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04030046 CITY OF CUPERTINO - �7 `°^� ""�' "'n .& / BUILDING DIVISION PERMITCONTRAC-TOR INFORMATION �`:, fI OILDING ADDRESS: WANG DAVID K AND ANNE PERMiTNo04030046 OWNER'S NAME: PERMrr L$UEDATE NE: SANITARY N9103 CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH aOO LICENSED CONTRACTOR'S DECLARATION OpO O O w '1 haffirmlicensed that I am under previsions of Chapter 9(commencing Job DescriprAN A LED Zan ereby withSeen .7flfl()at Division S of she Business and Pfofcssioru Code.and my lime is in full fora and offset. 5n= License Class Lk.« 200 AMP PANEL MAR 1 0 2004 nt-� Date Contractor ARCHI3ECT*S DECLARATION < 1 understand my plans shall he used as public recnNs G Licensed Professional a. BUILDING so 3 OWNER-BUILDER DECLARATION .� I hereby aRrtn deal I am exempt from the Comncmrs License Law for the p 0 following moon.(Section 7031.5.Business and Profession Calc:Any city or county which requires a Permit to m strvct,arm,.am,.,demolish,ar repair my nrucmm If F?i prior In its issuance,also meuiro the applicant(orsuch permit to rile a signed smomcnt m¢ that he is licensed p..am1.she provisianofMeCmarmum',LianaLaw(Chepe,9 Sq. Ft. Floor Area Valuation X1-0 (contmcncing wish Section 70111 of Division 3 of Me Business and Profcssimu Code)or y $ that he is ass mpt themfodm and Ne bass for she alleged exemption.Any violation of Section 703 LS by airy applicant for a permit subjects she applicant to a civil parsley of rA�Diai,«,g�',s, oat mom Nan riw headland dollars(ISM). 3 W N4t4?gr0 0 Occupancy Type ❑I,mowmr of Ne proprny,amy employes wish wagau Heir sole compensation, will do Ne work and Ne swclum is not intended in offered for sale(Set.7054•Business and Professions Cade:The Commodore License Law does Out apply to an owner of Required Inspections podpcny who builds or improves thereon.and who doessah work himselfor through his am employees•provided that fah improvements art nal founded or offered fmsale.If. however,she building or improvement if sold within one year of completion.Ne pwncr- builder will have the burden of proving that he did not Wild or improve for purpose of sale.). ❑1,u Owner of Ne propeny,am exclusively contracting wish licensed contractors 10 e muuet Ne godless(Sec.7004,Business and Pentagon.Cade:)The Contractors Li. me law does not apply to so owner Of,.,ny who Wilds or improves desmon.and who cantacts(Of such projects wish a caneaerar(s)licensed pursuant to she Contractors "Lease law. Ifundus B&PCfermisreamn Ow.e. / J WORKER'S COM ENSATIO ECLARA 1 hereby sf irm under penalty of perjury one of she following decsmtians: J J l have and said maintain aCerdficme ascertain to self-IM1WR for Workers COmpen sation,as provided for by Section 37M of the Labor Code,for Ne perfomenm of she work for which this permit is issued. ❑I have and will maintain Worrier's Comperuation Insurance.as rcluiad by Section 3700 of the laWr Code,for dee performance of the walk for which this permit is issued. My Workces Compensation Insurance carrier and Policy number ane: Carrier. Policy No.: _ CERTIFICATE OF EKEMP ION FROM WORKERS' COMPENSATION INSURANCE Qhs accum rad not W eomplcmd if the permit is for one hundred dollars(SIM) ar less.) I certify that in the performance of the work for which this permit is issued.I shall Out employ any,Pcrmnin wijecomg subject total Workeri Compensation Laws of Cabfo 6 tt o - APPlicanl gs L( i NOTICEU4 APP :I•e ser making this Cenificatc of Exemption,you should become�i met to she Warker's Compensation previsions of the labor Cale,you most .J 2 forthwith comply with such prenvisim or Chia pomp shall be decmcd revoked. zO V CONSTRUCTION LENDING AGENCY P:tz, Ihands,afrm Ma,mert iso caruweum lending ages,for ft pcifomanm of ' ^.G? the work for which this permit is issued(Sec.3097.Civ.C.) W lender's Name Dn Lender's Add. :D'7. O Q 1 certify Nat I have mad this application and sea:that the above information is F' cofmcL I agree to comply with all city and county ordianca and sum laws reclating to pU Wilding emistrunion.and herehymummoe representatives Ofdrf city to cult,upon the above-memmcd property far inspection plop. (We)egret Io ane,indemnify and keep harmless the City of Cupertino against F" Ta'A liabilities judgments,costs and eapcnsa which may in my way accrue againsnsaidCity U Z in consequence of the graining of this permit. r ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITHLL NON-POINT Issued by: Date s URCE REGUL ONS -7. l° Re-roofs Sr - rc of ApD'is ntraan Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant ser fuwre,building occupanutare or handle hrrardous material aa de0md by the Cupertino Municipal Cods,Chapter 9.12,and the Health and Safety .sr ly.s s3xan 9�a - All roofs shall be inspected prior to any roofing material being installed. Will the applicant or forum Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants a dcfncd by she Bay Arca Air Quality Management all new materials for inspection. Dstrin? Ycs dNo 1 have read the monism,materials requirements underChapter6.95urge Califor- m. alth&SarelyCode.Sections 255(15.25533 and 25534.1 undcrsmnd thou done Wilding dors not curmmly haw a means.Lha it is my hamomibility In has tM"'Incaparr of the requirements which orow qe, �ifs mora Ccnifes affxcupmc Signature of Applicant Date ( °"— " '�45"a 'zo - 0euthorivcd All roof coverin s to be Class"B"or better a rat Date g Community Development I ZIA, 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS PERMIT #6 U 2, OWNER'S NAME: JC 3 g IUC-7 PHONE # — p GENERAL CONTRACTOR: / FAX # I am not using any subcontractors: tel` lcXl- Signature '/ v Date Please check applicable subcontractors and complete the following information: 61 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass/ Glazing -----/'1r-Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile caner/C ntractor Signature Date a(Iffl- CITY OF CUPERTINO CITY OF CUPEkTINO PERMIT APPLICATION FORM 01 o APN # Date /B D vLk Building Address: L Mailing Address (if different from building address): Owner's N51: Phone # Contractor: r License #: 0("ex u :Ja.l 49 Contact: Phone- Cupertino Business License#: B ding Permit Info- 91 W lect [ Plumb ❑ Mech ❑ption:l V UfJ '�/� �CLs-cG L Commercial ❑ Sq.Ft. Floor Area: � ,ry $/Sq.Ft.: Cost of Project: CU Occupancy Group: r Type of Construction: p Please check this box f Ject is a ✓�'� second-sto addition: ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 1 OOK 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 1 BELEC1001 Elec 600V > l 000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILD G z � 7-3 I of 3 -7 / z '1-7 7 L - CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 Pb1g 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 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 of Furnace MECHANICAL BREMFURNOV Relo Furnace> IOK 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 BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL 2of3 CITY OF CUPERTINO CITY CUPEf�TTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMTHEATR Theatrical Ligbting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL M BREVENSYS 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 Temporairy 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 Change BUILDING 3 of 3