08040151 CITY OF CUPERTINO
BU LDING DIVISION PERMIT d Rt G Q Ii T URMA IO1�:�;;.
BUILD N,,GGp q0 ESS: PERMIT NO.
�V.SL COLD HARBOR AVE TBD — TO BE DETERMINED 08040151
OW NMS NAME: . PERMIT ISSUE DATE
WING LUK CHOY 04/21/2008
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT mum MECH
C G LICENSED CONTRACTOR'S DECLARATION O O O O
I hereby.M m that 1 am liamed under provisions of Chapter 9(commenting Job Description
'
with Suction 701"of Division 3 of the Enormous and Professhreas Coce,shut my Hcoman is ELCTRC PANEL CHNG OUT. E.M. ELECTRIC PD FOR BUS
y in full fora and if l! Z�J C.� U
"'2 LI —(d Lica "'f' J LIC 4/21/08 (EDUARDO X MOLINA) .
SF, Date _2l�d� Comsus"A `2 =l Pr frx
AR DECLAR11f10N
11 understand my pins shall he used u public records
Z6
3 rsa Licensed Professional
�`�y OWNER-BUILDER m Ce COSO ON
0 I hereby.(Sero that 11. esempt from the Cssions Co :Any c Law for the
is p O fallowing moon.(cation 7W 1.5, t,altar and ere.d mli Cada:Any city or aunty
$�
which requites a pemnit o consteucL altar knPmvm,demolish,lir rtpalr my structure '
prior to its issuance,also requires the applicant for such permit to file a signedsMomenl
€o that he is licensed pursuantlothe provision ofthe Contmeor'sUcmumLaw(Chamuo9 Sq.Ft.Floor Area $ Valuation
$ (commencing with Schon 7")of Division 3 afdm Business and Pro2winru Com)Or 1100
�.. that he u exempt therefrom and the basin for the alleged eaemptiom Any viotation of
Section 7031.5 by any,applicant fm.permit subjects the applicant to a civil penalty or
n3 6 9 0 9 0 3 0 ff Number Occupancy Type
e
m mart than five hundred dollars P Y YP
❑1,u owner of Na property,m my wploym wide wage u they mleeompensation,
will do the wok and the structure i.not Intended of offered rormle(Sec.7044,Business
and Preferment Code:Tim Committers License Law does nut apply to m owner of Required Inspections
property who build.orimprow Nemon,andwho darsuchwork Nmselfostluaogh his
awn emplayeen,provided that Such improvements art not immured aroRereL fault.IL
however,than building orimprowment It Sold within one year incompletion,the awar-
builder will have Ban burden of proving that he did not build or improve for purpose of
tale.).
0 1.as owner of the property am eselusively a.m.ming wills licensed ann exon in
arowct the prejat(Sec 7041,Business and Prafeselons Conte:)The CmmcorS U. .
came law does not apply b an owner of property who builds car impmwa thereon.end.
who contracts fosaueh pmjecu with a eontaamKa)liansed pursuant m the Conanemfn
Lkense law.
O l am attempt under See ,H&P C far N4 mason
v Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury,aro of the following declarations:
III ham and will ain Wil a CeNliesan ofCoa
nntto self-Incomp
on.
for WUMM's comn.
on. m
a provided for by Section 3700 of than labor Code,far the performance of the
work for which Iiia permit is unwed.
0 1 haw and will maintains Worker's Compensation Inwma,a required by Section
37Wof Ne labor Cade,for the performance ofmhe wast for which this permit is issued '
My Worker's Compensation Insurance artier anti Policy numberam:
Carrier. Policy No.:
N, CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fOtusemim need atbecomplemd Hdee peonit in foroahundmd WBus($100)
or MU)
I onnify deet in the perfamtana of the work for which this permit is issued,l Shall al - ..
employ any person in Soy summer an u to become subject to the Workers'Compensation
LAWS of CifgDam
Appicmt nsLi.
. �
NOTICE CA_ after mak ni MEm.o_f Exemption. _
you Should
become Subject o the Wades Compensation previsions of the labor Cada you must
.J O forthwith comply with such provisions or this permit shall be named revolted.'Z y CONSTRUCTION LENDING AGENCY
[.r I hereby affirm that Nem U.,cosuuctinn leading agency Tor the pemamsoam'
the work for which this permit Ian issued(Sec.3097,Civ.C.)
WRQ lnnmr's Nam,
Q z Lander'.Address
6)Q 1 unify that I haw read this application and sum dem the Show imormaden is
correct 1 agree to comply with all city and comty Militiamen end sum laws relating to
Q SV^ building construction.and hereby Induction mprommuuvts of this city to enter upon tae
W above-mentioned property for inspection purposes
L4 (We)agree to taw,indemnify ad keep harmless the City of Cupertino against
wl liabilities,judgments,costs and expenses which may in my way wens against Said Lily
V 7 in consequence of the graating of this permlL �7
s7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date r L
2L
SOUR RECULAT70 S,
Re-roofs
Sigmas or ApplicanulContsacor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future Wilding oaupmt atom orhamle huardou material
u dented by tae Cupertino Municipal Code.Chapter 9.13.and he Health and Surely
Comic,Se y.zss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yns 9170
Will art appInArt or future building occupant use tqulparest or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cmpt ba0 hmardnns air tmstsmcontaminatorm JcfneC by sea Biy Arta All Quality Management
all new materials for inspection.
.rw❑ /�
0 Ya
I have mod the haurdousma trials requirements undcr ChaNer6.95afthe CaHlor-
nuHcalN&Safely CwIc,Sactim x25505.25533 and 25534.1 mmrsund uatifthe building
dna rot corremdy haw.Mour,that its my mopemi0ility no notify the occupant lir the
mqui p�awhichmuub5.met�ojmiuu onCerdOcaaofoccupancy. SignatureofApplicant Date
$`5� ✓� �l-2z 68 All roof coverings to be Class'R"or better
weer or authored agent Dau-
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4FUPEkTINO
Building De artment
JOB ADDRE/SJS: PERMIT#
b 3 2 5/ 66' le) a r D h, 0Y0<S
OWNER'S NAME: rev /,' PHONE p 2 — 3 7
GENERAL CONTRACTOR: I FAX #
I am not using any subcontractors: 7jX M_te16 Z&�a - Z
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
• CITY OF CUPERTINO '
3 ITEMS OF 3 PERMIT RECEIPT _ OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . I . . . . : 36909030. 00
DATE ISSUED. . . . . . . : 04/21/2008
RECEIPT #. . . . . . . . . : BS000004542
REFERENCE ID # . . . : 08040151
SITE ADDRESS . . . . . : 10328 COLD HARBOR AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WING LUK CHOY
ADDRESS . . . . . . . . . . : 10328 COLD HARBOR AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3328
RECEIVED FROM . . . . : EDUARDO X MOLINA
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINEDLIC # 00096
COMPANY . . . . . . . . . . : TBD .- TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . .
TELEPHONE . . . . . . . . .
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 1, 100. 00 0 .50 0. 00 0.50 0 . 00
lEPERMITFE FLAT RATE 1 . 00 40.79 0 . 00 40.79 0. 00
1TRAVDOC FLAT RATE 1. 00 40.79 0 . 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 82 . 08 0. 00 82 . 08 0. 00
. METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- =-------------------
CREDIT CARD 82 . 08 VISA
---------------
TOTAL RECEIPT 82 . 08
•
t- CITY OF CUPERTINO
CITY or
CUPEkTINO GENERAL BUILDING -
PERMIT APPLICATION FORM
LAPN # �/ (� 0� 30, Q 0 Date:
7 y- z �-
ing Address:
AdE,
Mailing Address (if different from building address):
Owner's Name: Phone#:
; � o 416 ,9)
Contra r: Po7 2 96-.3 7
TK� � Fax: (--/0 9) /93
Contractor License#: '1/3 A 3 b
Cupertino Business License#:
• Contact: Phone:
C Gyi fi-a cl-u("
Fax:
Residential b4 Commercial
Job Description:
,E-le-c4-Aje A2 PV / ChAW vvr
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑
Building Permit Info:
Bldg ❑ Elect 10 Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 11-B ❑ 11, 111, V-A ❑ 11, 111, IV V-B B;--
Valuation: Square Footage:
/Oa
Project Size: Standard ER-Large ❑ Ma-or ❑
. Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditgreen.org
aa ,
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING B
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 BTEMPPER Temporary Building Permit (good for B
30 days)
1BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw).
1BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to &inc130 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5 Install ation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing& Gas Inspections P
(per hour)
1MEETINGIHR Application Meeting B
Sam CITY OF CUPERTINO
CUPH�f GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/DuplexNew B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
]CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
1 FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1 FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1 PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven(steel,pre- B
stressed concrete
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CITY OF CUPERTINO
CUPEYOF GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONR
1 RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSPI0 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1SIDEST/BK Siding, Stone & Brick Veneer B •
interior/exterior
1 SIDEOTHER Siding all other B
SKYLIGHTS
1SKYL<l0 SF Skylight less than 10 sf B
1 SKYL>1 OSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ca addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
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GC. - CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPERTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group ]GENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows
1 WINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1 PLMPLNCK Stand Alone Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1 BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1TRAVD0C Travel & Documentation B
1BUSLIC Business License B
•
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