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05100002 CITY OF CUPERTINO * ' 'w'-.=* r A* `° "� OUILDINC DIVISION P _ IT #CONTT A z, )RaINFORS.TION -= x,.h....aA.A ,.._...,... 5 '.'> ,WIM BUILDING ADDRESS: K H CONSTRUCTION PERMIT NGO 5100002 T,jTnA IN OWNER'S NAME: PERMIT ISSUE DATE IGNATIUS Y. DING _ 1045 SYCAMORE DR 10/07/2005 E: SANITARY NO. CONTROL NO. 'IF (650) 873-4878 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 woo LICENSED CONTRACTOR'S DECLARATION Job Description [u p 1 hereby affirm Nm I am licensem d under provisions of Chapter 9(comencing P SZ, with Section 7W0)of Division 3 drive Business and Professions Code,and myllet, se is imfull mmeand effect. REVISION-CONNECT RETAIN. WALL TO J YA? License ClassLic. 1 es Date Carl'...,n (E) STRUCTURAL or ARCHITECTS DECLARATION Sa 04 1 understood my plans shall w used ss public records Jed U soy Licensed Pmfcssional g OWNER-BUILDER DECLARATION <f I hereby affirm Na I am exempt from Or Conlexcmr's License Law far the a o following recon.(SecliOn 7031.5,Business and PrOfessiom Cut Any city tar c.only m which requires a permit to consumer,alter,improve.demolish,at repair any slrvewre _ poor lofts issuance,also requires the applicant for such permit o rile a signed statement Z< that he is licensed pursuant m the provisions or the Cmuramurs Liccnse law(Charter 9 Sq.Ft.Floor Area Valuation Ys,G (commencing with Section 7010)of Division 3 of the B usiness and Pmressions Codc)or y� that he is exempt therefrom and the basis for Ne alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type nor more thaa BK hundred delta,,(s500k 3 4 2 4 5 0 41 . 0 0 1,as owner Of the property,or my employees with wages M Seirsole compensation, will do the work.and the Reaction is not intended or offered for sale(Sec.7044,Business Required Inspections and Pmes no foxedmis Endo:The Conimormes License Law Ont apply to an owCner of 9 P property who builds mimpowee thereon,and who does such work himself or through his Own employers,provided Nal such improvements are not intended or Offered for sale.If. however,the building or improvement is mid within one year of completion.the owner- balt emetl..).rwill have rhe brd uen vi of prong that M1e did nm build Or narrow for purpom of \ 0 I,as Owner of Ne property,am exclusively contracting with licensed contractors to C conswcl the pmjcct(Sec.TNA,Business and Professions Code:)This Contractor's Li. � oder law docs not apply in an owner of property who Wilds or improves Ihemon,and who contracts for such projects with a eom ancoms)licensed pursuant to Ne Conuacmfs v License Law. ❑I am exempt under Sec. ,B&P C for this moon owner Data v WORKER'S COMPENSATION DECLARATION 1 hereby afOmo under penally of perjury one of Or following declarations have and will maintain a Cenificale Or Consent 10 self-insure for Workers Compote .non,u provided for by Section 37W of Ne Labor Code,for the performance Of the work for which Nis permit is issued. ❑I have and will maintain Worker's Compensation Insurance.as required by Section 37W of the labor Code,for do performance of the work for which this permit is issued. My Worker's Compensation Insurance cartier and Policy number arc: Cartier: Policy NO.: CERTIFICATE OF EKEMPrION FROM WORKERS' COMPENSATION INSURANCE (This section coed not be completed timer permit is for one hundred dollars($10131 or lcssJ I cemfv Nat in the performance of Out work for which Nis permit Is issued,1 shall not employ any petmn in any manner in az to become subject o the Workers'Compensation Laws or California.Date Applicant NOTICE TO APPLICANT:If.after making Nis Cenircate of Exemption,you should - become subject to the Worker's Compensation previsions of the labor Code,you must •,Z forthwith comply with such provisions or this permit shall W deemed revoked. Z O CONSTRUCTION LENDING AGENCY rp-r� I hereby affirm that there is aconametion lending agency for Ne perfurmmeeof tY 7 the work for which this permit is issued(Sec.3097,Civ.C.) W tenders Name D• Lcndcr's Address V Q I certify that I have read this application and mute Nat the aWve information is [t. Correct.l agree to comply with all city and county ordinances and smile laws relating to QU building construction,and hereby authorize representatives of this city to enter open the r Ck1 above-mentioned property Lor inspection purposes. gy (Wa)agree to save,indemnify and keep harmless the City of Co am no against rF.r ret liabilities,judgmene,costs and ex reins which may in any way accrue against said City UZ in consequence or the granting of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs HAZARDOUS Signature or AvprraDam MATERIALS DISCLOSURE Type of Roof Will the applicant or( uni building atrr Some or handle hazardous material az derived by the Cupertino Municipal Code.e.Chapter 9.12,and the Health and Safety Crede Section 255$a)7 All roofs shall be inspected prior to any roofing material being installed.❑Yes 0 N 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 'I hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. AIWI7 ❑Yes ON. I have mad Of hmardm amalerials requirements under Chapter 6.95 of thc Califon ria Health&Safety COOL,Sechans 255115,25533 and 25534.1 modumunO thmirthe h ti ter, does not currently how a Iarenl,that it is my responsibility to nobly the nxupant of the requirements which must Ne met poor toamanceora cenlrareorOccupancy Signature ofApplieant Date Owntt tar amhoriutl agcm Date All roof coverings to be Class "B" or better 3 1 IT I gI ;-77 it i / l f-Z LF i i - - ✓ i6 ¢SX�,2 f OFFIff ' z- ,z5 ' sa.G scc� IAN oil �Sc.4•� � �"��fT Q�GQgOFESS/qy�,�F S 2210 - A,YN O� APPROVED By: SCALE: /'/vim��--•• DaAwwrr r �"+2$ DATE: d�� I�EVIBEO -_—__--C�(t[J A(rG�.--•Vt}�c^ r -_ f�''t"' . _'i__ AWMIO MUMMA y CITY OF CUPERTINO I� 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 34245041 . 00 DATE ISSUED. . . . . . . : 10/03/2005 RECEIPT # . . . . . . . . . : 31460 REFERENCE ID # • : 05100002 SITE ADDRESS . . . . . : 10397 AVENIDA LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : IGNATIUS Y. DING ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3946 RECEIVED FROM . . . . : JOSEPHINE C DING CONTRACTOR . . . . . . . : THOMAS K H FUNG LIC # 26859 COMPANY . . . . . . . . . . : K H CONSTRUCTION ADDRESS . . . . . . . . . . : 1045 SYCAMORE DR CITY/STATE/ZIP . . . : MILLBRAE, CA 94030 TELEPHONE . . . . . . . . : (650) 873-4878 OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- -- -- ------- --- ---------- ---------- ---------- BPLANCKREP HOURS 1 . 00 87 . 14 0 . 00 87 . 14 0 . 00 ---------- ---------- ---------- --------- - TOTAL PERMIT 87 . 14 0 . 00 87 . 14 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------- - - - --- ---------- -- ------ - -- --- OTHER 87 . 14 NOVUS TOTAL RECEIPT 87 . 14 • • City of Cupertino Plan Check Transmittal q�, Permit# 05100002 Plancheck# 1 Project REVISION-RET WALL FileDate 10/3/05 Address 10397 AVENIDA Owner DING Description Plan Check Status (attach comments and return to Building with pian set) Plan Dept check# Date Due ate Staff Comment Date Approval? ASE 10/3/05 10/ 05 ASE ❑ ?')7.IL Additional Plan Check Fee ❑ Ho �o C Planning Fees Housing Mitigation Fee Amount Heart of the City Specific Plan Fee Amount �J N� c ff, 2-6s-� CITY OF CUPERTIO cuPEYOF PERMIT APPLICATION FORM o S o U o� N # Date: 3�z �s °el Building Address: Mailing Address (if different from building address): ka Owner's Name: Phone#: Contractor: License #: YNC • 111q ' Contact: Phone:,/s.,, _�i Cupertino Business License#: ora �..�,. Fax: 9 Building Pe pit Info: L Pe — �2 \c`, rtl CSG U Bldg ❑/ Elect ❑ Plumb L] Mech ❑ a ,e,o,571, Job Description: 5 V rtie f Residential Ly- Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a lV� second-story addition: ❑ roject Size: Standard EV Large ❑ Major ❑ 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 1 M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING 9 BCONSTAX 1nd/Off/Comm/ uasi 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 • «G 1 of 3 ^