rr aterials for inspec;ion. Distric�? QYcs Nu I havc rcad ihc hvardcws matcrials rcquiremcn�s unAcrChaptcr 6.45 of thc Califor- ❑ia Hcalih & Safcry Codc, Secuons 25505, 25533 and?5534.1 uncicrstand �hat if Uic building docs not curten�ly havc a icnan4 �at i� is my responsibility to noril'y thc occupant n( U�e rcyuiremcnts which must 6 ' r �o issuaricc aC a Ccnifica�c of Occup �`'� Signature of Applicant "" Date ,/� -% j`�' � S�'� All roof coverings to be Class B or better Owncr or authori agcnt �� , �' , CITY OF C'UPERTINO �� Z2-�j �G.� -�' �`�I�� r��. �UPFi�Tl�10 FERMIT APPLJ[CATION FORIVI APN # � � l 02- � �� ° � � Date: � ` .�-CD �'�� j :; � C� Building Address: � /a� � � � �' � S �- Owner's Name: Phone #: c� � � �? ---� g� - �� -__6-- . , , � ,. �� -- -- -- - ----- ----- -- -- ----- = E- �— � -T ': Cantractor:we��`� ��m. �"`�"�'l*� Phone: Liceiise #1: '�� , c � l 'e--- `� � �S� - y c? � 6 �'� �'" � ,�. �; Contact: �i- Phone: � Cupertino Business License #: Z b Building Permit Info: Elect ❑ Job Description: E'y�� '> ��:,�-ie � o� Residential Comrnercial ❑ Cost of Project: � `� �� c> Qty. if A plicable Fee ID Fee Description Fee Group BTEMP Tem orary Power ELECTRICAL EPERMITFEE El ;ct. Permit Issuance ELECTRICAL BUSLIC Business License BIJILDING CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 32628079.00 DATE ISSUED.......: 10/31/2007 RECEIPT #.......... BSC00003127 REFERENCE ID # ...: 07100223 SITE ADDRE5S .....: 10950 FLORA VISTA AVE SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... OWNER ............. MR XIE ADDRESS ..........: 10950 FLOR.A VISTA AVE CITY/STATE/ZIP ...: CUF'ERTINO, CA 95014 RECEIVED FROM ....: WE] ZIE CONTRACTOR .......: XIE;, CAIXING LIC # 24081 COMPANY ..........: WEI�KIN INTERNATIONAL IND INC ADDRESS ..........: 19�'25STEVENS CREEK BLVD CITY/STATE/ZIP ...: CUF'ERTINO, CA 95014 TELEPHONE ........: (4(�8)733 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 ----------------- --------------- -------------------- 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 3 ��:. . �� ; ,� Cupertino CA 95014 `^� Telephone (408) 777-3228 ClTY OF Fax (408) 777-3333 CUPEI�TINO Buildin De artment JOB ADDRESS: PERMIT # !o � 0 1 c Y� �'' i' � �� C� � C� v�2- bWNER'S NAME: ;� � �' � ; �� PHONE # � �= �1 � s� G _ GENERAL CONTRACTOR , � i �' , FAX # I am not using any subcontractors: Si;;nature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIrTESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heatin.g Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile , _._ , ... _ - , �� _ _ !"� � l �� . - _ � - , �=- C�wner/Contractor Signature Date