07080160 777777777-7777-77 A
CITX OF CUPERTINO
BUILDING DIVISION PERMIT CANT �Tt��I� ION•;
PERMIT NO.
BUILDING ADDRESS:
20775 SCOFIELD DR CALIFORNIA SKYLIGHTS 07080160
PERMIT ISSUE DATE
OWNERS NAME:
PUK KWUN SIT & YING WONG 2250C PARAGON DR 08/17/2007
SANITARY NO. CONTROL NO.
NE:
(408) 866-6759
BUILDING PERMIT INFO
AR ITECT/ENGINEEk BLDG ELECT PLUMB MECH
zLICENSED CONTRACTOR'S DECLARATION
m p I herebY affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
'vV withSccdon7000)ofDi *on 3oftheBusiness and Professions Code,and mylicense is SKYLIGHT REPAIR MINOR STRUCTURAL - CALIFORNIA
a- in full fdree and effect !� ,
Z Li CI Lic.# SKYLIGHTS RENEWALED BL 08/16/07
p Date contractmr
J A CHITECTS DECLARA 1 .J
i a< I understand my plans shall be used as public records
�aU
aN Licensed Professional
Oy OWNER-BUILDER DECLARATION
1 he affirm that 1 am exempt from the Contractor's License Law for the
3 p o following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
t' N prior m its issuance,also requires the applicant for such permit to file a signed statement Valuation
?r 5 q.Ft.Floor Area
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $3624
(commencing with Section 7000)of Division 3 of the Business and Professions Cede)or
?r3 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 A��*Tt Number Occupancy Type
not more than five hundred dollars($500). 35912003
V U
0 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 oroffered for sale(Sec.7044,Business Required Inspections
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 employees,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.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's 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 Contractor's
License Law.
0 I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
J I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,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,az required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance crier and Policy number are: {
Cartier. O Policy No./ 4 0' 0
'CERTIFICATEOF CEMPTION FRO ORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forane hundred dollars($100)
or less.)
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 Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z •' CONSTRUCTION LENDING AGENCY
F"t 1 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.)
W A Lender's Name
'Lender's Address
Uz
U 0 1 certify that 1 have read this application and state that the above information is
t" correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs and expenses which may in anyway accrue against said City
U Z in consequence of the granting of this permit. Date
►'+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCFAEGULAer!9NS_,01 __ 6
Re-roofs
Si of Ap h t/Contracior Dale Type of R sof
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
Code,Section 25532(a)? All roofs:,hall be inspected prior to any roofing material being installed.
Dyes 0 No
Will the applicant or future building occupant use equipment or devices which
If a roof i:,installed without first obtaining an inspection,I agree to remove
a.it hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection.
District?
0 Yes D No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
r quircmen ich t to issuance of a Certificatc of Occupancy. Signature of Applicant Date
All roof coverings to be Class"B or better
Owntr or authorized agent Date
11 a-,
CITE' OF CIUPERTINO
ITYOPERMIT APPLICATION FORM
CUPEkTINO
PN # Date:
Building Address: Mailing Address (if different from building address):
Owner's Name: Phone#: 3 9 30
4/0e e)/
Contractor: License #:
r, ,a'�, ,r1i s ; '•
Contact: ` Phone: , Cupertino Business License#:
Sce w/n Fax:
Building Permit Info:
Bldg Elect ❑ Pl imb ❑ Mech ❑
Job Description:
Residential IA Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: D O Occupancy Gro :I _-33 �' 2�
Type of Construction: Please check this box if the project is a
second-story addition: ❑
.oject Size: Standard EX Large ❑ Major ❑
Quantity Fee ID F!e Description Fee Group
BAPPLOTHER 01 her Appliances MECHANICAL
BBOILER1 Boilor<= 100,000 Btu MECHANICAL
BBOILER2 Boiler:> 100K to 500K Btu MECHANICAL ti
BBOILER3 Boiler > 500K to 1M Btu MECHANICAL
BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL
BBOILER5 Ba ler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH E otel and Motel BUILDING
BCONSTAXR Cons tax —Resi/Mobile BUILDING
BELEC 1000 Elec. 600V <= l OOOA ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec !__-vcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BE\VESTIGA Investigation fee BUILDING
1 of3
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: CathyS
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN 35c-12003 . 00
DATE ISSUED. . . . . . . : 08/ 17/2007
RECEIPT #. . . . . . . . . . BSH0002406
REFERENCE ID # . . . : 07(180160
SITE ADDRESS . . . . . : 20"75 SCOFIELD DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FUI: KWUN SIT & YING WONG
ADDRESS • : 20'175 SCOFIELD DR
CITY/STATE/ZIP . . . : CU:?ERTINO, CA 95014-2922
RECEIVED FROM . . . . : CA:JIFORNIA SKYLIGHT
CONTRACTOR . . . . . . . : TE:iRY KIYAMA LIC # 26844
COMPANY . . . . . . . . . . : CA,IFORNIA SKYLIGHTS
ADDRESS . 22:) PARAGON DR
CITY/STATE/ZIP . . . : SAV JOSE, CA 95131
TELEPHONE (438) 866-6759
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
_ _
-- -------------
---------- ---------- -
--------- ---
00
BENERGY PERMIT FEE 104.76 50.28 0. 00 50.28 0•
BPERMFEE VALUATION 3, 624. 00 104 .76 0. 00 104 .76 0. 00
BSEISMICRE VALUATION 3, 624. 00 0.50 0. 00 ------0_50 ------0_00
---------- ----------
TOTAL PERMIT 155.54 0. 00 155 .54 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -
CHECK 155 .54 1921
---------------
TOTAL RECEIPT 155 .54
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CITY OF
�;�PE�TINO rtment
Buildin De a
PERMIT #
JOB ADDRESS: '7�� 6 0
PHONE
OWNER'S NAME: v j` `
n FAX #
GENERAL CONTRACTOR: Sc
I am not using any subcontractors: Date
Signature
Please check a licable subcontractors and coni Tete the followin 'r'fB°USINESS LICENSE #
SUBCONTRACTOR BUSINESS NAME
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
------------
Date
Owner/Contractor Signature