02020085 CITY OF CUPERTINO - "r`,*-'" a^•:ppwdgn^r w t
BUILDING DIVISION PERMIT t,CONTRACTOR'•INFORMATION:
BUILDING ADDRESS: PERMIT NO.
02020 85
OWNER'S NAME:
APPLICATION SUB DATE
SHARON HUANG 02/22/2002
PHONE
SANITARY NO. CONTROL NO.
ARCHITECUENGINEER: BUDDING PERMIT INFO
BLDG ELECT PLUMB MECH
<r f 'I IJ LJ =3
G Z LICENSED CONTRACTOR'S DECLARATION IOb DIIOn
o Z q I hereby of irm that 1 em licensed under provisions of Chapter 9(commenceSCRing P
F'?tW with Section 700%of Division 3 of me Business attl Profeuines Code,and my license TERMITE REPAIR (2 BTHRMS . )
7 is in full face and eRat.
0:cutS DDiac4neC1"' Cionhaor INSTALL WATER HEATER. IrUNX4'G.C=0
gIn ARCHrrECrS DECLARATION
0 F 1 understand my plans shall w used as public Anods
o G
L"'A'"M
iam M Profess WMAR 0 4 2002
s�R OWNER-BUILDER DECLARATION
I hereby aRim that I am exempt from the Coneractor s License Law far the
t?Y< following mum.(Section 70313.Business and Professions Code:Any city or county
SO
-which rtqunesa permans comuct.alter.improve,demolish,or repair any structum•
BUILDING
C� Prior m'us issuance,also requite me AppUrant for suchpertdtm flk asigadsutemut
3- 'mprgt;IPlk(iypd pursJG1[m_P4p vislomorthe Contractors License Uw(mw"9 S Ftjloor Ares, nation
(commrcaint.w+thSation7 )Cf Division3or Ne Busa.mdI Professions Code) g j,, Q' a �,�::,
a thacha Sonfica-7031. by
my from and me basis for Um cts flidAemmgietr,Any i..try ` '` •-• •-r:. •`'
.,of not...than
3 v any ere ml,l ror a permit sobjecu the Applicant m e civil penalty Occupancy Type
' of not more thin flue hundred do�lms(SSW). m n ,
❑I,uowncr of the piaPenY•ter niY employeeawim wagaumeinole companutloe, -
-will do the aro704,-
Business
ro and Ute structure is not intended or offend for no(Sec:70g6,' -
'B her of aro a Professions Cade:The ova therco License a d does not apply m an equired Inspections " -
or through of his sty was woes or improva at such w who eon ash work nded or 10 2 - P I ERS
or through his own employees.provided that such improvements of an not intended 6f 103- LIFER
affered.for'iale:IChowever'me building 6r int -. .. _. —sees_ --.._
8 Pmvement is sold wimid no build
of 10 4 - REBAR
completion.for the owner-builder will wire the Widen of proving that he did std wild a
Improve for purpose ofWA).
...105--r
ANCHOR BOLTS ..-.....-'--- - - - -
co orme, project
inn (Sec.
7 am eu Busmess Y d Profession,
with IAl Th Contrmrs to ,
License the does
no(Sec, too owner
and Pinfuhoesilds or Theves thereon. 106 — SEWER & WATER .• . ..
"M
License Lew does hat apply m an owner th property who Wilds or improves thereon. 2 0 2 — UNDERFLOOR PLUMB I I4G ..
ted-ww-ronaacu forsuch Pmlau Wiesen.contmcmr(s) licemetl.punuent.m.the. sees___. ... .-_.--_. _-. ... .. .. .. __.. _.. .._sees_ ....._.....
.....-._ sees....sees_._....___...
a I a ams dSw, 203 - UNDERFLOOR ,MECHANICAL
❑lam Amor,eaem funder Sec. ' B&P,Cfor esia sessan
p. 204 - UNDERFLOOR FRAME
• ' WORKER'SCOMPENSATIONDECLARATION 205 - UNDERFLOOR INSULATION
i Kenny aiRim undo peneµy of perjury one of me ro0owint dalart6om:-
301 — ROUGH PLUMBING
1 ❑ 1 have and wui'meinwn A Cenifieatc of Consent m uvanawe for Wakui 302 — TUB & OR SHOWER
Compemation;u-pmvided for bySatiom3700 or the Labor case:ror the 303 — ROUGH MECHANICAL
_ perfomnnce or the wok ror which tMa,pemilo is iuped. 304 — ROUGH ELECTRICAL
t7ihasi Lnd'will ni'vinraia Woha's Comp:muion lrutirance,ea mquirtd by Section 305 - FRAME
3700 of the Labor Code,for perforemace of Ne work for which this permit is
issued.My Wohers Compensation huurence carver and Policy number are:
sees .-
. ...... . _... .. _ ..: .. sees
C'Emin, t , a1I Poll,No.: 30.7:,. .INSULATION r..:
CERTIFICATION OF EXEMPTION FROMWO.RKERS' - '. '3.0,7 )SHEET,RO
COMPENSATION INSURANCE I
- ._ .._.- _...........
. _..._.._...
roma sanon''neAn nd s,Completed if be permlt is for one hundred dollars 309 EXTERIOR LATH
51407°r '') 310 - INTERIOR LATH
shall
tion Uan of Cal' in any manner rho wa t}bewhich ubj tanit a issued,l 311 - SCRATCH CC4i'1'
I ccnif met in the
shall n' �
a NoriCETO.Laweof CaRfa,afterDera - hl'mto'becomewbjeitmtheWahen' 313 - ROOF NAIL
mpenaA sees...see s
NT
PP - .__.. ...
g aCeminrateorEuryapfibn:yogsnuuld` � � �'•� 501 "= FINAli ELECTRICAL ..ENERGY
Z bectinniubject m the webers Compensation provisions Orin 1.6m Cedc,youmust
00 foMwiescomptywithsuchprovisiomoresispemtitshallwdeemMmwkd. 502 - FINAL PLUMBING ENERGY
CONSTRUCTION �NniNcnceNcr, •. 503 FINAL--MECHANICAL -ENERGY
W
61'one :llciyr°rm`perrdmr,aae 504 - FINAL BUILDING ENERGY
y,p - LandhrsName._ - .. .. ,..is . -. ._ . : . .__ . 505 -.. FINAL ELECTRICAL .._
O.z Lnad�IAdenn 506 - GAS TEST
I cenify that I have read this Application and sane that me W.information is 507 - FINAL PLUMBING fi
boit8n.I agree m,comply
with
ell city
and county mdan
incct And stateis loowing
mwildingromtmaion,amherebyauesoize,representatives orthis city in enter upon 508 - FINAL MECHANICAL
me above-memioncd property for inspection purposes.,
L 0. (We)agree I.m..indemnify and keep harmless the City or Cupenlno against 509 - FINAL GRADE
LL rA liabilities,judgmen¢,costs and expenses which,may in any way accrue against said
Cd 51 F NAL G
Z Ciry consequence,in consequenorthe Pait
jointing of this perm .
APPLTCA.YrUNDERSTANDSAYDWILLCOMPLY WITH ALLNON.POIYI' ISSUedid�i4 r N RKS Date
SOURCE REGULATIONS..
$ignuturt,of Applic HAZARDOUS MATERIALS DISCLOSURE Date Re-roofs
NVUI'me Applicant or fume wilding occupant soon or handle hiiudous twerial ,Type Of Roof.. .
. pp Chapter 9.12 am me Health end Safety 1 . . -.. ._ . . ._..._.
udefined by me 32a)?w MunidpelCale, "-
Cdde;SeFtion 553DP)? . .a •'� I t ,• .-•.• •sees .,. .. '
0Yes ''0 No All roofs shall be inspected.prior to any roofing.material_bejng.snstalled.. ._.
Will the applicant Ar raw.wilding ompant tee equipment At device which
eIfaroof is installed without first obtaining an inspection, tee to remove
mit gasurdous air contaminants As defined by the BOY Area Air Quality Management g P g
1, District? - CI NA all new materials for inspection. Applicant understands and will comply with
loy. all hon-point source regulations;•
I have mad me haurdous materiels requirtmenu order Chapter 6.95 of me
California Health&Safety Code.Sections 25505,8533 esti 5336.1 uolAntand that
ifd' wilding does not currently have 8 tenant.that it is my responsibility to notify the
occupant of the requirements which must be met prior to issuance of a Cer ifiam of
cu
Ocpancy.
Signature of Applicant Date
Owner.,wmodmd agent Dane All roof coverings to be Class"B" or better
i sees
" '" - " OFFICE
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CITY OF CUPERTINO
10300 Torre Avenue Telephone 777-3228
GINSPECTION NOTICE
BUILDING�✓��� DIVISION
roe
ADDRESS TIME
DAILY REPORT❑ CORRECTION NOTICE❑ VIOLATIO
TYPE INSP.: BLDG.❑ ELEC.❑ PLBG.❑ MECH.❑
STOP WORK ❑ REINSPECTION FEE
,/w Gz O Q
`Loci �9�.t� �G3�✓ t
0-7 .✓ ✓✓ ✓
WEATHER INSP.
CARD TO REMAIN ON JOB-SITE
'� (> -2-
CRY OF CUPERTIN( ;
CUPEt�TINO PERMIT APPLICATION FORM
' APN#E..
2VO 3 Date:
7Buildiniessr' ,'.S�S �r x
Owner's Name: Phone#:
Contractor: v License#:
Contact: Phone#:
.Applicant/Contractor:
�' -vdy✓ r,(OrJ2
Building Permit Info:
'Bldg Elect Plumb Mech
Job Description: TG--020'nyyC- OLt1- iat 7-
Residential:
i3 ezao/-� - ��.,, p✓tr /,s✓
Residential: ���fT�u I�a�Tavi /f6T
ommercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
Architect/Engiineer: Valuation: DDO
Type of Construction: �"1%
QZ - ,j Occupancy Group:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILER1 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
I BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee I BUILDING
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