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07090108 77777777777 CITY OF CUPERTINO BUILDING DIVISION PERMIT � JE�AGTQ ' � RMATIf)l I. PERMIT NO. BUILDjJI�y9P� ESLOREE AVENUE QSP CONSTRUCTION 07090108 l j / PERMIT ISSUE DATE OWNER'S NAME: HO, FRANK 732 SCOTT BLVD 09/18/2007 SANITARY NO. CONTROL NO. NE: (408) 9,':1-8752 BUILDING PERMIT INFO ARCH1TEC(ENGINEER: BLDG ELECT PLUMB MECH 00Z LICENSED CONTRACTOR'S DECLARATION Job Description U P I hereby affirm that I am licensed under provisions of Chapter 9(commencing ZU with Section 70110)of Division 3 of the Business and Professions Cade,and my license is TEMPORARY POWER POLE o=H in full force and effect. License Class Lic.0 p Date Contractor t.to ARCHITECTS DECLARATION i a a I understand my plans shall be used as public records )WU u y Licensed Professional 0.< OWNER-BUILDER DECLARATION N I hereby affirm that 1 am exempt from the Contractor's License Law for the jn o following reason.(Section 7031.5,Business and Professions Code:Any city or county <1.9 which requires a permit to construct,alter.improve,demolish,or repair any structure prior to its issuance.also requires the applicant for such permit to file a signed statementt q Ft.Floor Area Valuation -?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $500 t=- (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or Q 0 5 9 that he is exempt therefrom and the basis for the alleged exemption.Any violation of � Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3 7 519 01`);17�Number not more than five hundred dollars(5500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work.and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Conrractoes Li- cense Law does not apply to an owner of property who builds or improves thereon.and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. E]I am exempt under.Sec. B&P/C�for this reason Owner /�tw .l a..�� Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manor so as to become subject to the Workers'Compensation Laws of California. tc. `1�{'f`�?� Applicant_E 1l_ 1-FO NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY [�rA I hereby affirm that there is a construction lending agency for the performance of a, the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 24 a z Lender's Address V 1) I certify that I have read this application and state that the above information is IT correct.I agree to comply with all city and county ordinances and state laws relating to rJ U building construction.and hereby authorize representatives or this city to enter upon the about-mcntiuncd property for inspection purposes. nWi (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date D-4 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOURCE REGULAAONS. 4(($la Re-roofs A�� Signature of Applicant/Contractor Date Type of R OOf t HAZARDOUS MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes �(No If a roof is installed without first obtaining an inspection,.I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection. District? C]Yes �No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if rhe building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which gnp be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date 9�1g10- All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 6);7o 9 n/vdo T ✓ P VIOWE CITY OF CUPEkTINO PERMIT APPLICATION FORM CPN# Date: Building Address: g-7 2 5 L:o R)EjE NJE Owner's Name: Phone#: Contractor: Phone: License #: CQ�P CP �t-c4:e') Contact: lc� H-0 Phone: c6� �� 2�0?-C� Cupertino Business Licen #: Building Permit Info: Elect W ICC-4A- Job Description: Residential ❑ Commercial ❑ Cost of Project: �� Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elcct. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING CITY OF ]UPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37519015 .00 DATE ISSUED. . . . . . . : 09/18/2007 RECEIPT #. . . . . . . . . : BS000002672 REFERENCE ID # . . . : 07090108 SITE ADDRESS 18725 LOREE AVENUE SUBDIVISION . . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . OWNER HO, FRANK ADDRESS . . . . . . . . . . : 18725 LOREE AVE CITY/STATE/ZIP . . . : CUFERTINO, CA 95014 RECEIVED FROM . . . . : FRPNK L HO CONTRACTOR TAT NGUYEN LIC # 26740 COMPANY QSF CONSTRUCTION ADDRESS 732 SCOTT BLVD CITY/STATE/ZIP . . . : SAYTTA CLARA, CA 95050 TELEPHONE (4C8) 921-8752 FEE ID UNIT QUANTITY IMOUNT 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 40.79 0. 00 40 .79 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 102 .89 0. 00 102 .89 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER CREDIT CARD 102 .89 VISA --------------- TOTAL RECEIPT 102 . 89 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --- 103 UFER 304 ROUGH ELECTRICAL Community Development 10300 Torre Avenue FV Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEkTINO Buildin De artment JOB ADDRE S: PERMIT # -0 70 c? O �2 eq OWNER'S NAME: PHONE 'Rq GENERAL CONTRACTOR: GLSC CAD Q S�XG'ti tsJ FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and co m fete 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 CA 18(01- Owner/Contractor 8(a17Owner/Contractor Signature Date