02080142 OF
TINO
CI BUILDI c DIIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10838 BUBB RD. 02080142
G1WRsLNaMI�G CHIOU APPLICATION
SANITARY NO. CONTROL NO.
q O Z ARCHITEC PENGINEER: f BUILDING PERMIT INFO
Lk" BLDG ELECT PLUMB MECH
<t r_1 1=J LJ LJ
LICENSED CONTRACTOR'S DECLARATION
0 Z In' 1 hereby affirm that l am licensed under fCha ter 9(commencingJob Description
D M_ Provisions ve T IjT 1 NAL MODEL
MMwith Section firr7000)ofect.Division Business and Profession Code,end my license F�y
m full farce and ellen. 4 Vll tie
0 0 U Datenu Class Lic.M
Date S DECLARATION F E E3 IJ 6 2 03
3 0 fi ARCHITECT'S DECLARATION
5�`u-� g 1 understand my plans shall be useJ as public records
a¢<a Licensed Professional
�G N
OWNER-BUILDER DECLARATION BUILDING
u� 1 hereby affirm that 1 oat exempt from the Contractor's License Law for the
I.' a following reason.(Section 7031.5.Business and Professions Code:Any city or county $5000
IFC which requires a Permit to canuun,alter,improve,demolish,or repair any structure
a3� -pdormi¢issuarce,also rcquirer the applicant for such pensntmflleasigned sutemea -- - - - - -- -- - —_-------- ----
colth4ircingwithS=ggn70Wprmisionsn3 of it
elaw(Chager9 c i„, 6$10i0�f2or'�IPai ( -;.,,, Valuation
(conigencingwiN Sectjgn 7000)of Division3ofthe Bnincsp andppppfpcions Code) Q_�SJr`Ig �. ,.,, . " , . :'ti ,. .,!i.�t i:aA n'd: •
or that he nlzhrrlpt therefrom and the hasis for the ell'eg�exembJah.Any violation '
-of Section 7031-.5 by any applicant for a iremlt subjects to applicant to a civil penalty
i of not more than five hundred doll...($500) 101ARN N004DATION Occupancy Type
°I,as owner of Ne property.or my employees with wages as their sole compensation, 102 PIERS
will do'the'work,'and the structure is not intended or offered far sale(see.7044,' 103 - UFER Required Ins ectitins't"" t
Business and'Professions Code:The Connector's License law does nm apply m an q p
comer of property Who Wilds or improves thereon,and who does such work himself 104 - REBAR
air through his awn employees.Provided Net such improvements tic not intended or _
uRerea'for sale.If,however.Ne'Wildin-or im-roveroem is sold within one - of _" -- -' ^.�
'completion.the owner-Wilder will have rise When of paving that he did not WiW or 105 - ANCHOR BOLTS „I' "'•'+
impmverorPurposeefsak.). 106 - SEWER & WATER
_ _. . _.
1;uowner of Ne pvpcny,am exdusively comrazting with licenutl conwnomm 20 --- UNDERFLOOR'��PLUMBING"'-"�. ,.
contact the project(Sm.7044,Business and Profusions Code)The Con ncnr's 2 03 - UNDERFLOOR MECHANICAL--
License Law does not apply to an owner of property who Wilds or improves theseon,
_and who contacts for.such,projects-with a contractor(s)l censed pursaant-to the ......_ 2 04-""'-'UNDERFLOOR..-.FRAM.E..__... __.-.-_
. Contraemrs License Law. ... ._ _.._._... .. _ ..__.--
connect
01amexempt um Set: B&I'Crordiirstwron 205 - UNDERFLOOR'''INSULATION
`s_µ/mer .1 Sec) ��LG�oZ 301 - ROUGH PLUMBING
-3 X \' KER•SCOMPBl5AT101WDECLXRATION 302 - TUB & OR SHOWER
"�- Ihereby rat noxa penalty of perjpry.a.or me rnnowing deduati.m: 303 - ROUGH MECHANICAL
- i.'- ° I have'and will onaimain'a Cenificate of Consent to self-insure for Worker's 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Cade, for the
_ perromt.nce or the work for which Nis Permit is issued. 305 - FRAME
°1 have and will maintain Worker's Compensation Insurance 'required by Section 3 06 - HOLDOWNS
371X1 of the Labor Cod for the plihi mance of he work far'which this Permit is
307 - INSULATION
- CERTIFlCATION OF .,a• aro, -308 - "rSHEETROCK"'
s dMy Workers Comp sato 1carrier
nm and P li y number
Garners ff t" t tt s..fP h YNo. . If s l f, r. ,. . .
EXEMPI'IONFROM,WORKERS'j a>:'* '+3.09 t ?IEXDERPOR_�i]]AtH.'
COMPENSATION INSURANCE_s' _ ._._.._._.__. .__.-,_.-___._----- -
-„. - - -- ...-3.10,___ ..I-NTERIOR--LATH-- ; - r):::ur,,; 1 —+
'' (This section need not he completed if the pert is for one hundred dollars 311 ' -ISCRATCH COAT '
ISI001 less 1
, .,313 'ROOF-•NAIL._,_
1 mfr Nai nth pert ratan of the work for whl h th s permit's r.s ed I
c n t uonl Lyaw or epn R, �°°` '_!m eO_m`stoct to the Workers 501 FINAL ELECTRILAL"'ENERGY
p= 502.. =_FINAL. PLUMB ING_..ENERGY .
Z 'NDTlr ink (CANT I mak gN ate Pi ypafnomd 503 - FINAL MECHANICAL "ENERGY '
z Z: harm n the wor smanorialn pro tt nv of the L4WrC Je,you nun
O 12 Poch reply th isionsserthisperms sludl he deem ed revoked 504 - FINAL BUILDING ENERGY „-
f„n CONSTRUC`NONLENDIIGAGENCY "-" 505 - FINAL ELECTRICAL t
1 hereby affirm that then Wit construction lending agency for the performance
'of chi work for huh N'a Perrnts�ssad(Sae 30197,civ.c) 506 - GAS TEST _
o r�
Lander',Ndreas _- .... _. . 507 FINAL; PLUMBING
Z Lend r Address. ,.tr.
,. U O .I..if,thatIhavereaddiisapplirationandtamathattheaboveinfeurr cis 5O FINAL MECHANICAL' -
'kT+ [� antro.1 agree to comply,with all city and loamy urdimnees end state laws relming 5 9 - INAL G DE
; 'O-p tabuildingconstoiction;and herebyauthorize representativesofthis citytoenter upon 5 0ANA
NAL NG
,�,r,T� 'the above-mentioned property for inspection purposes. ,
``'y (We)agrce[n save,mdcmn ly asd kmp harmless the Cly of Cupemnb ngainm 51L RKS �s^�
'Fn (A liabilities.ludgmems,costs and expenses which may to any way accrue against said V
V-► C t in consequence of the graining of this permit '
:APPLICANT UNDE TANDS AND W114.COMPLY WITH ALL NON-POINT Issuedb : Date
SOUR FREGUL- ONS. ' -2/_u y
all I
onof Applicen mrlctor + _Date D Re-roofs
ROOUS MATERIALS DISCLOSURE
Wdl de ap emu or fotute Wil bccupout store or handle hazardous Want Type of Roof
as definedby the C. isib o Mnninlsnl cone Chaprcr 9.12.anJ use xealth era safny _
Code SeW,W255321a) ! n :�"'!t
❑Ye ''" " No " ' All.roofs shall be inspected nor.to an roofin material beta installed. .
' XI r s .sl
P P Y- g g
Will the,applicant or future buildings pant use equipment or devices which' If a roof is installed without first obtaining an'inspectlOn;`I'Agree to remove
emit hawed us air contaminants as Jefned by the Bay Area Au Quality Munegminhod
All non=poilit so irca reglations. . pp ly with.
D.nn All new materials for inspection. Applicant understands andwill comp
❑Yes NO '
I have read the hazallouv materials requirements under Chapter 6.95 of the
Califomii Health&Safety Cade,Sections 25505,25533 end 25534.1 undemand that
tithe Wlldingdoes not Gurtenuy havearcnant.that it is mY responsibility to notify the - --_ _ _ _ _ --
cuPam of the requ mems which mus be met prior N issuance Of a Cenifieam of
G up O may. 26 , Signature of Applicant. _ . - . _ . .,.__. , ,- .Date
�- -
Ow or,amo aea nt All roof coverings to be Class "B" or better
.OFFICE .... . .... -._ . _. . -. ._.. ... . .. .. ....
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RFC.
AUG 6-200Z
BY:
Z ly
NEW ADD
A'F'RO VE®
IN ACCORDANCE WITH THE CITR Of
20 0 L (VATS HE,Irk CUPERTINO 0 , AND ORDI NCES
S (r iC1L& 5/{S I ✓ Sl/lii� (f '�A �ILCc (.S� )ATE
>IGNEU
chis set of ,lens a spe ..rfication 7
-1 C 0 LI NT E� he kept on the job at all Imes and it is un
C(✓ /��/ �Dt s/ti,Y r1�97E� 1 will to make any changes or alterations
/ E " se"ta Without written Permission from
`I'ns OePt•, City of Cupertino.
"--'t*gig of this Plan and specifications
u•• SA ted to permit or to be an
u,olatron of any
provision,
. .. .. . ,�•fiaace or state I-AW
j
Son CITY OF CUPERTINO 02-
CUP YOF PERMIT APPLICATION FORM
Ah
APN#' Date:
362 - o.2 osZ e/z6/ zd0�
Building Address:
108,300 v8,300 B U B g oA D
Owner's Name: Phone#:
r—
Contractor: TIM I-IU License#: 6 8 5 3 6
C. . wo C CON57KUCTIuN
Contact: Ti M �i N Phone#:
�� - 2 7= x`069
Applicant/Contractor: Fax#:
uil g Permit Info:
Bld Elect Plumb Mech
tion:
CR—esidenti-al: xn1-e,-nv,l QMo a Commercial:
Sq.Ft.Floor Area: Z $/Sq.Ft.:
Architect/Engineer: Valuation:
�SbOU
Type of Construction: r Occupancy
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances 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 Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
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