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11050138CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10211 ALHAMBRA AVE LOT 2 I BUILDERS & R: IALIFORNIA HOME I PERMIT NO: 11050138 I OWNER'S NAME: GEORGE TUNG 1775 JUNCTION AVE DATE ISSUED: 05 /17/2011 :,R'S PHONE: 4087027581 I SAN JOSE, CA 95112 ( PHONE NO: (408) 392 -8200 I ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # ` �C, k Contractor ��° r� Date ���r =Tr I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self - insure for Worker's Compensation, 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 provifN for Section 3700 of the Labor Code, for the performance of the work for h h is permit is issued. APPLICANT CERTIFICATION 1 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 of 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 accrue st id City in consequence of the granting of this permit. Additio the licant understands and will comply with all non -point s77 1/ 1 ations p he Cup Lino Municipal Code, Section 9.18. I Signature Date L_ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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 & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self - insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save :nify and keep harmless the City of Cupertino against liabilities, judgments, and expenses which may accrue against said City in consequence of the g. —wing of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date BUILDING PERMIT INFO: BLDG ELECT 1— PLUMB MECH r RESIDENTIAL r COMMERCIAL JOB DESCRIPTION: TEMP POWER Sq. Ft Floor Area: I Valuation: $300 APN Number: 32623043.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS yW, LAST CALLYD INSPECTION. Issued by: RE- ROOFS: 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 "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use d'i'ment or devices which emit hazardous air contaminants as defin y th Bay Area Air Quality Management District I will maintain complia with t C lino Municipal Code, Chapter 9.12 and the Health &Safe ode, Se s2 5, 25533, and 25534. Owner op4ut _ rrzed : Dater CONSTRUt CTION LENDING AGENCY ,106reby affirm th,4Aere is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional i1 5 ITEMS OF 5 il CITY Ob CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32623043.00 DATE ISSUED.......: 05/17/2011 RECEIPT #.........: BS000013473 REFERENCE ID # ...: 11050138 SITE ADDRESS .....: 10211 ALHAMBRA AVE LOT 2 SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER GEORGE TUNG ADDRESS 10215 ALHAMBRA AVE CITY /STATE /ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY /STATE /ZIP TELEPHONE .... OPERATOR: patg COPY ## : 1 CALIFORNIA HOME BUL SIMON KREK LIC # 31282 CALIFORNIA HOME BUILDERS & DES 1775 JUNCTION AVE SAN JOSE, CA 95112 (408) 392 -8200 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC - - - - -- NEW BAL ---- - - - - -- ---- - - - - -- 1BCBSC ------- - - - - -- VALUATION ---- - - - - -- 300.00 ---- - - - - -- 1.00 ---- - - - - -- 0.00 ---- 1.00 0.00 1BSEISMICR VALUATION 300.00 0.50 0.00 0.50 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0.00 1ERT <200 UNITS 1.00 42.00 0.00 42.00 0.00 1TRAVDOC FLAT RATE 1.00 42.00 0.00 42.00 - - -- 0.00 ---- - - - - -- TOTAL PERMIT ---- - - - - -- 127.50 ---- - - - - -- 0.00 ---- - - 127.50 0.00 METHOD OF PAYMENT --------------- -- CHECK TOTAL RECEIPT AMOUNT --------------- 127.50 --------------- 127.50 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- 402 TEMPORARY POWER F REFERENCE NUMBER --------------- - - - -- #4099 VOICE ID DESCRIPTION -- - - - - -- ---------------------- - - - - -- CUPERTINO GENERAL PERiVIIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 950'4 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building acupertino.or4 MEP MISC PLUMBING ❑ MECHANICAL ELECTRICAL MISCELLANEOUS ( 3 S PROJECT ADDRESS OWNER NAME �v`J\ ©(�.2�^�— G E-MAIL STREET ADDRESS ` l 1 f \ M CITY Em n In FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUILOER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME :::�--' r,,, , ,_,, LICENSE NUMBER © 7 I j �' , O tJ LICENSE TYPE BUS. LIC H COMPANY NAME ( E -MAIL S, o(- n FAX STREET ADDRESS ` CITY, SPATE, ZIP PHONE ARCHITEC rIENGINEER NAME LICENSE NUMBER BUS. LIC It COMPANY NAME E -MAIL FAX STREET ADDRESS !� CITY, STATE, ZIP PHONE 'SE OF SFD or Duplex ❑ Multi - Family aTRUCTURE: C] Commercial PROJECT IN WILDLAND URBAN INTERFACE AREA ❑ Yes ❑ No PROJECT IN FLOOD ZONE 11 Yes C1 NO DESCRIPTION OF WORK _ , e TffAtL VALUATION: r C� By my signature below, I certify to each of the followi application and the information I have provided i ordinances and state laws relating to buildin Signature of Applicant(Agent: am the property o nze ent to act on the property owner's behalf. I have read this I have re scription o and verify it is accurate. I agree to comply with all applicable local on. 1 auth rese s of Cupertino to enter the aboveyt�??ntif d property f i pection purposes. Date: / SUPPLE N 0 ON REQUIRED 1 A EPMracApp_201 Ldoc revised 03116111