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07060132 -777777777777-7 777777777.7.....7..7,7.77777777= CITY OF CUPERTINO BUILDING DIVISION PERMIT +Gt1TR +OR� ER11TION PERMIT NO. BUILDING ADDRESS: 10655 FLORA VISTA AVE PROVISION DEVELOPMENT 07060132 PERMIT ISSUE DATE OWNER'S NAME: MIMI PHAN & JEREMEY LE 510 LAWI:ENCE EXPWY 06/15 2007 SANITARY NO. CONTROL NO. )NE: (408) 265-0991 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH °C Z LICENSED CONTRACTOR'S DECLARATION VI hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description z with Section 7000)of Division 3 of the Business and ProfcssionsyCodc,and m license is TEMP POWER POLE. =y in full force and effenyplans GVYLJ Az L c nsc Cl Lam• p Dalc Contractor �shall CTS DEC TION i a< understand used as public records iaV u y Licensed Professional OWNER-BUILDER DECLARATION 1 hereby alriim that I am exempt from the Contractor's License Law for the :C Oo following reason.(Section 7031.5,Business and Professions Code:Any city or county 7 ,09 which requires a permit to construct,alter,improve,demolish,or repair any structure Z r prior to its issuance,also requires the applicant for such permit to file a signed statement ;;q FtFloor Area Valuation =a that he is licensed pursuant to the pmvisions of the Contractor's License Law(Chapter 9 . $500 (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 A�p*tT Number Occupancy Type not more than five hundred dollars($500). 3 2 6 0 8 0 2 ) . V V ❑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 sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs 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.). ❑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 cont actor(s)licensed pursuant to the Contractor's License Law. F]I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I 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. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work f*numbcr which this permit is issued. My Worke/es.�Coomppe►nsatiyio�nn'�Insurance carrier and PolicyCarrier. F�r,v�Policy No.: RTI TE OF EXEMPTION FRO ' COMPENSATION INSURAN (This section need not be completed if the permit is for one hundred dollars($100) or less.) I cenify 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 Workeri 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Q! the work for which this permit is issued(See.3097,Civ.C.) (L)Q Lender's Name 0 Lenders Address U 0 I certify that I have read this application and state that the above information is (L, 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 above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of upertino against liabilities,judgments,costs and expenses which Tay-in..aay c against said City U Z in consequence of the granting of this pcOnit. Date ►- APPLICANT UNDERSTANDS AN COMPLY WITH ALL NO OINT Issued by: SOURCE REGU TIONS. �, Re-roofs ignatu pplicant/Contractor Dare T of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardo material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes 11 0 Ro \`� If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or futu building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? f ❑Yes I have read the hazardous materials reqquitcmenef'un aplcr 6.95 of the Califor- nia Health&Safety Code,Sections 25505 25533 and25534.I understand that if the building does not currently have.a eert5ni,that it yymy'Fesponsibility to notify the OC panto'thc requiremogts which mutt be m ance of a Certificate cu J Signature of Applicant Date All roof coverings to be Class"B"or better �J D Owner or-authorized agent aut CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32608020.00 DATE ISSUED. . . . . . . : 06/15/2007 RECEIPT #. . . . . . . . . : BS000001666 REFERENCE ID # . . . : 07060132 SITE ADDRESS . . . . . : 10E55 FLORA VISTA AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . • OWNER . . . . . . . . . . . . : MIMI PHAN & JEREMEY LE ADDRESS : 20E;75 DUNBAR DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JEREMY M LE CONTRACTOR . . . . . . . : JOHN HA LIC # 29054 COMPANY . . . . . . . . . . : PROVISION DEVELOPMENT ADDRESS . 511) LAWRENCE EXPWY CITY/STATE/ZIP S4Z 245,0991 94085 TELEPHONE FEE 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 ----- -- -- TOTAL PERMIT 100.47 0. 00 100.47 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ____ --------------- ---------------- CHECK 100.47 #191 --------------- TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION _ -------- - ----------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF C UPERTINO a®r - TEMP POWER CUPEI�TINO PERMIT APPLICATION FORM APN # f ©� Date: Bui din -d ress.-- - v 0 is p Own e 's Name: Phone#: Or` yZl� U LAA -- ------- ----- License #: Contractor: Phone: So o tact: Phone: Cupertino lBusiness License #: otw � (4-99 ,-74t7-a�c( I _ C\ Building Permit Info: po Elect Job Description: Residential Commercial ❑ Cost of Project: i Qty. if Applicable Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING L