06030017 F
OFCUPERTINODING DIVISION PERMITENIJE
ADDRESS: NATIONAL CONSTRUCTION REN !f`006030017
2 BRET AVNBRT NAME: PERMrr M(TE DATE
XHDONG, ARTHUR 1355 FILIPE AVE - 03/06/2006
HONE: SANTTARY N0. CONTROL NO.
(818) 221-6057
ARCH=/EI (NEER: BUILDING PERMTr INFO
BIRO ELI= PLUMB MECH
0
u00 LICENSED CONTRACTOR'SDECLARATION Job Descri tion
I hereby M.tbu I.m ieo s vndm P�°+'I�°�+r of Chapter 9(cum
nereiny p
VIN Salm"IOW)a(Diri ion 3 of the Bmneu.nd ftdoom e,Code.and my la:enc Is
rreeode a TEMP POWER POLE �������
i Lemtmaean Clue .a
qq Dae c
Coe or
SW ARCH(TECTS DECLARATION
�a 77 I uMersond my pluu NJI be ivd u public rtcmd+
o lit d PmfeaW uh MAR o9 2006
OWNER-BUILDER DECLARATION
<� 1 hereby Milan that I am aempl fwe the Cmtrctars Iicnsc Vv fn the
00 follmnnj rec (Sawn 70Ll.Buanea+and Pm(cMona Code:My etY n cotmtY
$ which mquba.pener to cmwa:l..lter.MPro e.demoli.b,or mpdr my atrwuR
�^ primmiU iuwec..lw rryWru We+pplirntfar,ahpumitnBk.,ljnetl.,,"mav
wt M H lnenrod Purnunl n the l•°•ir«.,a use Contractor.liens V.(chapter 9 Sq.Ft. Floor Area
e�9 (caommemj w tb Sccano 7000)of DiWrm 3 of the Bulnw and Prefect eu Cudp or
– dor he or essmpt tbeedrorn sad the basis for the.IWjcd pd.My aid.6-a
Section 7031.5 by my.ppliunt for.petmlt.objrw Weit'lkma ora d lPctulty of of Occupancy Type
twt mete than BK bmdred dollars(ML
❑L n avrcr of de Property,a my enoPl%ns vW vajc,u Weir sok canp^uwM1
MB do We we&and t%wtrnrt u Nat tae or altered Inc we(Scc 70 u•Binutm Required Inspections
mud Prof. .Cade:Thmnor
Tine Coa .Llmn ue lav dotot.Pply to an ownv or 9
progenywhobullaaImpataa ti,no andwho mn,uchoohhiraeun War sale W,
owm em'theu.m.,ord Wat,uch ImW°emeatsio not hucof aorient]*lJon.rm sale If.
MwenaWe dm t1be bohepwwnem4m1ecdW of ytt or empkdm,th owe Of
buiWm vW h.K the EUNut or pvrinj wt he ed m rwW m ImpwK In pugoe of
uh).
L u awnv of de Ropm,an eaelo,ely cmtrctin j wiW 1{mtsd eomnttnm to
eenan°t the pan)eet(Sec.7(364.Baainea toil Pmrrultms Code)The Canocmr'a V-
caa,eLa.eonDot "an an owner a Property won WIW,or bnryow Wemmi.me.
who cmtraw for such pojeeu v th.coma=,(,)Ikeued perwant no the CmuactacY
Lice.Law.
❑I.m aeon veer Sec .B h PC fre a"ma+oo
:.=1 I n
WORKP^R. 10N DECLARATION
1 heteby.Mo uMv Pemlly of p iur,one M the followln{decl.ntima,
Fl
IbaK.d wBlmum.ia.CWrom o<Convatoself-ItuwefIXWmteraCmtprn-
smon,m P i<leG fm by Sottm 37DB of de Iaf11.Y Code,fIX the PnfrnlWnl Cr de
vmk foe v2ioh WV pnrnitb.mVn
❑1 NK and will maintain WIXs Cmnpuulon Inwwz,n mgvired by Scnkn
3700 aft labor Cade.for the prfmmaae al the vont for which its Permit V..-n.
MY Water,Compmua i.Wtvmce wrier and Pokey numbs arc
C.rtic. Polley No_
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATIONINSURANCE
obhxctlm aced not becaopkted Ifde permh U forme hueence Bolla ,(5100)
m len)
1 wtify Wu In tee pccfmmuee of We wah fIX which Wis pmmh 4 uan4 1 shall not
vPI'mypnon loan ran as to bdvtx mbjat to the WahetY Cmopenaation
taws ar C.lifo
Applic.at��
NOrICETD A 1liCdlAA(s comm�tknn P c or Of the Labor
on,yo You
tro t
b�wii wbjcn y the worker',Competuadm Pani,"of de labar coder°°mtw
Oz fIXWwiW comply with mch Provi,iavmth,l+etmn,wlhe anmm m°tca
zO CONMUCnON LFNDPlG AGENCY
(.. r Ihoe hich thi ton Wem'u.av,[(Sm3M,Civ.for this C.)
QLntdrfs Name
= z Iawer,Add=
U O 1 eenify that I ha,e Head this wpliemm and sun Wu the.Woo Infmn.dm 4
e�Iqm,wemnpty wild Jl city and cotmty oNlnuvcs"latte laws reatinj to
OU buiMinjmruuuctlon,and betebr.uWwire repm+e^ nivu a this city to coon open We
W .boK Mwerly for In,icetion pmpasa
(We)agree to etc,iwcmnify ud keep ba^oiw the Gly of Cupertino ajaimt
fa'j1 liabilities,Judjmcnmcmu and tap.whkb may W my-Y.mue aimat.ad City
UaZ In mnxyuarc of to jraeliej Of Wu Permit.
ti APPLICANT UND ANDS AND WILL COMPLY WITH ALL NON POIM Issued by: Date
S REG NS _
�__- - Re-roofs
S - m of Appll NAZtR S MATEU
RIs DISCLOSURE Type
✓Type of Roof
Will the appllov or future budding accvpm cm:or bandk bavadaus material
as defloeil by the Cupnloa M.mcip.l Coh,Chaper 9.12.and the Halal and Safety
.Sccdm u53u07
E]Y. % All roofs shall be inspected prior to any roofing material being installed.
°J
Will Ibc.pplkant or future building scup of tae equipment or dM.which If a roof is installed without first obtaining an inspection,I agree to remove
emit bav w air cmumio.m,as dell by tk Bay Am M Quality Mmajcment all new materials for inspection.
Duoint
1 h.K read tie Iua�N�w matenul.mquimnetu uvkr Oupimd.95 order Glifar _
rd.HnIW k SafmYCoh,Salim,235(13.25333 w123534.1 unktvand ala Jtie builWvj ..
due m cmmmlY Me a,ewe dw It u my ncrywulbOhY m mtirY the acc°P+nt of We
requbemew whkb mm x mor prior to iuu of a een;rtne of Oce%,;nm.:Y. Signature of Applicant Date
O.erarthori.dqera Date All roof coverings to be Class "B"or better
i
CITY OF CUPERTINO
I 1 of 1 PERMIT RECEIPT OPERATOR: bethe
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37510029.00
DATE ISSUED. . . . . . . : 03/06/2006
RECEIPT #. . . . . . . . . : 33449
REFERENCE ID 4 . . . : 06030017
SITE ADDRESS . . . . . : 10422 BRET AVENUE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : XHDONG, ARTHUR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ARTHUR DONG
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS . . . . . . . . . . : 1355 FILIPE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (818)221-6057
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BTEMP FLAT RATE 1.00 62 .10 0.00 62.10 0.00 -
EPERMITFEE FLAT RATE 1.00 38 .37 0.00 38.37 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 100.47 0.00 100.47 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ __---_-_-___---__-
OTHER 100.47 VISA
TOTAL RECEIPT 100.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO
TEMP POWER Op.of-7
• CITY-OF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:,
375-/0-0-zq
Building Address:
Io�2z
Owner's Name: �I � �/� _p � Phone #:�"�
Contractor: P ne: License#:
68 0
Contact: Phone: Cupertino Business License #:
2c1 �- �o-si�eo�-�-s S'ew,�. � ��3
Building Permit Info:
Elect ❑
Job Description:
Residential i Commercial ❑
Cost of Project: o
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary'Power ELECTRICAL
/ EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING