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06100188CITY OF CUPERILNU BUILDING DIVISION PERMIT BUILDING ADDRESS: 19701 ALDERBROOK WY OWNER'S NAME: CHIH CHIEN LIN )NE: ARCHITECTIENGINEER: i p p LICENSED CONTRACTOR'S DECLARATION U p I hereby affirm that I am licensed under provisions of Chapter 9 (commencing ? z w with Section 70(10) of Division 3 of the Business and Professions Code, and my license is r s in full force and If cL �� 2Z 3 Z Lice - L� # ' d- z - Contractor /u o 9 , c. M 3 t- Date � ARCHITECTS DECLARATION a< I understand my plans shall be used as public records )yU a H Licensed Professional OWNER- BUILDER DECLARATION yr �t I hereby atTirm that I am exempt from the Contractors License Law for the p O following reason. (Section 7031.5, Business and Professions Code: Any city or county 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 statement - ? < that he is licensed pursuant to the provisions of the Contractor's Lit. Law (Chapter 9 t=- (commencing with Section 7000) of Division 3 of the Business and Professions Co' or i that he is exempt therefrom and the basis for the alleged exemption. Any violation a[ Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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 and Professions Code. The Contractor's License Law does 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 far 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 sake.). ❑ I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractor's 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. g & p C for this mason C] I am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLARATION C) Z N r~ W? a� �z U wF 0 L U:2 I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self -insure for Workers Compen- ation, as provided for by Section 3700 of the Labor Code, for the performance of the vork for which this permit is issued. -1 1 have and will maintain Worker's Compensation Insurance, as required by Section 1700 of the Labor Code, for the performance of the work for which this permit is issued. v(y Worker's Compensation Insurance carrier and Policy number are: :arrier: 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 less.) 1 certify that in the performance of the work for which this permit is issued, I shall not employ any pers.on m any manne so as to become subject to the Workers' Compensation Laws of Califgfnia. Date Applicant C NOTICE TO AP CANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives or this city to enter upon the above - mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accmc against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT 7 IR E GULATIONS. 6 , 2-6 .i Signature of Applicant7C —on— tractor Date HAZARDOUS MATERIALS DISCLOSURE 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 Cole, Section 25532(a)7 ❑ Yes Jallo 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 District? ❑Yes 15No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & SafctyCodc, Sections 25505.25533 and 25534.1 understand that if the building does no urrcnlly have a tenant, that it is my responsibility to notify the occupant of the require cis which must be met prior to issuance of a Certificate of Occupancy. . o_ Z_t 1-1;i:1 ( Owner or authorized agent Date IEN LIN PERMIT NO. 06100188 PERMIT ISSUE DATE 10/26/2006 SANITARY NO. CONTROL NO. Job Description INSTALL PROPERTY LINE CLEAN OUT Ft. Floor Area Required Inspections ar -{ i Yy- Issued by: Re -roofs Type of Roof BUILDING PERMIT INFO ELECT PLUMB on $1200 Occupancy Type Date '�l�, All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue a IV Cupertino CA 95014 Telephone (408) 777 -3228 OF Fax (408) 777 -3333 rUPERTINO Buildin De artment JOB ADDRESS: PERMIT # OWNER'S NAME: c k ` � e t PHONE t'ob G b - G (3? GENERAL CONTRACTOR /.) t,,-) 'c- 01 u FAX # ,- 1 Z 2 r I am not using any subcontractors: Signature Date 4-1k,3 fnlln-Wina inf(1T'TT1gtinn- 1 1CdbC Ll LCI.A Q 1A%- 'Avib. .�a.aaia.va «s.,.�.....�., 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 C- 6 V-2 2.3 Roofing Septic Tank Sheet Metal Sheet Rock Tile /0-- Owner/ Contractor Signature Date CITY OF CUPERTINO 2m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # : 2 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36921045.00 DATE ISSUED.......: 10/26/2006 RECEIPT #......... 36575 REFERENCE ID # ...: 06100188 SITE ADDRESS .....: 19701 ALDERBROOK WY SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER CHIH CHIEN LIN ADDRESS .......... CITY /STATE /ZIP ...: RECEIVED FROM ....: MAGIC PLUMBING CONTRACTOR LIC # *OWNER* COMPANY CHIH CHIEN LIN ADDRESS .......... CITY /STATE /ZIP ...: , TELEPHONE ........ FEE ID UNIT QUANTITY AMOUNT PD -TO -DT - - - - -- THIS REC NEW ---- - - - - -- ---- - - BAL - - -- ---- - - - - -- ------- - - - - -- BPSEWER SEWER SYSTEM ---- - - - - -- 1.00 ---- - - - - -- ---- 21.58 0.00 21.58 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 - - - - -- 38.37 ---- - - - - -- ---- - 0.00 - - - -- TOTAL PERMIT ---- - - - - -- ---- 59.95 0.00 59.95 0.00 METHOD OF PAYMENT AMOUNT - - - -- NUMBER --------------- - -- ----------- - - - - -- ------ OTHER - 59.95 VISA TOTAL RECEIPT 59.95 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------- 106 SEWER & WATER - - - - -- -- - - - - 202 -- UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 507 FINAL PLUMBING CITY OF CUPERTINO U-01 001 8� REPIPE /S W E. . /MAIN SERVICE CUPEt�TINO PERMIT APPLICATION FORM APN # Date Building Address: Owner's Name: CL j1 i Ln % n Contractor: Contact: Building Permit Info: Phone: , 0 �T,)L . Bldg ❑ Elect ❑ Plumb Job Description: I `\ t �1; t) F r o (es � �� (� - -- Residential Commercial ❑ Cost of Project:/ 41� c t> - r.� J Qty. if FPP T1Perrintinn Phone #: License #: Cupertino Business License #: Fee Groun f1P�7111JQU1G L N\/ 1L BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gas Piping System Fee PLUMBING PPERMITFEE Plumbing Permit Issuance PLUMBING BPREPIPE Repipe of Fixtures PLUMBING BPFIXTURE Pblg. Fixture PLUMBING BPWSVCS Main Water Service PLUMBING BPSEWER Sewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC Business License BUILDING