07060221CITE' OF CUPER111NqJ
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
7408 STANFORD PL
OWNER'S NAME:
ERIC TOM
INE:
ARCHITECTIENGINEER:
10 00 LICENSED CONTRACTOR'S DECLARATION
% VP 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
z co with Section 70(10) of Division 3 of the Business and Professions Code, and my license is
t = w in full force and eftct.
Licen I s Lic. X
c pad Contrutor
t ARCHrrECrS DECLARATI N
.�
1 understand my plans shall be used as public records
,a
Licensed Professional
O a OWNER -BUILDER DECLARATION
a1 hereby affirm that I am exempt from the Contractor's License Law for the
Coo following reason. (Section 7031.5, Business and Professions Code: Any city or county
`< $ which requires a permit w conswct alter, improve, demolish, or repair any structure
U' rn 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
Zi- (commencing with Section 7000) of Division 3 of the Business and Professions Codc) or
.3 that he is exempt therefrom and the basis for the alleged exemption. Any violation of
1.Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
❑ 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 or offered for sale (Sec. 7044, Business
and Professions Code: The Conuactors 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.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Conuutoes Li-
ccnse Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractors) licensed pursuant to the Contractors
License Law.
❑ I am exempt under Sec. B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
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QSP CONSTRUCTION
732 SCOTr
(408)985-8159
PERMIT NO.
07060221
PERMIT ISSUE DATE
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
ELECT PLUMB
Job Description
INSTALL TEMP POWER POLE.
I hereby affirm under penalty of perjury one of the following declarations:
J 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
ation, as provided for by Section 3700 of the Labor Code, for the performance of the
vork for which this permit is issued.
] I have and will maintain Workers Compensation Insurance, as required by Section
1700 of the Labor Code, for the performance of the work for which this permit is issued.
r<y Workers Compensation Insurance carrier and Policy number are:
:arrier. Policy No.:
C RTIFICA E OF EXEMPTION FRO E S'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc 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
forthwith comply with such provisions 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 (See. 3097, Civ. C.)
Lender's Name
Lender's Address
I certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building construction, and hereby authorim representatives of this city to enter upon the
ahove-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
S EGULATIONS.
Signature of Applicant/Con t re
ISCLOSURE
i the applicant o 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)?
❑ Yes leo
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
District?
❑ Yes Nu
I 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
rcgttim=ts which must be met prior to issuance of a Certifpat hof Occup!icyt'
Owner or
Date
q. Ft. Floor Area
3593202E. 1Number
Issued by:
Re -roofs
Valuation
13
Type
Required Inspections
Type of Roof
All roofs ;hall be inspected prior to any roofing material being installed.
If a roof i; installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant
All roof coverings to be Class "B" or better
Date
2 ITEMS OF 2
CITY OF :UPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35932028.00
DATE ISSUED.......: 06/25/2007
RECEIPT #.........: BS000001787
REFERENCE ID # ...: 07060221
SITE ADDRESS 7408 STANFORD PL
SUBDIVISION ......
CITY CUFERTINO
IMPACT AREA ......
OWNER ERIC TOM
ADDRESS ...........
CITY/STATE/ZIP ...: CUFERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM QSF CONSTRUCTION
CONTRACTOR TAIL NGUYEN LIC # 26740
COMPANY QSF CONSTRUCTION
ADDRESS 732 SCOTT BLVD
CITY/STATE/ZIP ...: SAISTA CLARA, CA 95050
TELEPHONE ........: (4C8)985-8159
FEE ID UNIT
QUANTITY FMOUNT
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
----------
0.00
----------
TOTAL PERMIT
----------
100.47
----------
0.00
100.47
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
100.47
---------------
100.47
REFERENCE NUMBER
--------------------
#1990
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --------
103 UFER 304 ROUGH ELECTRICAL
CITY OF
CUPEkTINO
0-;7n6 0,;�eR/
CITY OF C UPERTINO
TEMP SOWER
PERMIT APPLI=CATION FORM
APN # 3
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Date:
Building Address:"� /i —� � r
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Owner's Name:
Phone #: _
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Contractor: Phone:
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License #:
Contact:+ Phone:
Cupertino Business License #:
1, N.0 '
Building Permit it
Elect 19"
Job Description:
Residential ommercial ❑
Cost of Project:,L
Qty. if
r -IPP M
Fee Description
Fee Group
nNYli"uvav -
BTEMP Temporary Power ELECTRICAL
EPERMITFEE Elect. Permit Issuance ELECTRICAL
BUSLIC B zsiness License BUILDING
CITY Of
f-WEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
-741-)x ".i±6
PERMIT #
-+O R'S NAME:
BUSINESS NAME
PHONE 40� oig
GENERAL CONTRACTOR:
FAX 9) Z
I am not using any subcontractors:
t;naitrc--- Date
Please check a licable subcontractors and complete the following information:
Owner =trac�torSi�gna�t�u�re
Da e
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 =trac�torSi�gna�t�u�re
Da e