08040083 CITY OF CUPERTINOrmePxk
BUILDING'DIVISION, PERMIT �vt\11�L1CTQRINPORMA 100
a _,� ON POW10M
Bu1L.Qlrc ppogFsJPERMTTNO.
ANICE AVE TBD — TO BE DETERMINED 08040083
OWNER'S NAME: PERMIT 15511E DATE
LEUNG ANASIA S AND BILLY K 04/11/2008
NE: SANITARY NO, CONTROL NO.
ARCHREC tENGINEER: BUILDING PERMR INFO
0 [� PLUMB
(� 0
300 LICENSED CONTRACTORS DECLARATION - Job Description
I hereby afnrm Nu 1 am licensed under previsions of Chapter 9(commencing
ZZS4 with Section 7M)of Division 3 of the Butluust and Professions Code,ud my licam is POOL DEMO
a=or in full force ad effect. f-
jbZ LimmuncWs Lk.M
JJ Dem DECLARATION
ATION
e1 understood my plans still he used u public records
e ud Licensed Pmfessiawl
m OWNER-BUILDER DECLARATION
i�E I history mlRno that I at exempt fmm Its Contractor's License Law for the
C O o following reasun.(Section 703 1.5,Business and Profouiou Code:Any city or county
Ill! which to itims a permit to concoct,alar,Improve.demolish.in repair any structure
14Sr. prior in its issuance.aim inquire[the applicut for such permit m rile a signed summer
that he is licensed pursuant o the pme,visloof the Connector's Ucenm Law(Chapter 9 Sq.Ft.Floor Area Valuation
5O (commencing with Section 7000)ofDivision 3ofthe Business adProfwsiomCode)or $5900
$ thu he It exempt tha from ad Ne baud for the alleged.....pd..My violins.of
Section 7031.5 by my applicumt for a permit subjects tie applkat to a civil penalty EdNumber - Occupancy Type
no
tome dun five hundred dolWs(5500). 35701088 ,
❑I,uowrcs of die propaty,wmy wploym with wagau Nish cele compewtiu, _
will dothework.aide ThatCue 4nmumndeA Law do for as apply to M,Owner of
and Pro sivibe u eude:That ContrsetoM1 License Law doss at apply to sr.owner ser Required Inspections
Own crywW Wiprovid mprovch impr andwW dnenawb wort himself Or Nmugh 6u
ownver,thebuiprog or improvement Neusser Improwmenuue not lordedorolfemd losdrize lf.
however,timebuildingor sofpvin4sat withinarcyeaofcompletion.Neownv-
alldw ME have the budco of Pr.Nng Nu W did tot build ser Improve:(w purpose of
I.at wvner of that Property.an uclusively contracting with licensed contranws m
uuct the project(See.1011,Business all Pro(esmaru Cade)The eormsemfs U.
ceue Law dors ow appy to no owrcr of property who builds or improv Ihmon.and,
who cantrmu for such projects with aconwnor(U licensed ponwnt to Ne Commandoes
Lmensu law.
Q tom esempt un u see. ,B d P C for this mason
Owner t Dau
ORK OMMNSAnON DECLARATION
1W.by afrmunderpemdtyerperjuryaneof Nefollo ngdecbradons
I Mn and will mainuu•CCrtifiamof Consent toself-m am faworker's Comperr-
adan,u provided for by Section 37(10 of do lahw Code.Its Ne perfemnawe of the
wort for which this permit is mood.
Q 1 haft ad will mainum Worker' s Compensation Issuance,u required by Section
3700o(the Labor Codc.for the performance.(Ne work far which this permit is caused. '
My Worker's Compeuation Insurance wrtier end Policy number son:
Carrier. Poliry No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Tis seetim need trot W eomplemd X We permit Is fororc huudreddoll.(SIM)
Or Ws.)
I«nify Nat in Ne performance of Ne wort for which this rmnh is issued,I than na
cmpleyany person in any murcryp becem�ybject u the Worken'Comper ation
Lswaof Califomts Dam 3'J���Op
Applieut �. +/lel
NOTICE TO APPLIC4ffT.If,aftifmakkii this CcAaa,of Exemption.you should
become subject to tic Worter's Compassuion provikow of No Labor Cade.you muss
.7 O forthwith comply with Ruth provisions or Nu permit thall he dammresulted.dresulted.,z.,y CONSTRUCTION LENDING AGENCY
E+ for
whichdutlPeNem issue(Sec.3 .Civ. ..)��ry ter tip ferfmmame al
C> the work Iwo which this permit ts tssrcd(ser.3097,civ.CJ
W 0 Undes Name
le ,
D Z ndeors Address
U Q 1 wstify that 1 haw mad this appilwion and sum this tie above information Is
It, COMCL 1 agree to comply with all city ad county on inmces and auto bora rotating the
-8 buildingconstruction.and herby suthodm repaemnutiv of thin city in Color upon tho
g37 shove-mcndaned pmpeny for inspection purpoms
Ov (We)agree to oft.indemnify ad loop h releu the City of Cupertino against
r/i liabilities judgments,cuss and expenses which may in my wayamm against aid Lily
U Z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH AIY NON-POINT Issued by: Date
SOURCE REGU[ATly�pps.
;l 'W1-C=A� [1"111149% Re-roofs
�Signuum of Appii sum am
AZARD us ALS DIscLosuaeus ALSDIscf.osuge Type of Roof
Will IM applicant ser forum building occupinutem or huntlle haurdaus maprial
u defined by tie Cupertino Municipal Code.chapter 9.11.aud tic Haddo and Safety
code.Section 255324)7
Qyecy,a All roofs shall be inspected prior to any roofing material being Installed,
wtil Ne applicat or fume Wilding axvpat um equipment or dcHma which If a roof is installed without first obtaining an inspection,I agree to remove
t hrVllrw air commiirunu u defined by th<Bay Ara Air Quality Managainnr all new materials forinspection.
motet,
QYu Qq No
I love mad the heuNtus miscriaHmquiemcnu under Chapmr6.95 Elitist Califor.
-Ise Hoalth&SafetyCede,see au 25505.25533 and 2553/.l understood dwlfdm Wilding
does not currently have a rnvmt.Nu It u my rommedbllity to Mfify tip wculum of Ne
requirements ' ism metpdortoissumccohCeniOwloofOc
w�/ fid Signature of Applicant Date
owrcrw Navod,p t sere— All roof coverings to be Class'n"or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35701088. 00
DATE ISSUED. . . . . . . : 04/11/2008
RECEIPT # . . . . . . . . . : BS000004452
REFERENCE ID # . . . : 08040083
SITE ADDRESS . . . . . : 22420 JANICE AVE
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LEUNG ANASIA S AND BILLY K
ADDRESS 22420 JANICE AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2747
RECEIVED FROM . . . . : BILLY LEUNG
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 5, 900. 00 0. 60 0. 00 0 . 60 0. 00
1DEMORES SQ FEET 0. 00 490.00 0. 00 490 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 490.60 0. 00 490 . 60 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 490. 60 MC ._
---------------
TOTAL RECEIPT 490. 60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
704 DEMO
CITY OF CUPERTINO
• DEMO
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
357 — o -— 059) VE) U I Z i/ I A8
Building Address: -{
2242 Ki '2 ve w 1zvk SDS
Mailing Address (if different from buildingAddress):
Owner's Name: Phone:
L cC
Contractor: �. Phone:
�OkS�^ U � l �OvA Fax:
Contractor License #: 90C`177-c-
Cu
pei7zc-
Cu ertino Business License #:
Contact: Phone:(4og) X81- -4,9 `d$
�GL I Vi Fax:�4ok)
Residential Sq Footage 700 Q Commercial ❑ Sq Footage
Job Description:
OoI
Valuation:
Please complete relevant portions of the Green Building Checklist & attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity Fee ID Fee Description Fee Group Permit Type
1DEMORES Demo-Residential B 1SFDWL-DEM
1BSEISMICRE Seismic Residential B
1DEMOCOM Demo-Commercial B ICOMML-DEM
1BSEISMICOM Seismic Commercial B
1BUSLIC Business License B
Community Development
10300 Torre Avenue
'-%W
v Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#UPEkTINO
Building De artment
JOB ADDRESS: �SS: � PERMIT #
cZa JCA 9 n ;,v0
OWNER'S N t 14( PHONE # toL o
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete 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
/Tiles
er Contractor Signature Date