04060034X00
YWCC
aiW
noR
!' w
CU
JaU
iLLG
04
hoc
_Z>
iFC
02
z
r;
C[T'uIOnINc
r4I'
oPER'�NNO PERMIT
=G®NTRAGTf ORM.A -. N
BUILDING ADDRESS:
CHEN'S CONSTRUCTION CO
PERMIT NO04 O 60034
902 COTTONWOOD
OWNER'S NAME:
PERMIT ISSUE DATE
YANG CHARLES I AND TRACY T
1271 WASHI
'ONE:
SANITARY NO. CONTROL NO.
(510)639-0853
ARCHITECfIENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
I IOb Description
rovitior Chapter 9 (ncing
rm that I am licensed under pos comme
1 hcrcby affins
p
with Section 7") or Division J of the Business and Professions Code, and my license is
REMODEL (E) KITCHEN,. UPGRADE ELECTRIC
L esfnrceanderten. =a
u«nm lav
Date .-- Contractor
bS
ARCI 1' DECLAR9TION
-
I understand my plans shall M used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm the, 1 am xempt from the Commnor's License Law Tor the
following reason. (Section 71131.5 Business and ProfesNnm Code: Any oily nr county
which requires a permit to construct. alter, improve, dcmulixh, Or repair any structure
prior to its issuance. also requires the applicant for such Permit o Glc a signed statement
that he is licensed pursuant m Ne pmvismas of the Contractor's License Law(Chapler 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 70011) or Division 3 of the Busincts and Professions Code) or
Nal he is exempt Bactefrom and the basis for Be alleged exemption. Any violation of
Cr OO
Occupancy Type
Section 7031.5 by any applicant far a permit subjects fie applicant to a civil penalty of
not mom than Bve hundred dollars (5500).
I, a5 owner of the property, or my employees with wages as their Sale compensation,
Required Inspections
will do Be work and the structure is not intended or offered for sale (Sm. 7W, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who buildsor improwas thereon, and who doessuch work himmff or through his
Own employees, provided that such impravemnnu an, not intended or offered for sale. If,
however, the building or improvement is mid within mic year of mo plcuan, the owner
• builder will have use burden of proving that he did not build or improve for purpom of
sale.).
1, as owner of the proper.. am exclusively emaruaing with licensed contractors to
construct the project (Sec. 704,1, Business and Pra fusion Cade:) Tits Convector's Li.
cense law docs not mprY to an owner of property who builds or improves thereon, and .
who contracts for such projinne with a conlractar(s) licensed pursuant to the Contractoes
License law.
1 am exempt under Sec. . B & P C for Nis reason
Owner Data
WORKERS COMPENSATION DECLARATION
I hcrcby affirm under penalty of perjury one of the following daelmatio ne
❑ 1 have and will main eia a CeniGca¢ of Consent to selFinsom for Worker's Compery
ration, as provided for by Section 37W of the labor Code, For the performance of the
work for which this Permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, u required by Section
37W of the labor Code. for the performance of Ne work for which this permit is issued.
'
My Wark,0g oripns;lTsmana carrier and Policy number a rt- /-
Carrier. - Policy No.: % �
Z o ••
CERTIFICATE OF EXEMPTION FROMW/ ES
COMPENSATION INSURANCE
Tuf section need not be completed tribe parran is far me hundred dollars (51 W)
or less.)
1 certify that in the pcffmrnmea of the work for which Nis permit is issued. I shall nut
employ any person in any manner to as to became subject a the Workers'' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT. IL after making this Certificate of Exemption, you should
Became subject to the Worker's Compensation previsions of the Labor Cade, you must
forthwith comply with such provisions or this permit shall he deemed revoker.
CONSfN LENDING AGENCY
I hereby off rte that theret it is a a coem nstruction lending agency for the performance of
m
' the work for which thu permit u issued (Sec. 7097, Co. CJ
Lenders Name
Lenders AOtlmss
j 1 certify that 1 have read this it,licmion and more that the above information is
' cortca. I agree to comply with all city and county ordinances and sum laws relating to
building construction. and hereby euthorim rcpmacnmuves of this city to enter upon the
1 above-mentioned property for inspection purposbs.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
j liabilities, judgments. ensu and estimates which may in any way accrue against said City
in consequents or the granting or this permit.
' APPLICANT UNDERS7ANDS AND WILL CPJMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGUL, S.
Re -roofs
Type Of ROOFWill
��Lr'"%�G t tU�i/6 �
Sign urs or h oai/Cmunal ! /,Date
HAZARDOUS MATERIALS DISCLOSU
ERIA SDISrcorhandlc
me eppii=antmfumrUSMA
hazardous materialat
rdprif
defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Code, Section 255320)?
All roofs shall be inspecany roofing material being installed.
❑Yes 0 N
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment ordcvices which
can it hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yo ON.
1 have mad Ne Bitterroot materials requirements under Chapter 6.95 ofd¢ Califon
ria Health &Safety Cale, Sections 25515.25537 and 25534.1 un&rswd Nu if the bobbing
Jms oat <uncn0y hme s tenant, mat i ' my responsibility m n IY d¢ oeCUPmL or the
mm<ma whr oat be mein Iocam ora ceN to ar a=anan=r.
Signature of Applicant Date
All roof coverings to be Class "B" or better
d
LLNoar ar m1 ri'. igeB,1
10'-3"
File: MichelleD(N)Kitch(E)
06-02-2004
Owner: Michelle Dong Li
902 Cottonwood Dr.
Cupertino, CA. 95014 C�
(408)781-3860 DINING
140 sq ft
Drawn By: John Chen 1
Chen's Construction Co. O
1271 Washington Av. \ /
PMB 638
San Leandro, CA. 94577
W C INS. 1719135
Of State Fund Ins. Corp. 0
State Lic.: 702842
Cel.(408)655-9488 \
O/Fax(510)639-0853
co
GFI
1). Remodel the (E) \\
Kitcher& replace 9 p
cabinet counters as the --------------
(E) sizes. - - C° M _ I /7 1
2). Upgrade the cel
electridWircuits and -
I Flu. Light
outlets in compliance
with the City Codes. '
3). Install some (N) Fluo.
Lights and Recessed \
Lights in Kitchen and
Dining Area. APPROVE \
4). Replace Appliances. D`NPACCORDANCE WITH TM Cv os 1 KITCHEN
5). No window or layout orf"o CODES Alvo oe I"A"CES
changes in the areas. s c ED � _3 ( 104 sq ft \'
i his set of plans and— o e 7 l
-f-
De kept on the job at aq h al on ;MSU
lawful to make an , Id it is un
rn same Y changes or zll r tT
without written perm-; sic 1 from
he building Dept., Cit of
M1 The Stam ir"g Y cuperi no —
P b of this plan and spe ifi
U (� SHALL NOT be held to1--
ofV
�proual the violation Of any or
jav Cifv D dnxnce anY projisinr 11-0n nr SrarP t 21 -811r1._3..
10'-3"
WORKING AREA
244 sq ft
M
CO
N
N
•
C
JUN 03 2004
CITY OF CUPt^TING
BUILDING r)FPAf-°v1ENT
IV5
0
0
A n 8 2 g T_
O
m
m0 xKN
o o K o04 4
Rog 0 �
o�p O
1p2m Z
oho VT.
a �
m
0
I U LJ d
I I
I N
I m
I Z
10'-
0
•
JUN o ° ZD -14
CITY OF CUP -7nphlC
BUILDING DTPA c-
�
m m
v
I
m
m
10'-
0
•
JUN o ° ZD -14
CITY OF CUP -7nphlC
BUILDING DTPA c-
J
auoms
CITY OF
CUPERTINO
PITY OF CUPERTINO 0
PERMIT APPLICATION FORM
oyo6(003v
APN # 34 l
Date:
Building Address: Mailing Address if dif rent from building address):
u
Owner's Name;
P one :
I
_
Contractgr,
License #:
I
eO
Contact: V Ph
Cupertino Business License#:
Fax
BBOILER4
Building.Permit Info:
Bldg — Elect Plumb Mecham
Job Description: U �yCU.{� /&,/,
EA(
.Residential ,r ,+ Cor ❑
Sq.Ft. Floor Area:
S/Sq.Ft.:
Cost of Project:
Occupancy Group:
BCONSTAX
Ind/Off/Comm/Quasi
Type of Construction:
Please check this box if the project is a
Con. Tax for BQ Zone
second -story addition: ❑
Project Size: Standard ❑ Large ❑ Major ❑
Hotel and Motel
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBOILERI
Boiler <= 100,000 Btu
MECHANICAL
BBOILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler> 500K to 1M Btu
MECHANICAL
BBOILER4
Boiler> IM 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
LJ
1 of 3
319.6)
CITY OF
CUPERTINO
CITY OF CUPERTINO*
PERMIT APPLICATION FORM
Quantity Fee ID
Fee Description
Fee Group
BMISCELL
Miscellaneous Fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOMMM
New Comm Mechanical
MECHANICAL
BNUCOMMP .
New Comm Plumb
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 rinklerBackflo
PLUMBING
BPSTORM
Storm/Rain Water
PLUMBING
BPTRAP
Kitchen Trap
PLUMBING
BPVENT
Alt of Drain & Vent
PLUMBING
BPWATER
Install/Alter Water Pie
PLUMBING
BPWHEATER
Water Heater/Vent
PLUMBING
BPWSVCS
Main Water Service
PLUMBING
BREINSPECT
Reinspection Fee
BUILDING
BREMACOVER
A/C Unit > 10,000 cfin
MECHANICAL
BREMAIRHAN
A/C Units <= 10,000 cfm
MECHANICAL
BREMAPPLI
Appliance Install
MECHANICAL
BREMBUSWAY
Remodel Busways
ELECTRICAL
BREMFIXT
Lighting Fixtures
ELECTRICAL
BREMFURN
Relocation bf 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
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
2 of 3
1
J
gon
OF
CUPERTINO
1
4PITY OF CUPERTINO i
PERMIT APPLICATION FORM
uantily Fee ID
Fee Description
Fee Group
BREMSIGNAD
Rmdl Signs Add Branch
ELECTRICAL
BREMSIGNS
Remodel Sips, 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
BSPECIAL
Special Inspection
BUILDING
BSWIM
Swimming Pool
BUILDING
BTEMP
Temporary Power
ELECTRICAL
BTEMPPERM
Temporary Bldg Permit
BUILDING
BTEMPSVCS
Temp Dist Svcs
ELECTRICAL
BUSLIC
Business License
BUILDING
ELECTRIC
Electrical sq foot
ELECTRICAL
EPERMITFEE
Elec Permit Issuance
ELECTRICAL
MPERMFEE
Mechanicals . foot
MECHANICAL
MPERMITFEE
Mech Permit Issuance
MECHANICAL
PPERMITFEE
Plumbing Permit Issue
PLUMBING
PPLBG
Plumbing Fee sq foot
PLUMBING
ZADDCHG
Address Chane
BUILDING
r
LJ
•
3 of 3