The URL can be used to link to this page

03120028+lop rn�kG° 3 off' 3 co FZFt �59 00 r C V W? 0.� VC OF r. V U2F CITY OF CUPERTINO CON'TR °AC�I'O.I2INF®T2MATION BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 03120028 BR'S NAME: PERMIT ISSUE DATE PHONE: SANITARY OL Nit. ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description p 1 hamby affrm that I am IIaGCd under provWam.f Chapter 9 (commencing with Secuan 700) of DMdOa 5 ofthe B.A. and prefeatons Cade. end my Ikertse is License Class �`rCL7' Licit ELECTRICAL UPGRADE /REMODEL - Date Connector ARCHtIEcrS DECLARATION ,( I und.nund my photo shall W umd as public ¢cards Licensed Perfeuional OWNER - BUILDER DECLARATION ' 'j ZI I hcrehy AEm Nn i am exempt from the Contractors License Law for the following mount. (Section 70513. Business and Professions Cade: Any city or count which raquoss a permit it construct alter, impmw. demo) W, m mpur any uruemnhs prior te iLL issuuae. ilsu requires tie applicant for such permit to file • signed ststemanl FI r ea Valuati thafha is licensed punuantmthe proviaionsaftheCmuecorg LImnm law (CMpar9 .Ft. IL (commencing with Section 7000) of Division 3 of the Businessand Professions Code) or d that he so exempt therefrom and the basis far the 91,1c al exempdan. MY violation of 3 '-dWy_tftT*er0 0 '- Occupancy Type Section 7W 1.5 by my applicant for a permit subjects die applicant to a civil Penalty Of nun mom Nan five hundred dollars (M). ❑ I,anWrtefaf Nepsoputy, mmyemploymwith "rAuthehmkanmpenadon, Required Inspections will do the work,and themuctumis notlnu ded orolfer.d Intel. (See 70th, Business and Professions Code: The Conumteh License law dnea Out apply to an owner of property who bus Ids or im proves thereon. and who does each work himself or through his awn employees, provided thatauch improwmmts an notianded ma @red for sale. If. however, the building or lmpmwmmt is sold within arc year ofcompletion, the owner - builder will haw the burden of proving first M did Imp Wild Or improve for purpose of 4LL1C,). u 1, as owner of out property, am Gclusiwly contracting with licensed conumors to construct the project (Sec. 7044, Business and Pmfessiav Cade) The communities u. cense law data nap apply in an owner of property who builds or tmprows thereon. and, who contracts for such projects with a comacor(G licensed punuanua the Conuano'. License Law. - ❑lsorm, p dale. 118,PCfardid..n D.e 2 v `ORKER'S t rL�RTION COMPENSATION i hereby arum under penally of perjury arc of the following declarmoru: ❑ 1 haw and Will rnmoudn a Ceniftcaa of Caluen11. acif-imm- for WarkeraCwnpcn- smon, as pmA&d1 for by Section 57M of the labor Code, for the perfarmarce Of the work for which this permit is issued. ❑ 1 hew and will maintain Workers Compensation Insurance, ss inquired by Section 57M alum labor Coda. for the performuae of dm work for which this permit is issued. My Worker. Cmal casNon Insurance carrier and Policy number are: C.mer. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (TbIs section need not W completed if the Permit is fm one hundred Milan ($100) . fir toss ) I eerily dal In the performance of the work for which this Permit is issued, l shall not employ any Wroon In my manner At as th become subject to dM Wafkeri GompeNadon Laws of California. Dee Apphicanl NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject in the Workers Compensation provisions of the labor Code, you must forthwith comply with such proMsinns or this permit shell be doomed! mwktd. CONSTRUCTION LENDING AGENCY I hereby affirm that them is a construction lending agency for sin: matur,ance or the work far which this permit is issued ISec. 5097, Ch,. C.) Lenders Nurse Lending Address 1 «mfy that I haw mad Nis application and SWC u u the show Information Is CO=L I agree to comply with all city and county ordinances and .tae taws mauling W building conmuucton, and hereby ori2 mpmsenutiws of NU city te enter upon Nc ahavc nspect purposes. for lm i reify an (We) agree to aw, indemnify and keep harmless the City of (W )agree to aw, n iIlabllldG.jYdgmCa,COSLL p n and which may la my Way BCCa against s aid City in consequence of the gaming of this pemlit. 1 APPL ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Dale o/ SOU -REGULATIONS. Re -roofs Type of Roof V Sn of ApplicanUContractar Dae HAZARDOUS MATERIA ISCLOSURE OF Will the applicant or future Wilding occupantstote or handle hasardoa maarial defined by the Cupenim Municipal Cade. Chapter 9.11, and the Health and Safety M, Section 255324)? da NU All roofs shall he inspected prior to any roofing material being installed. ❑Yes If a roof is installed without first obtaining an inspection, I agree to remove V.1311 the applicant or future Wilding occupxnl use equipment or devices which coif haloes air cenuminsn s at Maned by the Bay Ana Air Quality Management all new materials for inspection. District? �/ ❑Yc. tg No I hove mui the hmandoes materials mquimm.ms under Chapter 6.95 of the Califos- niaHealth k Safety Code, Sattimu 25505.25553 and 25534.1 undemand that ifthe Wilding data rot currently nano that i1 a my hoperannity, o rosily the occupmt Of the myviremenu hie melpdarwWUmccoraCeltincateofOCCUpmcy .1L E Signature of Applicant Date J ri All roof coverings to be Class "B" or better Owner or tha6' D ItZsm 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Elk: Lot: APN ........: 32623024.00 DATE ISSUED.......: 12/05/2003 RECEIPT #.........: 23974 REFERENCE ID # ...: 03120028 SITE ADDRESS .....: 10207 ALHAMBRA AV SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: suem COPY # : 2 OWNER ............: LI -MIN DANG ADDRESS ..........: CITY /STATE /ZIP ...: CUPERTINO CA, CA 95014 -1203 RECEIVED FROM ....: LI -MIN DANG CONTRACTOR .......: LIC # COMPANY ..........: ADDRESS ..........: CITY /STATE /ZIP .... . . TELEPHONE ........: FEE ID UNIT QUANTITY _ ___ ______ ___ ____ AMOUNT PD -TO -DT THIS REC NEW BAL ______ ___ _______ BENERGY PERMIT FEE 1.00 ____ _ __ 23.10 ___ ____ __ __ 0.00 __ ____ __ ____ ___ _______ 23.10 0.00 BELEC200 METERS 1.00 27.25 0.00 27.25 0.00 BPERMFEE VALUATION 500.00 77.00 0.00 77.00 0.00 EPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00 BSEISMICRE VALUATION 500.00 0.50 0.00 0.50 0.00 TOTAL PERMIT __________ 163.37 ______ _ 0.00 ___ ____ ______ ___ _ ______ 163.37 0.00 METHOD OF PAYMENT AMOUNT _ ______ NUMBER ______ __ __ ------------ CHECK 163.37 ------------------ 0783 TOTAL RECEIPT 163.37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • CITY OF • CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 03.00002F APN # Q Fee ID Date: Fee Group Building Address 10a07 A-Gqmbm A v, Cu , 2Y4ivt0, CH o Other Appliances Owner's Name: Lt- Phone #: (40g) z Z 710 Contractor: O� License #: Boiler <= 100,000 Btu Contact: Cupertino Business License #: ling Permit Info: MECHANICAL ld Elec Plumb Q �❑ c Jo escription: BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL Residential ❑ ci ❑ Boiler> 1.75M Btu MECHANICAL Sq.Ft. Floor Area: BCONSTAX $ q.Ft.: _ BCONSTAX Ind/Off/Comm/Quasi BUILDING Cost of Project: !:: BCONSTAXBQ Occupancy Group: BUILDING Type of Construction: BCONSTAXH Hotel and Motel BUILDING Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler > 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC I Comm. Housing Mit. Fee BUILDING 1 of 3 �' CITY OF CUPERTINO 'CST OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF &2F New Sf &2F Res Bld s MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Stonn/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM 3USWAY Remodel Buswa s ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance E19�CTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical s . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE P1 urnbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change BUILDING 3 of 3 J J •