06020150 ;21722
TY OF CUPERTINOs,
BUILDING DIVISION PERMIT 4C®NTRACTQR TNI; RMA.'TIO1V•;,
DING ADDRESS: PERMIT N0.o6O2 O1SO
COL BER'S NAME: PERMITL4UBOATE
YUWEI SHI 02/24/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDGO ELECTO PLUMB MECHO
Sop LICENSED CONTRACTOR'S DECLARATION JbDescriP tion
jdj 1 hereby afflrm Nao
Must 1 am Hummed under provisions of Chapter 9(commencing
with Section 70M)at DiAsion 3 of Me Business and Professions Code,and my license is
n; in fail to.and effCL REPIPE FOR WHOLE HOUSE
j Z License Clan L.kJ
�8'
Data car X, 6` contractorCONTRACTOR: P.J. CHEN CONSTRUCTION
ARCHITECTS DEC 1
I understand my plans shall W used as public records
u Licensed Protocol onal11 \l
OWNERBUIIDER DECLARATION
<� 1 hereby affbm that I am exempt from the Cantractoes License Law for the
0 0 follnwing reason.(Sudan 7031.5,Business and Profession Code:Any city or county ! r�
I$ which mquires a permit w constme4 minor.hnprove,demolish,or repair any structure 1 sa�Ij ggnf'_•
_zt' prior m its issuance,also requires thcappliesnt far such permit to fila a signed mummm
< than he is licensed Pursuant I.Me provisions of the Comments License Law(Chapter 9 Sq.Ft.Floor Area Q /❑p;/V,a$luati 2 �(]'(]
O (commencing with Section 7000)of Division 3 of the Business and processions Code)at
$ But he b exempt dumnd from athe bub fm Me alleged exampdm.Any violation of
Se ream0thm fibro my Ap Application
for SW It subjects Me applicant W a civil penalty of APN Number " `OcbdP�Yi 'Pry:&.
35618044 . 00 �1�
❑1,am weer of Me property,or my employees with wages At their sole compensation,
will do the wads.and drawactoe b not intended or offered fee Aside(Sec.7044,Business Required Inspections
Nd Profession,Code:TheCmusctoM1 License taw does rust apply ta an owner eer of q P
property who WIIAs orimgnoves thnmon,ared whodnessuch work himselformtough his
own employees,provided thatauch Improvements m,not Intended mortared TorWe.If,
however,the building or Improvement is sold within on year of compicdon.Ne awnor.
builder will have the burden of proving that he did not Wild or Improve fm purpose of
site.).
❑1,as owner of the property,am exclusively contracting with licensed conuacmn m
construct the project(Seo,7004,Business and Profession,Code:)The Caymans U.
cense law does not apply w an owner of propertywho Wilds m improves desmon.and.
who concocts for such projects with a comm cter(s)licensed pursuant ta the Communes
License Law.
❑I am exempt underSec. .B&P C fm thismaann
Owmr Dau
Ak WORKBRS COMPENSATION DECLARATION
1 therebyaRU a under penally of perjury am of the following declarations:
1 hmwand will maintain•CeNnesu of Consent taselNinsure lm Workees Camper,
sedan,u provided for by Sudan 370)of the Labor Code,for tW performance of dm
work for which this permit is Issued.
❑I have and will maintain Workers Compemadon Insurance.u required by Section
My arthelabor Cade.fon Mermarmameof theworkres wbir Athis permitb Word.
My Workers CCeampewdon Insunntt�esmior and Polity number am: '
Cartier. Z�e�'f+e /Gsav�Policy No.: {_
CPAnFI�ATE OF EX-5'I.P170N FROM ORK
COMPII TIChi ll RANGE
(This smOm need not bucompleted If the Permit It froom hundmddollsrs($100)
or less.)
I cerdry that in Me performame of Me work for which this permit is issued.I Pull ret
employ any person in my manner an u At became subject to dm WodmKCompensa0on
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CetiOmte of Exemption,you Moved
become subject no du Workers Compens.uon provisions of the Labor Code,you am
.J ZfoMwilh comply with such provisions or this permit shill be deemed mwked.
O
Z tiCONSTRUCTION LENDING AGENCY
(:w 1hereby.M.than Mere Is.mnsum0ca lendingagemY fmthe perfxonanmof
a Me work fur which this permit is issued(Sm.3097.Civ.C.)
Q Lender's Name
=12 Lenders Address
U0 I cutely that I have read thb.pplicsoon and sou that the above Information It
LU F correct.I agree W comply with all city and county ordinances and sum Iowa mlating to
0 building construction,and hereby w Maria rtpusenutives of this city to enter upon the
017 show- Boned property for impaction purposes.
(We)agree to move,indemnify and keep harmless the City of Cupertino against
rrA imbilitia,judgmanta,cads andexpemes which may in my my acetate maim,said City
U7 in consequence or the granting of this permit.
F7 APPLICANT UNDERSTANDS AND WI MPLY WITH ALL NON40INT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
sgnature afApphcamfDomrantar (r D��
G HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appllesnt or future Wilding acoupanutare orhandic huardom material
ss defined by the CuPemm Municipal Cade.Chapter 9.12.sM Me Health and Safety
om.Section 25532()7 All roofs shall be inspected prior to an roofing material beim Installed.
❑Yes 'a No
P P Y g g
Will the applicant or future building occupant tee equipment or devices which -If a roof is installed without first obtaining an inspection,I agree to remove
it haymdnus air conuminanu As defined by the Bay Area Air Quality Management all new materials for inspection.
DisuicQ
❑Yes bN.
thaw
mad gar harallou nmcriabtequj(menu under .Chapter6,95 o(me califop
nb HcmIa k SafetyCode.Sa7iau 25505.2'1373 and2353d.1 un4rsuM MuifMc building
dors not curmndy how a unapt.JI ss'Bb my responsibility M redly cuPant of
requirements which must tprlar to issumce or.ccrincauo e'upanmr. Signature of Applicant Date
''� ��� All roof coverings to be Class"B"or better
sorter or authorised agent / Dau
Community Development
10300 Torre Avenue
w.
*` Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPE(�TINO
Building De artment
JOB ADDRESS: / PERMIT#
z-tt � �i0ics V C7 6G 201 'r d
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR. ori, FAX #
I am not using any subcontractors:
Signature Dater
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
REPIPE/SEWERS/MAIN SERVICE
CUPERTINO PERMIT APPLICATION FORM
APN # / Date:
y'b a a 5` 2 moi: �J
Building Address:
A/z.
Owner's Name: Phone#:
�JaPe. 154(f— 9>73 9"/
Contractor: f?J o adk��„ghone: � License#:
Brio 0,2?O6053 76
Contact: Phone: Cupertino Business License#:
Buildi g Permit Info:
Bldg ❑ Elect ❑ Plumb
Job Description: P -C/
Residential g Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg. Permit Fees BUILDING
BPGAS Gas Piping System Fee PLUMBING
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Repipe of Fixtures PLUMBING
BPFIXTURE Pb] . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
613
I 7