The URL can be used to link to this page

07080042-Y OF C;UYr ,11fN" BUILDING DIVISION PERMIT INGER RD OWNER'S NAME: RAYMOND & SHUMING CHU ARCHITECT/ENGINEER: I hereby affirm that I am 1'1censcd under provisions of Chapter 9 (commencing vith Section 7000) of Division 3 of the Business and Professions Code, and my license is n full force and effect .icense Class Lic. A )ate Contractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following mason. (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 License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 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 We (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 employers, provided that such improvements are not intended or offered for 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 sale.). 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) The Contractors 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 Contractors License Law. B & P C for reason ❑ I am exempt under Sec a� Owner ' i WORKER'S COlC4ldENSATION D1.ARAnuN I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self -insure for Workees Compen- sation, as provided for by Section 3700 of the Labor Code. for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Scctiam 3700. of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: F0 ;artier.Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE PERMIT NO. LNB CON:'TRUCTION, INC 07080042 PERMIT ISSUE DATE 581 BELI,EVUE SANITARY N . CONTROL NO. (415)58`_-3884 BUILDING PERMIT INFO T11 nr, ELECT PLUMB Job Description INSTALL TEMP. POWER POLE (This section need not be completed if the permit is for one hundred dollars ($100) hr less.) certify that in the performance of the work for which this permit is issued. I shall not :_rnploy any person in any manner me bject to the Workers' Compensation ,.aws of Califmmi te Applicant NOTICE A : If, after ing this CertiG of Exemption, you should become subject to the Worker's Com nation provisions f the Labor Codc you mull forthwith comply with such provision 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. 1 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 in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE kEGULAI]ONS. fY// /D 1 Signature of Applicant/Con r V 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 Cock. Section 25532(a)? ❑ Yes E6. Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Iiay Area Air Quality Management District? `/ ❑Yes o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcal th & Safety Code, Section 25505.25533 and 25534.1 understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of tie require mcn ch must be m t pct or to i of a Certificate of.Qccupancg�� /a Owner or authorized agent V Datc / E q. Ft. Floor Area 3693502( ). E Number Issued b) Re -roofs Valuation $1800 Occupancy Required Inspections Type of Roof 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 rlaterials for inspection. Signatur,; of Applicant Date All roof coverings to be Class "B" or better CITY OF CUPEkT1NO CITY OF C'UPERTINO ``EMP POWER PERMIT APPL][CATION FORM 6 -1 S, cG y Z ,PN # ) � % 5 � U 2 � C� U ELECTRICAL Date: V/6 /0 7 Building Address: 102-1r i n / l L / /C,,/I Y&V Owner's Name:p & Contractor: _M (� C, p Phone: -- Ph � 2- � v --------- License #: Contact: Phone: 41 -309-388(L Cupertino Business License #: 2S'�� Building Permit Info: 0 6 0 0 0 S� Elect Job Description: jnStaj ttmp I Residential Comm rcia ❑ Cost of Project: 4!P' b V v Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL / EPERMITFEE El,,ct. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: CathyS COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36935026.00 DATE ISSUED.......: 08/06/2007 RECEIPT #.......... BSC00002270 REFERENCE ID # ...: 07C80042 SITE ADDRESS .....: 20221 BOLLINGER RD SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: RAYMOND & SHUMING CHU ADDRESS ..........: 20221 BOLLINGER RD CITY/STATE/ZIP ...: CUPERTINO, CA 95014-4434 RECEIVED FROM ....: SHU-MING CHANG CONTRACTOR .......: BALRY LO LIC # 25507 COMPANY ..........: LND CONSTRUCTION, INC ADDRESS ..........: 581. BELLEVUE AVE CITY/STATE/ZIP ...: DAI,Y CITY, CA 94014 TELEPHONE ........: (4.5)585-3884 FEE ID UNIT QUANTITY 2LMOUNT PD -TO -DT THIS REC NEW BAL ----------------- ---------- --TEMP ----------------------- FLAT RATE 1.00 --------------------- 62.10 0.00 62.10 0.00 EPERMITFEE FLAT RATE 1.00 38.370.00 38.37 0.00 -------------------- TOTAL PERMIT --•------------------ 100.47 0.00 100.47 0.00 '> METHOD OF_PAYMENT AMOUNT REFERENCE NUMBER -------------------- CHECK 100.47 1392 TOTAL --------------- RECEIPT 100.47 VOTCE ID DESCRIPTION VOICE ID DESCRIPTION -------- �,103 UFER 304 ROUGH ELECTRICAL