08050089 BUILDING DIVISION PERK T CONTRtle'FOR INF'U tNfAT70N
BUI G���"ORFS ' PERMIT NO.
E STATES DR NATIONAL CONSTRUCTION 08050089 ,
OWNER'S NAME: RENTALS PERMIT ISSUE DATE
GARY SHEN 15319 CHATSWORTH ST 05/09/2008
E: (818) 221-605T SANITARY NO. CONTROL NO.
ARCHIEC/ENGINEER: BUILDING PERMIT INFO
BLDG EIEC PLUMB MECH
0 0 0 0
u O a LICENSED CONTRACTOR'S DECLARATION
ZC 1 hmey alntm thouf am li fteomal d munJcr pmvioksh of Cnodd. 9 my tic-nems Job Description
n<n with Basion l0(U)ofOividon3of ds B.M.and Profcuions Codd.sod mylicenteu TEMP POWER POLE
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e ms mail
ARCHITECTS DECLARATION
e 1 undentsnJ my plans Mall ho urttl as public rtmrJa
pyU
g G Idccnsed Pmfesuanm
aC`yi OWNER-BUIIDt frour ORATION
O E 1 masa affirm that I I.S.exempt tram the le mraoara :Any c Law for IW
COC which g orm.(Scum 1Bd I. L 4w.s aranp Puc.&ons Gods:Any city m mourn
$ which re9utins a c.elm b cUnmm0.aWc nnprow,d Pc i,t,m rtpail I any mmu,to
I< priorbits inuedpalso rtquim IWvisions Of far such Permit bfileasiamal w(submcot
that
omnonconsctllutanant blur of Division
of the eBuacbrslJanmsions CaIWr9 Sq.FC Floor Area Valuation
x�$ (ctIts It oompt Section and
Divisionr oflWegedcnam Protrusions vi Codc)or $400
^ Sc ho B 31.5 b therefrom and or basis for the alleged eumpnt to Any it pmaon of
.1 on,d ss five
mty'hod doll for a permit objects IW applicanuo a civil penalty of Number Occupancy Type
not meta dun Rw huMrtd dollen($300). 36924004 : P Y YP
❑Luowrcr of We property,or my wPloyw with Mguulho'v sole canpenudm,
WHIOIWwok,and Weawmomumtimendedmoffee for We(Sm.l .Buuneu
and Psofcmioms Cade onuac The Cn"I.i s,law doer,rot apply b an owner of Required Inspections
pmpeny who builds w imposes tbermn,and who dots ouch work Whosmf or through his
own emplaym,provided that such improwmem tie not inu:nded aroRead for sale.U,
however,dre Wilding ra improwmmt is sold a did ane nem of completion,the ose of
Wilda will haw IW Nudes of Proving than W did ort build or improv for purpose of
tile.).
1.as owner of the property.am vcluslwly contracting with IianuA contractors to
conroupt dm pmjen(Sec.load.Buuneu and Professions Cotler)The Coatroom's Li
cameLaw does oot apply b an owner of property who Wilds or mr,mr.sWarton,mm,
who emuuts for such projects with a conuvoar(s)licensed pmmant to We Conuamors
Lice.law.
❑lam ucmpt undv� Date C for this moon
Owner �� —'0
ORKER'S COMPENSATION DECLARATION
I Waby a1Rm umcr Formby o(peiju y oro of the fallowing decluulonc
,w uW will..low.a Cmifcam ofconsem no self-imare for waters camper
salon,u psovidud for by Sccuon 31M of We labor Code.for the petfomuc of tW
work for which this pcmil is iva d.
❑1 haw and will maintain Workers Campemation Imuran=,as required by Section
3100 of We labor Cade.for We pc,farmenc.of IW work for which dus perma Is 1&00&
My Workers Compensation luorana canna and Policy number are:
Cuda. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This accost rcW Out becanPkud if de prmtit Is foraahunW W dollua(SIM)
or leu)
1 certify that in the nalmonancu of dm work for which this Instant is issued.I shall not
cmPioy any pcnon in my marmrF to hmpmcanM1�^�bt�W,pr�c�SC pemadon
LawsA,pIof Califf Date �'/ U.\ dIT^Op
NCTICn✓ is _
None:If,afuc,makingthis Cinificamsa of La W,Exemption.'mNaos
bamme subject b it Wohero Campeoution provisions me of the labor Code-you most
.J O forthwith comely with such pcoviuons or than permit Nall W domed mmketl.
tZ) CONSMUC ION LENDING AGENCY
[-+ IWrehyErm that Wert isacunsuucMcony agealho y forperformanau(
the
Eli? work fur which flus,flus,permit u Wa.ad(S37091,,Civ.C)
MW Q Landers Nunc
a z lantlers Addmu
U O I amity,that 1 haw rod this application and mu than tW show information u
I, cortccr.l apo b comply with 9161,tial county mJinutaa and tine IoM relaJng to
O Wilding construction.mil Wmby authosire mpommuntives ofthu city to cur upon dm
W show-taenuonmd pmpeny for.speNm puryo¢s
I„ G (WO agree b.saw,indemnify and keep harmless the City of Cupertino against
to I.soiaquaneofth.coband ea pensearon. try In any Myamue against uitl City
U z A APPLICANT
of the RtSTAN of permit. _
APPLICANT UNDE0. NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date - �.� air•
souBCE�e uun s.rg D -�
at-0? 0 Re-roofs
tratua o(AppltanHAZARRDDOUS MATERIALS DISCLOSURE Dab Type of Roof
Will the applicant or forum Wilding occupant more orhanme haurdous numulal
u defined by the Cupertino Municipal Codo,Chapter 9.13.um tW Hulth and Safety
Calc,Section 155334)1
oYm 3 No All roofs shall be inspected prior to any roofing material being installed.
Will IW applicant w future Wilding occupant true equiPmml or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Dtwwha amens all cmumioums u dcOmtl by db Bay Area Air Quality Management all new materials for inspection.
❑YuNo
I haw mad dR huarmus mabriais requirements underCWpor 6.95 of Ne Califon
ria Hu1th&safmy Cale,Seamns 15505.15537 and 15534.1 umcnbnd IWt if dm Wilding
docs nocu ly haws mum,1th�at it is my responsibility b mufy IW occupant of thc
moi ntswM1mmuPW 'p1arbRsumau.faccrtiWab ramppgr Signature of Applicant Date
O�-D7 - O
ow2mml5i autharbnd Cgcnl Date All roof coverings to be Class'n!'or better
CITY OF CUPERTINO
•4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36924004 . 00
DATE ISSUED. . . . .. . : 05/09/2008
RECEIPT # . . . . . . . . . : BS000004722
REFERENCE ID # . . . : 08050089
SITE ADDRESS . . . . . : 898 E ESTATES DR
SUBDIVISION . . . . . . . .
CITY . . . . . . . . . . . ... i CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : GARY SHEN
ADDRESS . . . . . . . . . . : 898 E ESTATES DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4560
RECEIVED FROM . . . . : GANG SHEN
CONTRACTOR . . . . . . . : NATIONAL CONSTRUCTION RENTALS LIC # 22537
COMPANY . . . . . . . . . . : NATIONAL CONSTRUCTION RENTALS
ADDRESS 15319 CHATSWORTH •ST '
CITY/STATE/ZIP . . . : MISSION HILLS, CA 91345
TELEPHONE (818) 221-6057
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- ------- ----- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 400 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1ERT<200 UNITS 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
ITRAVDOC FLAT RATE 1. 00 40 . 79 0 . 00 40 . 79 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 122 . 87 0 . 00 122 . 87 0 . 00
METHOD OF PAYMENT AMOUNT . REFERENCE NUMBER
--------- --------------- --------------------
CHECK 122 . 87 #367
---------------
TOTAL RECEIPT 122 , 87
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------- ------------------- - ----- -----
-----------
402 TEMPORARY POWER
•
- otos Dv�9
CITY OF CUPERTINO
TEMP POWER
CUPERTINO PERMIT APPLICATION FORM
q
APN # 2 6 7 — `Z 4 0 0 . C)�. Date: oo , coo
Building Address: r
FSTIT-S �W. GU,P,RTiA)v CSI 5TO//4.Z
Owner's Name: Phone #:
(�A NF S L-A) "1-3
Con//tractor: Phone #: /_ op-3ra –_67
Lr��
G VQt( &t.( 60 74 E-C64C t0✓l Fax #:
Contact: Phone#:
C7o- C 44- �p3- ddI3
Contractor License #:
Cupertino Business License #:
Job Description:
/ E/'G<,./' QdW ems✓ d'� Lam.
Residential ® Commercial ❑
Valuation (cost of project): O o
Quantity Fee ID Fee Description Fee Group Permit Type
IERT>1K Res. Temp Power>IK E 1REAP14
Amps
IERT<200 Res. Temp Power<200 E
Amps
1 ERT2001 K Res. Temp Power 200-1 K E
Amps
1 EPERMITFE Electric Permit Issuance E
/ 1 ELCPLNCK Electric Plan Check E
/ 1BSEISMICR Seismic Residential B
I TRAVDOC Travel & Documentation B
Fee
CITY OF CUPERTINO
E�- TEMP POWER
OF
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
1BSEISMICO Seismic Commercial B 10EAP14
IECT<200 Connnercial Temp Power E
<200 Amps
IECT>IK Commercial Temp Power E
>1K Amps
IECT2001K Commercial Temp Power E
100-1 K Amps
ITRAVDOC Travel & Documentation B
Fee
1BUSLIC Business License B
e
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS:_ PERMIT # D L�
�Sfgt�� �r. a Qrrf lel o Q O
ONER'S NAME: A N / N
- 5Y-Y5APHOE #
W
GENERAL CONTRACTOR&4—/- e c n/d,�_ FAX #
I am not using any subcontractors:
Signature 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