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07030212 77 CITY OF CUPERTINO BUILDING DIVISION PERMIT + � T �G. 0R Z ' .0 PERMIT NO. 11I1�16JWES`REENLEAF DR ATLANTA CONSTRUCTION INC 07030212 j - PERMIT ISSUE DATE OWNER'S NAME: WILLIE LU 342 DAISY DR. 03/22/2007 SANITARY NO. CONTROL NO. !HONE: (408) 205-5520 BUILDING PERMIT INFO ARCHrMCT/ENGINEER: BLDG ELECT PLUMB MECH i c p LICENSED CONTRACTOR'S DECLARATION Job Description U F I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is TEMPORARY POWER POLE y in full force and effect z License Class Lte•f► p Date Contractor ITECTS DECLARATI N i x< 1 understand my plans stall he used as public records �yU U.l- Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the jp 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 u Z} prior to its issuance,also requires the applicant for such permit to file a signed statementValuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $1000 OO0 e.F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or it 3 that he is exempt Utetefrom 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 of32630173 Number Occupancy Type not more than rive hundred dollars(1500). ❑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 "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 sate.). 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 forsuch projects with a contract sl licensed pursuant to the Contractofs License Law. ❑I am exempt under Sec B&P C for this reason Owner Date OR OMPEN ATTO LARATION 1 hereby affirm under penalty of perjury,one of the following declarations: ❑1 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. ❑1 have and will maintain Worker's Compensation Insurance,as 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 carrier and Policy number arc: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one 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 moaner s be t ubj o the rlr ri Compensation Laws of California.Dale Applicant NOTICE TO APPLICANT: f, fter 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— CONSTRUC 71ON LENDING AGENCY (~-h C.) 1 hereby affirm that there is a constroctinn lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name a z LcndersAddress U C) 1 certify that I have read this application and state that the above information is h correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorise representatives of this city to enter upon the U 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 U z in consequence of the grantin is p tit, Date - Z Z- ►'� APPLIA�� CANT UNDERST WfL�COMPLY WITH ALL NON-POINT Issued b'/: SOURCE REG / e Re-roofs sig tort o i tractorate HAZARDOUS MATERIALS SCLOSURE Type of:Zoof Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? �// All roof:.shall be inspected prior to any roofing material being installed. ❑Yes ,1�tvo Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as fined by the Bay Arca Air Quality Management all new 1 naterials for inspection. District? ❑Yes Nu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25 5, 533 and 25534.I understand that if the building does not currently have ate t i my responsibility to notify the occupant of the rcyuiremeurswhichmut issuanceofaCertificateof cupanry Signatur-,of Applicant Date 1 All roof coverings to be Class"B"or better O or authori7Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT' RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 32630173 . 00 DATE ISSUED. . . . . . . : 03/22/2007 RECEIPT #. . . . . BS000000761 REFERENCE ID # . . . : 07030212 SITE ADDRESS . . . . . : 20818 GREENLEAF DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER WILLIE LU ADDRESS 20818 GREENLEAF DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR FRANCIS HO LIC # 24120 COMPANY ATLANTA CONSTRUCTION INC ADDRESS 342 DAISY DR. CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE (408) 205-5520 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 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 100.47 0.00 100.47 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 100.47 DISCOVER --------------- TOTAL RECEIPT 100.47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 103 UFER 304 ROUGH ELECTRICAL CITY OF CUPERTINO Ile TEMP POWER CITY Of CuPtKIINU PERMIT APPLICATION FORM APN# 3 � Date: &7 �p Building Address: Div, Owner's Name Phone#: 83o - 6) Contractor: Phone: 0 _2etS_ License #: A64 / -f 'i,/ . 7 Contact: -Phone: Cupertino Business Lice se A: �21Z Building PermoL nfo: ------- -L r _�,c C) Elect Job Description: Residential /P� Commercial F-1 Cost of Project: Qty. if Applic#e Fee ID Fee Description Fee Group BTEMP Temporary Power ELECTRICAL EPERMITFEE Elect. Permit Issuance ELECTRICAL BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY Of Fax(408)777-3333 CUPEkTINO Buildi n De artment JOB ADDRESS: �S / PERMIT# ,L a,614- OWNER'S AME: � � ( PHONE# - GENERAL CONTRACTOR: . , FAX# I am not using any subcontractors: 62,3 Si;;nature Date Please check applicable subcontractors and complete the following information: 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 _ Z Owne ontractor ature Date