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07050278 CITE'OF CUPERTINO - BUILDING DIVISION PERMIT M Cdr '�?kI�C C1R I)�1TC : PERMIT NO. BUILgi>YG,t11).C),{tES$.AZELBROOK DR NATIONPL CONSTRUCTION 07050278 OWNER'S LNlA7MEl: j� RENTAh PERMIT ISSUE DATE LI-ZEN TING & CHII-LUH CHEN 15319 -CHATSWORTH ST 05/30/2007 )NE: (818) 21-6057 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHrMCT/ENGINEER: BLDG ELECT PLUMB MECH p C LICENSED CONTRACTOR'S DECLARATION Job Description U 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing :Xwith Section 7000)of Division 3 of the Business and Professions Code,and my license is TEMP PCWER FOR BUILDING CONSTRUCTION BLDG PERMIT =y in full force and effect. r Z License Class Lic.# 0 7 0 2 01 C 5 t-wo Dam Contractor ARCHITECTS DECLARATION i a< 1 understand my plans shall be used as public records )aV m t Licensed Professional y OWNER-BUILDER DECLARATION "t 1 hereby affirm that 1 am exempt from the Contractors License Law for the jo following reason.(Section 7031.5,Business and Professions Code:Any city or county Pi which requires a permit to construct,alter,improve,demolish,or repair any structure a Z yy prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation _< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area $390 F (commencing with Section 7000)of Division 3 of the Business and Professions Calc)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 326280-F 2 ti Number Occupancy Type 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 sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors License Law does not apply to an owner of q p 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 safe.). as owner of the property.am exclusively contracting with licensed contractors to nstruct 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 Contractors License Law. ❑I am exempt under Sec. B&P C for this mason Owner �DTl IHtS COMPENS N DEC TIO I hereby affirm under penalty of perjury one of the following declarations: n I have and will maintain a Certificate of Consent to self-insure for Workers 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 for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Chis 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 manner so as to become subject to the Workers'Compensation Laws of Californi Applicant NOTICE 7`09COLItAITME 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 rA CONSTRUCTION LENDING AGENCY [�4 1 hereby affirm that there is a construction lending agency for the performance of (y, the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 2 Lender's Address U 0 I certify that I have read this application and state that the above information is LL►-' 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. a (We)agree to save,indemnify and keep harmless the City of Cupertino against In liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE C�yu ONS. / Re-roofs nat �-' sigure App icant/Con ctor Dam Type Of Roof 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 shall be inspected prior to any roofing material being installed. ❑Yes o Will the applicant or future building occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? Cl YesIo 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 does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which-must be met prior to issuance of a Certificate of Occupan SignaturE of Applicant Date t All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMI" RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: B11:: Lot: APN 32628052 . 00 DATE ISSUED. . . . . . . : 05,'30/2007 RECEIPT #. . . . . . . . . BS0)00001495 REFERENCE ID # . . . : 07050278 SITE ADDRESS . . . . . : 21:-51 HAZELBROOK DR SUBDIVISION CITY CUPERTINO IMPACT AREA . . . . . . OWNER LI -ZEN TING & CHII-LUH CHEN ADDRESS 974 CASCADE DR CITY/STATE/ZIP . . . : SU]INYVALE, CA 94087 RECEIVED FROM . . . . : LI -ZEN TING CONTRACTOR NA`C'IONAL CONSTRUCTION RENTALS LIC # 22537 COMPANY NATIONAL CONSTRUCTION RENTALS ADDRESS 15:319 CHATSWORTH ST CITY/STATE/ZIP . . . : MISSION HILLS, CA 91345 TELEPHONE (8L8) 221-6057 FEE ID UNIT QUANTITY AMOUNTPD-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 ----------------- --------------- -------------------- CHECK 100.47 188 --------------- TOTAL RECEIPT 100 .47 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL 090 - � CITY OF CUPERTINO TEMP POWER CITY OF CUPEkTINO PERMIT APPLICATION FORM APN# Date: - 2-9- ase s- 0 2T? Building Address: Owner's Name. Phone#: G ( )q q Contractor: /�f � r�,,� }� Pl�o5: j-�j��,_�j�Z_ 6�� License#: Contact: Phone: �1 Cupertino Business License#: Building Permit Info: C3tdje�rti,i�' Elect ❑ Job Description: -�- _ poWet- -PoY b4Id4Na, C,� m+yt�te�7A Residential I Commercial F-1o Cost of Project: 0 Qty. if Applicable Fee ID Fee Description Fee Group BTEMP T.-mporary 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 `UPEkTINO Building Department JOB ADDRESS: PERMIT# HOr OWNER'S NAME:r C1j _ , PHONE # -O6 Z 2— GENERAL GENERAL CONTRACTOR: za FAX# I am not using any subcontractors: S' 0/0 Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical �-;�afi� �'G# 6 37 c 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 1—Tile o O Owner/Contractor Signature Date