06080232 CITY OF CUPERTINO ytp„t9 ` e ��r•'
BUILDING DIVISION PERMIT &QNTRAGTOINFO�iMATIQN�
*INE "! '?
BuIIDINC ADDRESS: HBDT CONSTRUCTION, INC. P"`"'rf NOD6080232
10873 BARRAN A DR
OWNEWS NAME PFRMrr SUE DATE
KOGACHI WAYNE AND CHEN JI- HI5050 E.L. CAMINO REAL 9105 08/29/2006
NE SANITARY NO. CONTROL NO.
(650) 988-6828
ARCHrtECT/ENGINPFJI: BUILDING PERMIT INFO
BLDG E CT PWMB MECH
Toa LICENSED CONTRACTORS DECLARATION Job Description
�tzC 1 hncby men thu I w liad urtdc,nsprov oraof Chaper 9(c«n hz
W with Secure 70)0)ofDlvlon 3nfOc Bushes+And Rafc{amu Coda,Andmy luencu
in full force udtuff INSTALL TEMPORARY POWER POLE
;n3 Beene Clm L.ic.
F Due Cnntramm
ARCHITECTS DECLARATION
i 1 and rrd my plan.Oban be used u public record,
u
trdr Licrxed Pturessiond
Oj OWNEno OmheOER rnDECLARATION
E I hereby,lien mu 1 am ecu ine Tram lPo Cmiu,mao,c:Any c tyc(or me
-O O wide,
i ewint ma A (section W 0713,Buctter.and Pm(mcum Calc:Any om m Loamy
wnoa rtquirc,, .Allmcnnwucl.aide,nttforsudwmis4«e.Atmywamvre - 678
�I�^ peamiu i,vurLm.dm rryl,irea the,pplkam for such permitm Rk,d¢,cd v,rmal Valuation
C C that he is li¢tecd po.L to the pmvicmu of me Comnctul,Banc La-(Chapla9 Sq.Ft. FIOOr Area
e� (amntmcitl{wth Seclu.7000I of DivLdae 3 of the Bue.and Pmfadow Code)or
On,is u aumpt themft«n and me had,for me Jth{d reemplm Aey HdaJm of
Scdon 70713 by my,ppllaet fu a subjects subjede applicant to a evil Peulty Of Occupancy Type
v«more thea fvm huedtd dolW ISM
J4 1,u owner of de ptaymr.or by®pleyera whb wa{n u their sole coraperuulm,
Rmme.a,k,And the wnmm ,no,Intended moffered f«,alesec.raa,Ban Required Ins eons
IOM Plofeacon,Cade The Contrumh f.l¢_I.A.doth am apply m,n awoer a( pe
pmpmy who huBd,«improve,mmetik IOM Ybo daa wch wert bWadf m through his
wrn nopbym,provided that mcb boptovemenu art not intended aaffeml(Wattle,If.
bwe er,th hoildin{a hnptoKarcOn u mid wunh one year of eampledaa me owher-
builder wiB hawe Oe bmdmt of pmvlo{thea he and rot build m Improve f«porpme of p
sak.1 �� B
Ia(L u Wnef a the poPert/•ane otlmicly cmtmle{vuh Ikenrd cano,clm,m lt�� f�(JJY
cenunemthed pts not ISec.o An, B.rop rty whean Cade)The Conte V
wen VY donsotappymwaYraofproperly wtobad,rnimp,Wn cco and. ,q
who.Lace fm such vmkm,nm,lmtnct«(D llcenad pu,eant m the Cmoctah �Fp'
L a no w.
�f I w eaempt undm See Ae g12-mu moon Y �
r �� �Lure I21D 6 nen
ORICERS COMPFIISATRSN Of Ora fRAT1011 q
I ltemby.fnro]soder Peadtra Perjury mcor the rolloYint^c•+•.,��,.,•. aty
❑1 Nn and vIT mdnuio a Culp^,.of C«nem m,e7f-lasac fa Wartd,Cmnprry
satlmt u provided fm M Saban 7100 of me Iib W Code.fa me pcnfarmx¢of me
Yat fid which this purnl,is r„ud.
1 bum and w l toahuln W«ter,C.,emsattm Idumm,As required by Semon .
lT((YI errme,, Code,for the perfomwe of me Yat f«wb' duct pvmi,uttered
My v ores Compemados Iancnla carrier and Pd'ry nonther art:
Ortim PaO y Na:
CERTIFICATE OF FXEM MON FROM WORKERS
COMPENSATION IZZURANCE -
MIAs'uoh aced not be c«opleed B the pernou is C..ho&cd do0a,s(SIOM
«kat)
I cidfv thea or we pufmmance of OcYtoahhm om f«naawhich this permit u owed I dull,.
ull n«
.Plgwypermnlnmy manrcfpo 'b eject the Wa fC«epumWn
Iowa a Cdtf«oiL Due XX 6
NOTICE TOAP dic,WcT:If,after CoAumatin{rkP CWu ae Of FumurCodYou-y,hood
biome wbjcm m tic WohcM1 Compcoucon ennit al m me tabor Code pea must
.,O fanhYimcamplr with weh prmman«sok prnnit,hdl be dared soaked. '
Z Di CONSTRUCTION LENDING AGENCY
I bnmr drum son there 4.can,IrtNmt lectin{,Retry f«the perf..of
1d > me Ysak r«which sob permd k Lv«d(Srt 7(141,Clv.C.)
W QLergcrs Nix
7z Lcnices Addneet
U0 1 unify that 1 lu,e red Out applkuim ad u.m thou the Oboe Of.tion k
W P c« .Tat=to comply Yeah At dry and ccunty«dlnuia,an,im I lawn retailing
OU buildingcmunceton.a�W.Ind"Wtucroby uy"Iucctcamlivcsof Ussery locmmupnnthe
[2] mo.c mcnucmcd properly for im,ccioa punpocs.
(Nt)apce to sate,indemnify,dkap yl em Ne CITY M CvpA.zagCnt
r0.jl Ilosllltlo,J W{xu,.emu and eapemc,Yhim xY le any very accrue a{ilw,aW Clry
U a7, In ccosNW^co of the{ruWn{of this pamIL
�-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE,AgE � S.
IZIoGRroofs N � n e-
Sipa of A,,Ib.VCanlncmr One
N RDOUSMATERIALS DISCLOSURE Type of Roof
W01 de apdnnt m(utas bwldin{occupant Otero or haadk hnaNws m,miil
as defined by the Cupertino Municipal Code-Chapter 9.11 and the Health and Safmy
4 cadc.S .25532(.)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yn aNa
Will the applkmt a future hWldnt Occupant um cgipoteat W Jcvlmt which If a roof is installed without firs[obtaining an inspection,I agree to remove
chill hau,dow dr cmuaatwnu as defined by the Bay Area Air Quality Manu{cmea all new materials for inspection.
Dw n1
❑Yea (6 No
I here head me haamau matuiaLs period.w,kr Chapter 6.95 a(Oc Callfo. .
m Health&Safety Code,Socuaru 35505.25533 and 25534.1 tndervand On Bmc builmn¢
Jia tintcwrt,Wy ime a vmanL son A v y mspona illy In mtiry the pm,.r the
,aquiremen i met prior ofACmuneacofOcculty. Signature of Applicant Date
77r
oYner mnri'rrd a t Dpe. All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
�� J� Cupertino CA 95014
"` Telephone(408) 777-3228
OF Fax(408)777-3333
`UPEkTINO
Building Department
JOB ADDRESS: ea�� � PER 0 # 2 2
OWNER'S NAME: PHONE # - -
GENERAL CONTRACTOR FAX # - -
Xam not using any subcontractors: g)2-q106
Signature Date
Please check applicable subcontractors and complete the followin 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
sm 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32601011 . 00
DATE ISSUED. . . . . . . : 08/29/2006
RECEIPT # . . . . . . . . . : 35806
REFERENCE ID # . . . 06080232
SITE ADDRESS . . . . . : 10873 BARRANCA DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KOGACHI WAYNE AND CHEN JI-CHI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JI CHI CHEN
CONTRACTOR . . . . . . . : HOGAN CHANG LIC # 25648
COMPANY . . . . . . . . . . : HBDT CONSTRUCTION, INC.
ADDRESS . . . . . . . . . . : 5050 EL CAMINO REAL 4105
CITY/STATE/ZIP . . . : LOS ALTOS, CA 94022
TELEPHONE . . . . . . . . : (650) 988-6828
EE ID UNIT QUANTITY AMOUNT 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 38 . 37 0 . 00 38 . 37 0 . 00
-- ------- ------ - ----- ----
TOTAL PERMIT 100 .47 0 . 00 100 . 47 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - - - - --------- - - ------------ ----- -
OTHER 100 .47 AMEX
TOTAL RECEIPT 100 47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
103 UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO
TEMP POWER
CITY OF
�UPEkTINO PERMIT APPLICATION FORM
APN# 301 ^ 01 1 Date: ah1 LgI O(10
Building Address:
0813 BAYYAKc, Dr . C to,o
Owner's Name: Phone#:
ZICCHEW 40L
Contractor: Phone: License #:
14 -T � — Eos - ffi
Contact: 0 0 Phone: Cupertino Busines License #:
104ho C)�Aw 40 - 123
Sn3 - X863
Building Permit Info:
Elect ®.
Job Description:
Residential & Commercial ❑
Cost of Project:
16, o0
Qty. if
Applicable Fee ID Fee Description Fee Group
BTEMP Temporary Power ELECTRICAL
1 EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING