05100076 CITY OF CUPERTINO ' ter
BUILDING DIVISION PERMIT ,CONTRACTOR INk;Q.R,ivIATIAN :`.
BUILDING ADDRESS: COLOA CONSTRUCTION, INC PERMITND.05100076
10735 MARTINWOOD WY
OWNER'S NAME: PERMIT ISSUE DATE
JENG HUNG WEN 1671 CANYON VIEW 10/14/2005
NE:
SANITARY NO. CONTROL NO.
(408) 891-2449
ARCHIIEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u0, LICENSED CONTRACTOR'S DECLARATION JobDescri tion
UC 1 hereby affirm that 1 am licensed under previsions of Chapter 9(commencing P
b
with Section 7001)of Division 3 of On Bill.and Profcssm.Code,and my licensee
„ inrnmmeaneeffea 2�1�3 TEMPORARY POWER POLE
D ? Liecnx Class Lk.N 1
�-p Dau O Contractor (A NI0/vt ' au ��®
ARCHnTCTS DECLARATION 6 =/App!!
I undersunJ my plans shall W used ac,us Puhlic records
OyU
;Qt�, Licensed Pmksslonal
OWNER-BUILDER DECLARATION
iP 1 hereby affirm Nal 1 am esempt from the Contractors Licenm Law for the OCT 2005
0 C following mason.(Sccuf
on 71131.5,Business and Professions Code:Any city or county
s$ which require a permit In construct,ebur,improve,demolish,or repair any structure $300
prior m its issuance.also mquims On applicant for such Permit to file a signed mtement
< that he is licensed punuml m the previsions of Ne Contmcwr's Uccrue law(Chapter 9 Sq.Ft.Floor .� A �I"�p!s Valuation
s�$ (commencing with Section 7000)or Division 3 of de Business and Profesiom Codd)or
e3 at W e common te
lmfmm and Or base for lie alleged exemption.Any violation of
(hFL. 111111 \s
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Occupancy Type
not mom than five hundred dollars($500). P Y YP
❑1,as owner of im pmpeny,m my employers with wage v their sole compensation,
will do the work and theavuctum is not intended or offered portable(Sec.7011,Busier`•
and Profetiav Code:The Cimuna mes License Law does mot apply m an owner of Required Inspections
property who buildsor improve thereon,andwho doessuch work himsebfor through his
own employees,provided that such improvements are not intended reoffered for sale.If.
however,the building or improvement is sold within one yeas of completion.the owner-
builder will have On burden of proving that W did nes Wild or improve for purpose of
sir,I
irJ
❑1,as owner of Ne property,em exclusively contracting with licensed conuaewrs in
convect the PmjecL(Sec.7061,Business and Professions Code:)The Commemrs Li.
cense law does not apply to an owner of Property,who Wilds or improves themon,and.
who contracts for such pmlecu with a eontracsor(s)licensed pursuant in the Contrmsers
License Law.
❑1 ore maempt under Sec. .B&P C for Nis match
Owner Data
WORKER'S COMPENSATION DECLARATION
ION
hanky ism under penalty of perjury ore of the following decimations:
1 have and will maintain aCcnificam of Covent to selLimum for WomcesCanpm- -
ution,as provided for by Section 3700 of the Later Code,for the Performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Li cd Code.for On performance of the work for which this permit is issued.
My Worker's Compensation Insurance artier and Policy number am:
Cartier: 'i�1 G �Poliry No.: (, Hey
l_
CECERTI CATEOF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need Out be complcud if tW Permit isforonc hum reddolla a(SIM)
or less.)
1 cenih Nan in the performma of the work for which Nis Permit is ismed.I shall not
employ any person in my manner an ase bceomc subjecum the Workers Compcesadon
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Cerifmau of Exemption,you should
become subject In the Worker's Compensation provisions of the Law,Code.you must
.J 2, forthwith comply with such provisions or this Permit shall W deemed mmked.
Z O CONSTRUCnON LENDING AGENCY
Ce I hereby aRthi chat them issued(Suctinn lending agency ler the Pcrfurmance of ,
Ce the Ices(tar which Ne permit is issued(Sec.3097,Civ.C.)
W Icndcrs Name
0.
z Lender's Address
U Q 1 Certify that I have mad this application and sue that the mdw information is
U., F mrtcm I agree te comply with all city and county ordinances and sum laws relating to
O U building convection,and hereby authorise repraenusiscs or this city to tour upon the
r� shove-mcnumeepmpenyfor
and cape
purposes;.
(We)agree to save,indemnify and keep harmless the C I nino against
rjj liabilidu,Judgmcnts,costs ane expenses which a ainnsaid City
U? in consegmrec or On granting of�WF LPcrlhL—L
APPLICANT UND TA1f65 AND H. OMPLY WITH ALL NOWPOINT Issued by: Date �'y ti (—
SOURC ATIONS.
)154 b5 Re-roofs
SignatuRt(ApplicanJ�on nlrr r y”au
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant Of future Wilding occupant nom or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Code.ectionn53x(a)a / All roofs shall be inspected prior to any roofing material being installed.
Yea QJ No
Will the aPPReant err future Winding occupant use equipment of devices whichIf a roof is installed without first obtaining an inspection,I agree to remove
emit habamous air comnmimmus as defined by the Bay Area Air Quality Management all new materials for inspection.
Disuicn7
❑Yes ,{rl Nu
I have read the Wrardnuxmaterials quiremeneun u,ra- orkCalifor-
niaFlcalth&SafctYCodc.Sc vwu35505.135J1aW?5 rnanddutifthc Wilding
does not currently has a tenant,yeL I, y�a i ilily te notify the occuPmt of the
requirements which mu LW- en�ri aHs 0...ra Ccnificateof Oce may. Signature of Applicant Date
io r
nm or authorized agent ate All roof coverings to be Class"B"or better
r - Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�JPEkTINO
Building Department
JOB ADDRESS: PERMIT #
Io73�:- /1 OD -) CS-/aoo--? G
OWNER'S NAME: jewc. d ri 6 Gly PHONE # —2
GENERAL CONTRACTOR: FAX # S'-0
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 NA' io `1 al 9F CzmS'. PFT1ZL
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 to
CITY OF CUPERTINO
I� 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36936032.00
DATE ISSUED. . . . . . . : 10/14/2005
RECEIPT #. . . . . . . . . : 31617
REFERENCE ID # . . . : 05100076
SITE ADDRESS . . . . . : 10735 MARTINWOOD WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JENG HUNG WEN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : PROVISION DEVELOPMEN
CONTRACTOR . . . . . . . : PHUNG NGUYEN LIC # 25450
COMPANY . . . . . . . . . . : COLOA CONSTRUCTION, .INC
ADDRESS . . . . . . . . . . : 1671 CANYON VIEW DR.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95132
TELEPHONE . . . . . . . . : (408) 891-2449
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
__________ _____________ __________ __________ __________ __________ __________
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
_________________ ------------ -------------------
CHECK
__-_____--_---_-:CHECK 100.47 2706
TOTAL RECEIPT 100.47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER UFER 304 ROUGH ELECTRICAL
•
CITY OF CUPERTINO
��\' TEMP POWER
• e T
UPEkTINO PERMIT APPLICATION FORM
APN# 3& q 3 / 6 2 Date:
Buildin Address: l0 J
!E '�i35 ,
Owner's Name: Phone #:
6f 6
Contractor: /oo Phone: License #:
Contact: Phone: Cupertino Business License #:
J6 q r� t 06 S-4R C 1
Building Permit Info:
Elect ®•
Job Description:
Residential Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
/ BTEMP Temporary Power ELECTRICAL
( EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC Business License BUILDING