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04110105E CITYOFCUPERTINO `"3' ` BUILDING DIVISION PERT :CONTRACTOR INFO,,, O BUILDING ADDRESS: DZUNG NGUYEN PERMRN'64110105 10386 ANSON AV OWNER'S NAME: PER.Mn LSSUEDATE DZUNG NGUYEN 4 ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG . ELECT. PLUMB MECH p LICENSED CONTRACT'OR'S DECLARATION n C 1 hereby affirm Nal I am licensed an&' provisions of Chaplel9 (commencing .IOb MAIM ' U with Section 7")of Division 3 of the Business old Professions Coda. and my license is 11 rf `yy n in Na Bamennd ef(ea. KITCHEN REMODEL U 0 VVM333 License Class Lie. a ve a Da¢ Concracmr ARCHITECTS DECLARATION x(} ``y,J L MAR < 1 understand my plans shell bss public used public records ta U Licensed g`,f1 gg q la pada, p y /�� ,3 OWNER-BUILDER DECLARATION IIJ f�n\�IIt\/I`\/:C/l—/s ersoyaonnl 1 hereby affirm Nac 1 am exempt lrum the Convanoh License Law for the II Il gt�J,J\� I Iv'� O fallowing reason. (Section MIS, Business and Professions Cade: Any city or county F'I l'I�IIII�\'\I E' which mquifes a Permit to construct. alae, improve, demolish, or repair any atruemre 000 '. y '< prior to its issuance, also mquims the applicant for such Permit to file a signed su i mem he is licensed Law (Charter 9 Sq. Ft. Floor Area Valuation --'-. - -- - '� that pursuant oMeprovisions OfMeConmcmr'SLic me $ (commencing with Section 7(100) of Division 3 of the Business and Profsidns Cole) or ' Nat he is exempt Ncmfrdn and the buns for he alleged exemption. Any violation of e Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of not mom Nan five hundred dollars (5500). 0 1, u owner of the property, or my employe. with congas. their sole min,unsadon, 'Required Inspections will do the work, and the alsucmre is not intended or offered for sale (Sec. 7W. Busiaeu and Professors Cade: The Conuacmra Liam law docs not apply N an owner or Property who builds orimPrays thereon, and who dmsswh work himulf or through his own employees, provided that such improvements are not intended or offered for sale. It, however. the building or improvement is sold within one yens of completion, the owner- builder will have Ne burden of proving that he did not build or improve for purpose of .k.). ❑ 1, as Owner of the propert,, am exclusively contracting with licensed contractors to comtruct the project (See. 9044. Basins and Pm(sions Cade) The Cononemr's U more law does not apply to ad owner or propsny who Wilds or improves Neeson. and who contracts for such projects with o eommetor(s) licenced pursuant so one Contractors , • License law. ❑ 1 un — . B A, P C for this pond ��exturn,t/iuundeer�Sec. A.,'//�{tLl�f.l4l. Dale W K 'S COMPENSATION DECLARATjON> 1 hereby grim under p salty of perjury ane of the following declarations: ❑ 1 have and will maintain aCeruftnm of Consent m self-insum forworkso"Compere , sation, m provided for by Section 37W of be labor Code. far the perfmmamx of the _ work for which Nis permit is issued. ❑ 1 have and will maintain Workers Compensation Insurance,. required by Sudan 3700 of Me labor Code. for Ne performance of de, work for which this Permit is issued. ' My Worker's Compensation Insunintt carrier and Policy number arc: Cartier. Policy No.: CERTIFICATE OF EX EM MON FROM WORKERS' COMPENSATION INSURANCE (This section need not M complemd Rthe pamil is formic hundred dollars (SIM) or Lx.) 1 ttniry the, in N of N work for which Nia permit is issued. I N411 nm Itr9.1ratim Imply ype Son ill a�pcommilan lob embject co the Workers Compensation Laws fc2i ry[018,6I 1!//� �y/st>LA APPIi an S ++� NN APPLICA after making this Ccnificale of Emalplian. you Mould subjal in Me Workers Compensation provisions of the labor Cnea you most Z foMwith comply with such provisions or Nis Permit shall be deemed revoked. N _ CONSTRUCTION LENDING AGENCY I oar that Nero is a construction 30 lending agency for the performance of cErm which the week for which Nu permit is kttue0 (Sec. 3097. CO. C.) Name ALandees landcr's Addrs zumR,'a 0 is 1 certify that 1 have rood this application and sea that the shove cos / f•' bilatiun coronet 1agree mcomply with all city and county Ordinances and stag lawsalininge ! U ionand hereby thari,erpose, utivrs of Nis city mcnar upon Nc W G abovengcotioned enna, an keep hs . anovc (We) . cd a. ertysam find m indemnify (We) gree to eve, indemnify and keep harmls the City or Cupertino .gait rq aswhich may in any way accmc against said City Iiemu , / Zin ,rreircaOfIn.cotolm, of MTs APPLICANTaUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 'r so GULATIONS. Re-roofs rgraum of Appli V cA xtor Date HA ARDOUS MATERIALS DISCLOSURE Type of Roof Will the, applicant ser future building occupantawm or handle havardous mamrial az defined by the Caperton Municipal Cade. Chapter 9.12, and Ne Health and Safety Carlo. selves, zsS]z(a)? All roofs shall be inspected to any roofing material being installed. Ones, SN. prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which remit hazardous air contaminants az defined by Nc Bay Arca Air Quality Management all new materials for inspection. - District? M./ . [3 ye. L"µnu I have read Use humorous materials reyuiremmu under Cnapar 6,95 of the Califor- ' nix Health &Safety Conde, Smcdons25505, 25533 and 25534.1 understand thdt if tha building does n annually have a truant, that it is my responsibility to nobly the oceuPanc Of the myuimme hnichtWmet pnorusissuance are Ccnifi.tcrtx4apancy Signature of Applicant Date All roof coverings to be Class "B" or better der to aalmci,ad ag l �� Date PC��j- •; CITY OF CUPEI_TINO is 9 Assessor's Parcel Number: 326-41-053 Name of owner. Dzung Nguyen Project address. 10386 Anson Avenue Contact person. Dzung Nguyen Phone. 8-777-0322 Fax. Net square footage of lot. 7,821 Square footage: First floor: Second floor: Garage: TOTAL: SF Existing 1,546 SF 624 SF 460 SF 2,630 SF 624 SF 460 SF 2,630 SF Are there at least two 10 foot by 20 foot clear spaces inside the garage? O N Is privacy protection planting required for the project? On what floor(s) is work being done? First Brief description of work. Updating kitchen: cabinets, light fixtures, extending gas line for new gas range Code editions: 2001 CBC 2001 CPC Effective 11/1/02 (Y -1)2001 CFC (Y - N)2001 CMC (Y- N) (Y - N)2001 NEC (Y - N) . DL.., D..a:.. •.. D......,,:,. Rl...L D,.,.I- D....., l' D....:,.,,A n/1pinn r� _0 CD w m m 0 O N CD + rt rt p�D V 0 = O rn a3 �C , �i D _=; QoIN O N 7 Q O N �3 CD -0 0' CL Q m O O0 O C O ^, y =F CD tD 0 s = w c � a) o Q < m mrn� i m n CL -0 CL m' m � CL 0 0 c C-)� c O CD w (D O � O D o y C7 0 D=3 m D cn< oCD A C (D o � CD X N N G) 7 O �• I _ _ CD � — I I d d. x o CD m y �i u m d to O k^v I I B �-- I I I I 0 m CD � �Pp-�aoTM TMEcmfjily J tN ACOORDAN D INANGi$ pAT I SIGNEDt speoiticatio na Mt l PI n This a job at all times and h 1§ be ke r Dmake any changas or altd'at IaW1U1 ._..nice if - Without written on same w Deft. City of budding I &P Ettir„ spur.,;ali the Ian The stamping of this P NDT be held to P rnd nnii ci errs pCavi, SHALL approval 01 the violation Ordinance o' or oI any Cdy I I � m m r� _0 CD w m m 0 O N CD + rt rt p�D V 0 = O rn a3 �C , �i D _=; QoIN O N 7 Q O N �3 CD -0 0' CL Q m O O0 O C O ^, y =F CD tD 0 s = w c � a) o Q < m mrn� i m n CL -0 CL m' m � CL 0 0 c C-)� c O CD w (D O � O D o y C7 0 D=3 m D cn< oCD A C (D o � 0-1 n <. m a m O d d. x o CD m y u m d to O r� _0 CD w m m 0 O N CD + rt rt p�D V 0 = O rn a3 �C , �i D _=; QoIN O N 7 Q O N �3 CD -0 0' CL Q m O O0 O C O ^, y =F CD tD 0 s = w c � a) o Q < m mrn� i m n CL -0 CL m' m � CL 0 0 c C-)� c O CD w (D O � O D o y C7 0 D=3 m D cn< oCD A C (D OWER -BUILDER VERIFICATWN 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. V All the work authorized by this permit B. _ A portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. _ A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to Gtt"v'ttttGLL 3. —I will utilize unlicensed person(s) other than my immediate family to perform all or eportions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be performed I declare under penalty of perjury that the above is true and correct. Owner -Builder Information (reverse � side). Property Owner's Signaare2 FI" : t,vy to I have read and understand the Datic-� tl L /R.o04 Permit-#( 0411OID� Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. 0 is i CITY OF CUPERTINO Dear Property Owner: City of Cupertino Building Departm 10300 Torre AvenV Phone: (408) 777-3228 An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are all to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino • Primed on Recycled Paper CITY OF •CUPEkTINO *CITY OF CUPERTINA PERMIT APPLICATION FORM APN #'32b / Cs� 3 Fee Description Date: 41 /f7 /za- -4 Building Address: Mailing Address (if different from building address): to3$(o ANSON hv2� BBOILERI Owner's Name: MECHANICAL Phone #: �zuNCi TJ�u i�� MECHANICAL ito$ -7"17- �I32Z Contr4lbr: MECHANICAL License #: Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Contact: Phone: 1,oQ i-1-7 -q32 Cupertino Business License#: 'D2u w& QC,0 YC4J Fax: BUILDING BCONSTAX .Building Permit Info: BUILDING Bldg ❑ Elect ❑ Plumb Mech ❑ Job Description: BCONSTAXH _S Residential Ir 1 Ommeicial ❑ Sq.Ft. Floor Area: BUILDING /Sq.Ft.: 1 Cost of Project: ELECTRICAL Occupancy Gro Elec 600V > 1000A ELECTRICAL -- Type of Construction: ( Please check this box if the project is a Energy BUILDING second -story addition: ❑ Project Size: Standard ❑ Lar Ma'or ❑ BINVESTIGA Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 BBOILER5 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 II L I of JRa SCITY OF CUPERTINCS CUP TYOF O PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 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 Cbeck Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING - BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING 13PSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM StomVRain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BRENLkHU AN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways 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 REMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 CITY OF CUPERTINO WITY OF CUPERTINOO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 Mechanicals . foot MECHANICAL �. MPERAIITFEE Mech Permit Issuance _ MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Change __. BUILDING 3 of 3 CITY OF CUPERTINOFra„,z3*xrx"•'-'�` DIVISION PIrRMIT CONTRACTOR INFORMATION - - - BUILDING BUILDING ADDRESS: - DZUNG NGUYEN PERMITNV411O1O5 10386 ANSON A OWNER'S NAME: PERMIT ISSUE DATE - DZUNG NGUYEN 4 E: SANITARY NO. CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO - _ BLUG ELECT. PLUMB- ---MECH o- LICENSED CONTRACTOR 'SDECLARATION - lobDescri IIDn 1 hemby affirm thm 1 am licensed under previsions of Chapter 9 (commencing p- with Sermon l0lAB ar Division 3 of the Business and Professions Code. and my license is mfull fmceandelfeet. KITCHEN REMODEL License Class L.Ic. 0 Date - - TS DELL ARCHITECTS OECLARATTON be used 1 unticmtanJ my plans shall W uxtl ax public records Licensed Profesaional OWNER-BUILDER DECLARATION T 1 hereby from mat 1 License law for eW exempt from the Conon; �A nal Code: Any city of county fallowing mason (section 1. hi ]ID 1.5. Business andimprove _ J _ emtawn, peer, impmw, demolish, or repair any which inquirer a t ve de _1 Sq. F[. Floor Area _ -'--- -Valuation— - — tametum issuance. also re Oatpooheitsensedprsuamyons the applicant of forsucthe Common's afiMa, signedstatement- wit pursuant (ChapterCode) the Comrumrind the") 7to of Divisalof (commencing Professions or (comas exempt Section7")and ofthumson3 ththe Business and Professions Ctionof - - 'Nat W u exempt tMse(mm and me bmu for the allcgrA ,..mption. My violation of Is irgotl Section 7031.5 by any applicant for a Permit subjects the applicaauo a civil penalty of a Occupancy Type not mom than five hundred Ml... (S50)). ❑1, as owner of the property, or my employees wish wages as their sole eompewtion, - will do the work. and the swmurt is not intended or offered formals (Sec. 7061, Business Required Inspections and Pmfeasiom Cadc: The Conaaemes Liame Law does nae apply in an Owner of property who builds or improver dmemen,and whodoessuch work himself ordmmugh his own employca, provided shat such improvements ane not intended cluttered forsale If. _ however, the building or improvement is sold within one year of completion, the owner. builder will love the burden of proving that h<did not build Or improve for purpose of- salc.). ❑ h as owner of On pmperi , on exciumv.1y connecting with licensed mmmeres, to COO11=1 On project (Sec. 7044, Business and Prefasioal Cade:) The Contractor's Li. ccale Law docs not apply to an owner of property who builds at improves themem. and , who column; for such projecta with. ecnuaetoms) licensed pursuant to the Conuureh License law. — ❑ 1 son exempt underSee. , B & P C far this mason 0 Yf/f J4C- Date 11 11 2m W K 'S COMPENSATION DECIARATIT> I hereby affirm antler reality of perjury one of On following decluaeiom: I haw and will maintain a Certificate of Consent to self-insure for Worker as provided for by Section 37M of the labor Code, for the perrmmance of Ne .. _ — ... work for which this permit is issued. - ❑ 1 have and will maintain Wormer Compensation Insunna, in required by Section 3]00 of the tabor CoM.for de perfosmantt of dee work for which mu permit is issued. - My Workers Compensation Insurance canner and Policy number am: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section recd not be completed little Permit u force hundred dollars ($100) or Mss.) 1 ccnify rent in thIrryrynnnee of the work for which this Permit is issued. I shall not ' e. ployanypcimo ina�mjmanner 5n}sw cxubjtteee me WC rkers'Compemation Laws Calif 'a D I f/ r 7W �lnp tj APPIi a N TO APPLICA after making Our Certificate Of Exemption, you should 'subjcn to the Worker's Compensation previsions of the Labor Chile, you muse forthwith Comply with such previsions Or this Permit shall W deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm mat dem is a comemninn lending agency for de perfurmmum or the work for which this permit is issued (Sec. 3091, Civ. C.) Lenders Name -----' fender's Address 1 cenify, mat 1 have read this application and some that the above information u coned 1 agree to comply with all city and county ordinances and sure laws mlaung to Wilding construction, and hereby endocrine mpmscnmiwa of this city to enter upon f above-blemioncd pmpeny rat inspection purposes. (Wes) eget ea save, indemnify and keep harmless the City Of Cupertino against a Iiabilieiu,judgments, costs and cxpealct which may in any way we= against mod City ` in consequence of the granting of this permit. // APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date f S GULATIONS. Re-roofs / —Qt f ob dgnamrc of Appli Hu Ae RDOUS MATERIALS DISCLOSURE. Da Type of Roof Will de applicant or fucose Wilding wcuprom mom or handle hazardous material as defined by the Cupertino Municipal Coda. Chapter 9. 12. and the Health and Sarmy Conn. sectiet 35533(q? � All roofs shall be inspected prior to an roofing material being P P Y g g installed. ❑Yes $Na _ If a roof is installed without first obtaining an inspection, I agree to remove Will On applicant Or future building Occupant ase equipment or devices which zone hanrdnus air contaminants as defined by the Bay A. Air Quality Management all new materials for inspection. District? / ❑ Yes W4. I have mad the hxardous mvcrials ounimmcnu under Cheper 6.95 of the Caiifnt, nip "co" Sdi1Cdc. S,,rumca 25505.25533 and 15534.1 undersuM ths. ifthc Wilding . does intently hack a monk thin it is my responsibility in notify the dceupam of the `quire hich t W met poor to issuance of a Cesu0cad f Oceupvmry. Signature of Applicant Date 170 All roof coverings to be Class "B" or better . _ moaner Or affirm cl ag Dates