06040053z
CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
SACK CHANG CONSTRUCTION
PERMIT NO. 06040053
1037AITV
OWNER'S NAME:
PERMIT ISSUE DATE
CHUAN MIN CHANG
10220 STERLJIIG—BLUD
4,111,1900C,
LONE:
SANITARY NO. CONTROL NO.
(408)517-8878
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
1 Wmby a(tirm that 1 am licensed under provisions of Chapter 9 (mmmerci
u
with Section TOM) of Division 3 of the Business and Profcuiou Calc, and my license Is
Job DO
in fell force andettecL
TEMPORARY POWER USING
License Class Lk. N
Due Contractor
ARCHITECTS DECLARATION
I W used as merit
_
JUN -
understood my plans shall public
2006
Licensed Professional
OWNER -BUILDER DECLARATION
I WrtM1Y aRnn that 1 em ucmpt from dto ConuxseYa License Law for the
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following reason. (Section 1031.5, Business and professions, Code: Any city or county
which requires a permit he construct eller, improve, demolish, or mpoir any structure
0 0
prior to its issuance, also requires the applicant forsoch permit to file asignd suiement
Conuacmr'sLianuLaw 9
Sq. Ft. Floor Area
Valuation
licensed pursuant mNeprovisinmofthe (Chapter
(commencing with Section )(Ylfl) of Division 3 of NC Business and Pmfeuioru Coda) or
Nal W u exmnpt nAmefrom and the basis for the alleged exemption. Any violation of
F
Occupancy Type
Section 7031.5 by arty appli..t for a permit subjects Nc applicant to a civil penalty of
not moo Nan five hundred dollars (5500).
I, as ownm of ilia property. or my employees with wages u their sole compensation,
Required Inspections
will on the work and thea.,. is oro mended or offered for rale (Sec. TON, Busi�•<.
and Psefeaslons Code: The Committees Lianas Taw does Mt apply Nan ..set
propeny who Wilds orimproves thereon, andwho doessuch work himselfor through his
own employnra, provided Nat such improvements art not intended woffertd for rale. If.
however, the building or improvement is sold within ane year of completion, Ne owner -
builder will have the burden of proving Nat W did not build or improve for purpose of
sale.).
tZI, as owner a(,he nopcny. am exclusively conuxting with licensed mnmomrs to
construct the project (Sec. 7044, Business and Professions Code:) The Conrantor Lt.
Cense Law does not apply In an owner of prupeny who Wilds or improves Neeson, and.
who contracts for such projects with a conuacbrts) licensed pursuant to We Contractor
License Taw.
❑lam exempt mSee .B k PC for Nu n
Owner ase
I &M O f 0 RATION
I hereby a M. uder penalty a( perjury an. the fallowing declarations:
❑ I haveadwillmainuinaCe,ift, Caas oxlf-imurtforwmaCescompen-
.non, u provided for by Section 3700 Caf Ne r Code, for the performance of Ne
work for which this permit u issued.
❑ 1 have ad will maintain Worker Compensation Insurance, as myuimd by Section
3700 of Ne labor Cods, for the performance of Ne wvh for which this permit u issued
'
My Workers Compensation Insurance Cartier and Policy number are
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORXERS'
COMPENSATION INSURANCE
(Thu section need not W completed if the permit B foranc hundred dollars (5100)
Carless.)
I cenify N4'c
enee of Nc work fa{ which Nis permit u ivued,l shall noteupuyan
c b cInasubjecthWarkenCompemaBmLaverofCApplicantNOTICE:
I , a cr a d g ts enifie a of empion, you should
Wcome no,-, to the Worker C. -soon provisions pf Labor Cotla you must
Nis permit sh dmmcd rooked.
CONSTRUCION LENDING AGENCY
kmby affirm that Nem u a Construction leading agency for tine performance of
the work for which this permit is issued (See. 3097, Civ, C.)
Lcmicls Name
I<ndsYa Add.
1 eenify that I have read this application and sone that dr above information u
'
I agree to comply with all city and county ordinances and ser¢ laws miming to
building convection, and hereby authorim representatives of this city to enter upon the
alcove-mentiuncd propertr for inspcdOn purlases
(We) agree to titre, indemnify and keep hannlcu the City of Cupcninp against
liabilides,judgmcns, costo end expcmes which may in any way acme against said Ctry
in uence of the granting of s peornit.
APPLICA UNDERSTANDS AnND WILL MPLY WITH ALL NON -POINT
Issued by: Date z/—I l %a
SOU GULATIONS.
Re -roofs
Type of Roof
4V27�� ��
Sign u a Applican motor - - Dam
HAZARDOUS MATERIALS i LOSURE
Will No applicanror (mum Wilding amp• oto m handle hmardous motorial
u dsrned by the Cupertino Munkiryl Code. Ch f 9.11, and the HCaIth and Safely
Code, Section 15531(a)?
❑Yes E(Nu
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection, I agree to
Will the applicant or future building occupant sex equipment or device which
P gr remove
emit herardnus air conuminms u defined by the Bay Area Air Quality Management
all new materials for inspection.
District'
❑Yes t]1+u
1 have red me hanrdasmacerials rtyuircmentsunder Chapter6.95oft a Califon-
/
nu Hcsw k saftltrcodca Smdms 25505. Nnif the Wilding
Joon not c only have a tenant. Nat h is my mspomihility m notify dm occupant of Nc
my ous,a115SMty to un ify t
m n whlchmuuWmeIOur toissuance CcrdrC.wofCeeopancy.
Signature of Applicant Date
All roof coverings to be Class "B" or better
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•em 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37514027.00
DATE ISSUED.......: 04/11/2006
RECEIPT #.........: 33927
REFERENCE ID # ...: 06040053
SITE ADDRESS .....: 10370 STERN AVE
SUBDIVISION ......:
CITY .............: CUPERTINO
IMPACT AREA ......:
OWNER ............:
ADDRESS ..........:
CITY/STATE/ZIP ...
CHUAN MIN CHANG
CUPERTINO, CA 95014
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: JACK CHANG
CONTRACTOR .......: CHUAN-MIN CHANG LIC # 27816
COMPANY ..........: JACK CHANG CONSTRUCTION
ADDRESS ..........: 10220 STERLING BLVD
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
TELEPHONE ........: (408)517-8878
•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
----------------- ------------ ------------------
CHECK 100.47 1072
TOTAL RECEIPT 100.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
N
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
PERMIT #
OWNER'S NAME: _
PHONE # .S -1-,q go I
GENERAL CONTRACTOR: CAAur - pxju
FAX #
I am not using any subcontractors:
11
Signature
Please check applicable subcontractors and complete the following information:
0 _
Owner/Contractor i afire
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
E
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
0 _
Owner/Contractor i afire
Date
C
CITY OF
CUPERTINO
CITY OF CUPERTINO
.E117P POWER
PERMIT APPLICATION FORM
APN #31 5 _ 14-071
Date:
—D
Building Address:
I Q\)e-
Owner's Name:
Pho e #:
License #:
Contracto Phone:
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LA rA KN_
Contact:
Phone:
Cupertino Business License #:
Buik4ng Permit Info-tt e•
d lY
Elect ®
Job Description:
Residential
Commercial ❑
Cost of Project:
•
0
Qty. if
Applicabje Fee ID
Fee Description
Fee Gronn
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING