08040180 CITY OF CUPERTINO �^k �u+ys -ynt�`a7L �y� 1 i
BUILDING DIVISION PERMITCQI: QAw 11��iQ yR1V, A"CIC�D �sg. .
BUIL 1 GA gg,,RESS: PERMTTNO.
� 1gt5 BERRY COURT (PARCEL 3) D L D CONSTRUCTION 08040180
OWNER'S NAME: PERMIT ISSUE DATE
Elk HSING KUNG 1447 HAMPTON DR 04/25/2008
rte:
(408) 666-5298 SANITARY NO. CONTROL NO.
ARCHTIEC(ENGINEER: BUILDING PERMIT INFO
BILDOO ELECTO PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION Job Description
U hereby hby anion that I am licensed under provisions of Chapter 9(commencing peon
with Section]01111)afDivision Sof Ne Business and Pmfessiope Code�andmylicanadis TEMPORARY POWER
;U
in full force and effect. /�
: ? Llano I(,us Lk.»v
Da¢ LL/�.n/n°PContractor
ARCHTIECTS DECLARA N
1 otdcnm rad my plans Mall he used As public records
y sad Licensed Pmfcssional
OWNER- fr DECLARATION
0 1 hereby air,.than 1 em saampt eumpl from the Cssion o :A nm Lew for the
LOO following reamn.permit
t 703 1.5,avalwes and rte,Profession Code:Any m or county
which requires a permit to unmown,alter,imprnw,h Permit t ri e pair any ttemure
Zy
prior toits censed e,almarequire the iamns of for such Permit Iofileasigned anatomcm
�$ themehe ncinwit punuanl tothe of Didppe of the Gommcessan Prol Uw(C odc)or Sq.Ft.Floor Area $500 Valuation
(hat he It ane with suction]000)th Division 5 of the aged Business and on.Any fen laden or
�.-
that he 7 31,5 b ihcrefmm and the aper for the alleged exemption.to Any l pbdon of
Section 7W n by any red dant for o permit subjrna the applicant o civil penalty of Number Occupancy e
not mom than Teem hundred dolWa(5.5001 35719079 .' P YTYP
❑I,u owner of the property,or my employees wit urges as theh mle compensation,
will do The work,and tion mauetum is not intended or offered for sale(Sec.7011,Burros
and Profesdom Code:The Contractor's License Law does oro apply to an owner or Required Inspections
property who builds o i mprom dw a on,and who does such work himself or trough his
own empWinces,provided that such improvements pee not intended proffered for We If,
however,the building or impmwment is mid within one yew of completion,the owner.
Wilder will haw the burden of proving that he did not build or improve for purpose of
safe.).
I.As owner of the property,am=mainly conuaning with licensed cenuacmrs to
construct the project(Sec.7044,Business end Professiope Code)The Contractor's U.
case Law dors not apply As an owner of property who builds or impmm thereon,ad,
who contracts for such pmjccs wit a conoammp)licensed pursuant m the CLnu stoes
Litz.Law.
❑I em exempt under See. ,B&PC for this mown
Owner Data
WORKER'S COMPENSATION DECLARATION
01 1 hereby affirm under peaily of perjuryne oof tion following declantiom:
naw mM will mamusin A Cemfsesto of Consent to self-Insum for WarkeYe Compere
adon,As provided for by Section 3700 of the Labor Cade,for the performance of the
work for which this permit is issued.
❑I haw and will mdntsr Workees Compensation Insurance,As required by SAction
3700 of the Labor Code,for the performance of the work for which this Permit is lamed.
My Workers Compenwiom Insurance carrier and Policy number are: f.f_
career,\'*%�i 1-'!. v u.- Policy No.:t �'`� µr i
C Fl TE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhisanctio,need rot hocempleted lithe pconit ISferau hundred dollen(5100)
or IASL)
1 cenify dont In the performance a the work for which this permit ripened,l mall not
employ Anypemon in mymanner.pe to become subject to the Worgenc Cpmpensodm
Laws of Califon,&Data
Applicant
NOTICE TO APPUCANr.If,after making this Certificate of aumMion;you mould
become subject to the Worker's Compepektion provision,of the labor Code.you mean
.J O fpMwith comply with such Presidents or this permit mall he decreed nonsked.Lzt y CONSTRUCTION LENDING AGENCY
(-^ I hereby affirm that more is a construction lending agency for the performance of
Ci the work for which this permit Is issued(Sec.3097,Civ.C.)
W Q Londes'a Nation
z LoAder'sAddma,
U Q 1 comfy that I have trsd this application and wain the tite show information r
LT.P comes.I agree to comply with all city ad county ordinances and mute:ism relating At - -
0U Wildingconstruction.and hereby authodm representation of this city to enter upon the
W
above-Mjuniged property for c pcedpn purposes
�'LL (We)agree m ave,indemnify and keep hanmless the City of Cupertino agmen
,.y rA in conseq,Judgmentsecoatsand espeneesmit. may in Any way actor ysiest said City
C)z A APPLICANT
of the granting of Ws D WILL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z1=G�
SOURCE REGULATIONS. ��/ 0,4,6e
�,6e Re-roofs
Stgneure of Appliwtot
HAZARDOUS
�a�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(Muni Wildinge.Chaptnomoand di Health and
C de.S by the Cupertino Municipal Code.Chapter 9.12.roti the Hcalt and Safely
Code.OY 25532(a)7 0Np All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or future building occupants UW cyuipmcm or devices which P g
I h=nktua air contsminents As defined by the Bay Area Air Quality Management all new materials for inspection.
Ll?
❑Yes �J No
I have read the haampusm gals requnumcros under Chapter 6.95 of the Caffpr.
nia Hralth&Safety Code Sccdas25505.25533md25534.1uMc dteirtc hu khat
does not currently have a terms,tet It r my respoodiality to notify the.,wro t of ese
requnermouwhuchxmeI pno issuance of Cenilkae of aAu7�,, (Ay 6 Signature of Applicant Date
c� s
Owner per authprirc0dcal
�y All roof coverings to be Class'1?"or better
I
• CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: bet he
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35719079. 03
DATE ISSUED. . . . . . . : 04/25/2008
RECEIPT #. . . . . . . . . : BS000004577
REFERENCE ID # . . . : 08040180
SITE ADDRESS . . . . . : 22168 BERRY COURT (PARCEL 3)
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HSING KUNG
ADDRESS . . . . . . . . . . : 22168 BERRY COURT (PARCEL 3)
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : BING YI
CONTRACTOR . . . . . . . : ENDE WU LIC # 23939
COMPANY . . . . . . . . . . : D & D CONSTRUCTION
ADDRESS . . . . . . . . . . : 1447 HAMPTON DR
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087
TELEPHONE . . . . . . . . : (408) 666-5298
• FEE ID UNIT QUANTITY . AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --------— ---------- ---------- ----------
1BSEISMICR VALUATION 500 . 00 0 .50 0.00 0 .50 0 .00
1EPERMITFE FLAT RATE 1 . 00 40 .79 0. 00 40 .79 0 . 00
IERT2001K UNITS 1 .00 61.19 0. 00 61 .19 0 .00
1TRAVDOC FLAT RATE 1 . 00 40 .79 0. 00 40 .79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 143 .27 0. 00 143 .27 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -_------------------
CHECK 143 .27' 111
---------------
TOTAL RECEIPT 143 .27
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
402
--------------------------
402 TEMPORARY POWER
•
CITY OF CUPERTINO
L TEMP POWER
CUPERTINO PERMIT APPLICATION FORM
APN #
357 - 19 -071
Building Address:
o?,?4S Re-rr C� , �� e,Ti�. ` `F (--21711 A1cnz6,,. !4✓e. )
Owner's Name: Phone #:
RIIJL-7 Yl 408- 253-39!'�
Contractor: Phone 8) 66 6•- MYOa
Ede WLA Fax #:
Contact: Phone#:
Contractor License #: 6R7- -7 6 I
Cupertino Business License #:
Job Description:
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No
Residential [ Commercial ❑
Valuation (cost of project):
ry
Quantity Fee ID Fee Description Fee Group Permit Type
1 ERT>1 K Res. Temp Power>I K E 1REAP14
Amps
1 ERT<200 Res. Temp Power<200 E
Amps
IERT2001K Res. Temp Power 200-1K E
Amps
IEPERMITFE Electric Permit Issuance E
1 ELCPLNCK Electric Plan Check E
1BSEISMICR Seismic Residential B
CITY OF CUPERTINO
Cep, TEMP POWER
CUPE�FINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
IBSEISMICO Seismic Commercial B 10EAP14
IECT<200 Commercial Temp Power E
<200 Amps
IECT>1K Commercial Temp Power E
>1K Am s
lECT2001K Commercial Temp Power E
100-1KAm s
1TRAVDOC Travel & Documentation B
Fee
IBUSLIC Business License B
•