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03050032 tBC ITY OF CUPERTINO �0%r 7 `SRF BUILDING DIVISION PERMITNFORMATTONUILDING ADDRESS: ...... ERMIT ND03050032 573 (7AqTT,F.TQ7q RT OWNER'S NAME: PENT" DS/Z003 -LI HUANG NE: SANITARY NO. CONTROL NO. ARCHI7HCTIPNGINEER: BUILDING PERMIT INFO BLDG HLELT PLUMB MECH p if O O l� glop LICENSED CONTRACTOR'S DECLARATION lob Description 1 he afOrm Nes 1 am licensed under Previsions of Chapter 9(commencing p Z wide Session 7")or DlHsion 3 of the Business and professions Code,and my license IS < mfmLfoceande � �A72INSTALL 8 RECESSED LIGHTS FUNALE® 5�? Lkena I z Dam ` —&eac,or CONTRACTOR: U. S .A. SERVICES ARCHITECT'S DECLARATI N D I understand my plans"I he sad u Public mead, MAY 3 0 2003 it i 3 Licensed Pmfmlanal OW NER,BUHDER DECLARATION I 1 hertby vliim that 1 am exempt from the Con ommes License Law for the BUILDING O O follawing moon.(Scat 7031.5,Busima and Professions Code:My city ear county BUILDING e'$ which hold.a pC1111I1 m construct.alter,improve.demalkh.or Milan my structure' �Sa prior At its issuance,also Williams the applicant forsuch permit ill Ilia A Sigme mtement that he lellccmN uanlm M purpmisionsafthe Conmcmri Licxmc lAw(CluPmn9 Sq.Ft.Floor Area Valuation a s'$ (wmmcncing with Section 7000)adDivision 3 of Oat Busommand Proleamam Code)or .. Mut he is Alumina therefrom and the basis for the alleged esampdMy violadaon. n of $1100 Sector 7031.5 by airy applicant for a permit subjects the applicant in a civil Penalty of APN Number Occupancy Type not mom Nen Bve hundred dollars($500). ❑Lea awnsof Ne pWopeny,amY wplayees wide ergs ASttek tele wmPemMm, 35618057 . 00 will do thework and Ne mommre t nmimended oronmal forsale(Sec.7044,Business Lp and Pmfsdos Cade.The Comemme,Lkese Law dues not apply m an owned,at ♦pODS � property who buildam)mprmetemm c t ,and who dosauch wort himalforthrough his 304 — ROUGH GL.IG l�eCAL own employees,provided met Such improvements am nnintended araaemd for ale If. 501 — FINAL ELECTRICAL ENERGY howler.the building of ImPmtammal la Said within mu year of cwnPledon.Ido cower, builder will have the burdce of timing Nes he did ret build or improve far purpose of 505 - FINAL ELECTRICAL ASIA.). 0 1,AS owtmr of Ne property,am selusively contracting with Hcensed conuanmn in convect Mte project(Sec.7W.Bwlnea and Profession Code:)The Conmcmri Li- case Law deer nes Apply AS an owrcr of property who builds or improves Nseon.and. who warrant for turd projects wide acontnnoKa)licensed pursuant in the Contncto's Lie..Law. ❑I am tempt under See .B k P C for this mean Owner Dau WORKER'S COMPENSATION DECLARATION I hereby amrtm under penalty of Perjury ane of the following dalarWanx I hove and will maintain a Certificates of Conant to self-imum for WmgetsCmnpem AStion,As provided for by Scatter 3700 of the labor Code,for the performance or the walk for which this permit is issued. have and will maintain Workeiri Compensation Insunns.AS required by Section 700of the Labor Code,for the imfomame of the work fm which Nie permit is Issued. My Walkela pe Most tante artier end Polley/number m: Carrier. Polity FROM �+��6 Z-O CE IFICATEOFE)ATIONI NFROM WORKERS' COMPENSATION INSURANCE rMit maim need not ba completed if the pemm la furan hundred dnIum(SIM) or lea) 1 certify Net in the performance of the work for which this permit la iaucd.l shall not employ any perman in any manner m As m become subject to the WOrkeri Compenutian law of Cali(amta.Dam Applicant NOTICE TO APPLICANT:IL after making NIS Gniftcate of Exemption,you should become subject m the Worker's Compensation provision,of the labor Cade.you mot ,Jz foMwiN comply with such provision m this permit shall M decmM revoked. z 2 CONSTRUCTION LENDING AGENCY '[r I hereby elRrm that Mtertla a construction leading agency for the performance of a Mu walk for which Nu permit U issued(Sec.3097,Civ.C.) W�Q Lendcr's Noted z Lender's Address U O 1 cenifr that I have mad thisapplication and sum that the above Waterman is D.F correct.I agree to comply with all city and county ordinances and sum law,slating m DU building contraction.and hereby ambodm apraanutives of this city u tour upon the til ebovcmemianed Property for Wpecuon purposes (We)ague m ave;.indemnify and keep humka the City of Cupertino&gains, y liabilities.judgmenu,caro and expenses which may in any way acme against Wit City U`1 is caNeymMe of do granting of this perask. ^�+ APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NT Issued by:9 Date SOURCE REGULATIONS. /� /4-- --�— b Re-roofs Signature i f APplicim/Cmunclor Dam HAZARDOUS MA*RIALS DISCLOSURE Type of Roof Will Mte applicant or forum building occupant tame rehandle hasNoos material As&limit by Ne Cupertino Municipal Code,Chapter 9.13,and Mte Health and Safety use,Seaton WNW? All roofs shall be inspected prior to any roofing material being installed. ❑Ys Will to applicant or future Wilding occupant me equipment an devices which If a roof is installed without first obtaining an inspection,I agree to remove mit h®etas air commumanu As dcMcd by the Bay Arta Air Quality Management all new materials for inspection. District? l ❑Ys &bia- 1 have read the hvsmous materials mqu im mems under CTu par 695 clue Collier. niaHaINB SAfctyCOde,Sca a s 25505.15533 md25534.I unMwand thtirdbe building Miles not currently have&to a it or my responsibility m noMl'y the Pon the requimman u but rmiau of aCertifiateof Signature of Applicant Date Owner or aatherinudage DaA� All roof coverings to be Class"B"or better r - CITY OF CUPERTINO 3 os?1 a� Z_ CITY OF PERMIT APPLICATION FORM CUPEI,TINO W-PN# Date: v S GG v Building Address: y 7 3 Owner's Name: Phone #: Contractor- License#: 7 75 X63 Contact: vl O VP npVe x#: G _ 2-0O ZSR erQ Applicant/C-ontraotor: p p 5 A s Vi -,/Z3 -z- Building Building Permit Info: Bldg Elect Plumb Mech Job Description, �}.t_r, 0'j Residential: 4 ^ .Gr/ �" O5rnercia y • / Sq.Ft. Floor Area: $/Sq.F . �o - Architect/Engineer: Valuation: e of Construction: Occupancy Group: X � 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 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 BMITIGATC Comm. Housing Mit. Fee BUILDING 21g� 1 of 3 1% 1g54. 1 � CITY OF CUPERTINO �- CITY OF PERMIT APPLICATION FORM CUPEkTINO M Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs 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 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 Check 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 BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/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 Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREAUU AN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I 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 2 of 3 : CITY OF CUPERTINO ; CITY OF PERMIT APPLICATION FORM ' CUPERTINO , 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 ELECTRICAL 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 BSF&2FAM Single&2 Family BUILDING BSFNA Single Family New Add BUILDING BSPECIAL . Special Inspection BUILDING BSVvgM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Tempo 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 Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING' ZADDCHG Address Chane e--WILDING 3 of 3