05070115 CITY OF CUPERTINO x,"a. ',�a
BUILDING DIVISION PERMIT co Y'TRACTOR INFORM' TI01�,
BUILDING ADDRESS: PAN—ASIA CONSTRUCTION PERMIT No.05070115
OWNER'S NAME: PERMIT ISSUE DATE
CHEAH JOO Wq'I
E; SANITARY NO. CONTROL NO.
(408) 528-0181
ARCHIlEG7/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
OM Zp LICENSED CONTRACTOR'S DECLARATION
rd uk�F 1 hereby affirm that 1 am licensed under pmviaimu of Chapter 9(commencing lob Descriptl'nns
■�J
with Section?000)afDiviaion3of the Business and ProfcuTEMPORARY POWER APP
iomCow.andmylicems,Is FINAL
C®
a� In full force and effect. LICATIO �rl
j n Z License Out Lk.X
n Dow cowwwwr -
Ig- ARCHITECTS DECLARATION
2 I urkenund my plans shall M usedu public retards "� f 2005
3�
a tad Licensed Professional
^y5 OWNER-BUILDER DECLARATION BUILDING
H a 0 1 hereby.(Sero on 11. exempt from 0e Contractor's Co License city
o for the
O� following mason.(SeNon 7(omm B.aper. and Pr.dem n"Code:Any City socounty
which its ira•e.als re emmru0.tlkG Wprow,h permit t nr rtmig any tWmure
tprior hathe slcensed0.ahu requires the applicant o for swhpermrtte snowile a sow statement
that he is it pmwenu0 the of Division
of Nc Conlncbiioncevetww Chapter Sq.Ft.Floor Area Valuation
�S (eomme,exampdtScNen 7000)ofDosis for of tiro Burnasandm.fAny vi Code)or
Nat he k eumpt Nert(rom and the best for the ailcgcd eumption.My Woladon of
Section 7031.5 by any applicant for a permit subjects the applicant te a Nvil Penalty of 3 APR MN&—r Occupancy Type
not mart Nan live hundred dollars(5300).
O I,as owner o(Ne property,or my employee,with wages as their sole comp m atim.
wllldo the work.and NeeWcture is not intended.,ODCred fofale(Sce.7Bad,BuaIKY Required Inspections
and Profession"Code:The umm cters Lian" n ee Law donot apply to an owner of q p
property who builds or improve Hereon,and who doesamh work himulf or Nmugh his
awn employees,provided that such improwmenu arc nmimended oroffumd forsole.If.
however,the building or improvement is sold within om you of completion,He owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
some I.
O L as owner of the property.am exclusively contaaing with Handed anrttters te
construct the project(Se,.7014,Business and Professions Cade:)The Conusemr's Li-
cove Law does not appy to an owwr of property who Wilds orimprowa Hereon,and,
who wMacls for such Projects with a conuutor(s)licensed pursuant to the c.nractors
License Law.
❑lam uemp under Sec ,Bd:PCfor Nis
Owwr vO�
WOR/Kpy MPENSATION DECLARATION
1 hereby NTrm under pmWty of perjury one of Ne following declaruioa:
O 1 have and will maintain aCeNOate o(Coment to self-immoo fm WorkeM1 Comport.
seder.u provided for by Section 3700 of the labor Code,for we performance of the
wart for which this permit is issued.
O 1 haw and will mainum Wotr s Compensation Insurance,a required by Section
37M of the labor Code.far the performance of the work for which this permit is issued.
My Workers Cammn"ation Insurance arra and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CMA sec0on wed not W completed If de permit islmow hundred dollars(SIM)
or lea)
I cer i(y that In the performance of the work for which this permit is issued.l Hall trot
employ any person in my mater an esu become abject to the Workins Compen"Non
lawso(Caii(.m' • -� l� n
Applicant
NOTICE TO APPLICANT:If,afar making this CenfBate of Exemption,you should
become abject an He Worker's Compensation provisions of the labor Code,you most
.,O forthwith comply with such provisions or this permit Hail W demand rtwked.
z ,~� CONSTRUCTION LENDING AGENCY
+
[+ 1hereby•M.Nat inert is•ronsuwtirn lending sgcncy for de Performance of
�i? He wort for which this permit is Wood(Se,.3097,Ch,C.) '
6Wi Q Lender's Nunc
.7. z Lenders Address
U O I certify,HAI 1 low reed this application urd sum Hu the Above information is
W 1, conte,1 agree w amply with all city and county ordinances and sues laws relating to
O U building construction,and hereby authorise reprettnafves of this city te enter open He
W abow-coommeed PmNny for inspection Purposes.
(We)agree to saw.iadcmnify,and kap harmless tie City of Cupertino against
rrAA t(abilides,judgments.cats and expenses which may in sty way secret against soldCity
U Z in coaegeence of the Sterling of this permiL
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date( —eS`
SOURCE REGUU NQ 5. ^ `7 a 14r O�
�J Re-roofs ?mac
Signuurt of ApplignVCDate
RDOUS MATERIALS DISCLOSURE Type of Roof
WIII Ne applicant or(oboe Wilding eampat Halloa
9.1 or handle ety
u deanN by Oe Cupertino Municipal Code.Chapterr9.12.W tbo Fieaith add Safety fety
Cade.Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
Oyer ON.
Will the applicant of future Wilding occupant esu equipment m deal=which If a roof is installed without first obtaining an inspection,I agree to remove
emir huardnu airconumiaru at defiwd by Nc Bay Ara Air Quality Management all new materials for inspection.
District?
OYa ON.
I hew ma0 dre huadws minerals re W iremenu under Chapter 695 0(thc GI for-
niaH.INa SofctyCade,Swd=0505.25533W2S534.1undens "if Ne Wilding
dao ret currently have a tont,that it is my responsibility to ratify the occupant of Ne
requimme, whit bometprmteWuanceofaCeglfya�efOccupany, Signature of Applicant Date
Owner or amhonn t GG�� �C)31SDow All roof coverings to be Class"B"or better
Community Development
10300 Tone Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
OUPEI,TINO
Building De artment-
JOB ADDRESS: PERMIT# O SO?O.14r
2p606
OWNER'S NAME: `Nn ican v a N J k3-Chemo PHONE # 4OR-446 9(z3
GENERAL CONTRACTOR a n A-&4q FAX #
I am not using any subcontractors: T o�
gnature 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
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
I� 1 Of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35916034 .00
DATE ISSUED. . . . . . . : 07/19/2005
RECEIPT #. . . . . . . . . : 30433
REFERENCE ID # . . . : 05070115
SITE ADDRESS . . . . . : 20606 PARADISE DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHEAH JOO W AND YIN B
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2916
RECEIVED FROM . . . . : DOREEN CHEAH
CONTRACTOR . . . . . . . : MICHAEL T TRINH LIC # 25664
COMPANY . . . . . . . . . . : PAN-ASIA CONSTRUCTION
ADDRESS . . . . . . . . . . : 3171 HERITAGE SPRINGS CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95148
TELEPHONE . . . . . . . . : (408)528-0181
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FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
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 4344
TOTAL RECEIPT 100.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
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019D-q-01 15
CITY OF CUPERTINO.
TEMP POWER
T
OF
SCUPERINO PERMIT APPLICATION FORM
APN# 59_ ` ug_ O Date: C
Building Address:
2o6O G PA2Ar_",t SE bR.t v-E , C-U PERT 1,4 6 CA 9 Sp 1
Owner's Name: Phone#:
ti i ry B l Pff,.( P Blo c—tet �4i -G
Contractor: Phone: License#:
PA#�J /A-S 40$ 94t Ottl -791310
Contact: Phone: Cupertino Business License #:
ICHPfEL rzlfJh VSs S9,z 9 T7
Building Permit Info: { ,�, ,, �c� ,
Elect ❑ p6"le.
Job Description:
TeA^po-r powev cLpplkA4i6n
Residential Commercial ❑
Cost of Project: 4 QU
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING
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