Loading...
03090224 CITY OF CUPEWI'INO „ra - BUILDING DIVISION PERMITCONTRACTOR INFORMATION;; BUILDING ADDRESS: YANG, YANG PER MIT.°03090224 OWNER'S NAME: PERMITLSSUEDATE YANG YANG 03 IFNE: SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 100 LICENSED CONTRACTOR'S DECLARATION �"I F❑ 1 hereby affirm that 1 am lianscd under provisions of Chapter 9(commencing lob'Description iW with Sectlon7")of Division 3 ofthc Business and Professions Code.and my license is ee I.con force and ere". BACKFLOW FRONT & BACK YARD j ? License Class Lic,x f,a Dale Cum ramhr ""'j ARCHTLCCS DECLARATION f n U 1 understand my plans shall b,used as public records 1p� � 'a.f, Licensed Professional v 9 INAA® 0 OWNER BUILDER DECLARATION a i I hereby affirm that I am exempt from the Contractor's license Law far the MAR 1 0 2004 0 o following reason.(Section 7(1315.Business and Professions Code:Any oily or county which requires a permit to construct,alter,improve.demolish,or repair any strumure uZi prior q)its issmnce.also requires the applicant for such armil to file a signed oaemcm cs'c that he is licensed pursuant to meprovisimuofthe ContractoriLicense Lsw(Chapter9 Sq. Ft. Floor Area pµ�y�1� V���r�(��5y1paa�a�a c" (commencing with Section 7000)of Division 3 of the Business and Professions Cole)or BJVIONG a;$ that he is exempt themfrem and me basis for me alleged exemption.Any violation of 36224039 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ane ApN Number Occupancy Type not more than five hundred dollars(SSW). P Y 0 L as owner of the or my employees with wages az meirsole compensation, wi 11 do me work.and theswetpm iso,t intended or offered for aale(Sec.7094,Business — �1 and Professions Code:The contractor's License law does not apply to an owmer of 2 02 - UNDER U UNILSS�G property who builds or improves menton,and whodoes such work himself or through his we ompmyces,provided that such im,rovementsare nal intended orolfered ver safe It, 301 — ROUGH PLUMBING however,the building or improvement is sold within one year or completion,the owner builder will have the burden of proving that he did not build or improve for p nose of 302 - TUB & OR SHOWER salt.). ❑ I.as Owner of me property.am exclusively convecting with licensed contractors to 502 - FINAL PLUMBING ENERGY construct the project(Sec.7094.Business and Profusions Code:)The Contractor's Li- 506 — GAS TEST cense law docs not apply to an owner of property who wilds or improves thereon.and 507 — FINAL PLUMBING who contracts for such projects with a contractor(s)licensed pursuant to me Contractor's License Law. Ii"I m exempt under See. B A,P C for this match r_ Data 0 d6 2'� . WO KB S C NSATIO,DLC ON 1 herebyafOnn under,anallyofperjury hoeofthc in,dcclafnitoic ave and will maintain a Certificate of Consent to self-intim for Woker'scumpen- sation,ra provide)for by Section 3760 of Be labor Code,for me pmfmmance of the work for which this permit is issued. ❑ I haus and will maintain Worker's Compensation Insurance,az required by Section 3700 of the Libor Code,for the arformance of the work for which this permit is issued. My Worker's Com pensaion Insurance carrier and Policy number am: Carrier: Policy No.: . CERTIFICATE OF EX EM MON FROM WORK ERS' COMPENSATION INSURANCE (This section need not w completed if me permit is for one hundred dollars($IQ)) less) 1 certify mat in the performance of the work for which this permit is issued,1 shall not employ any parson in any manner so w Or wcome subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,otter making this Certificate of Exemption,you should become subject to the Worker'a Com pewalion previsions critic labor Code,you must Ofurmwi N comply with such provisions orthis,termi t shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY 1 hereby affirm that them is a construction lending agency fon the performance of Y 7 me work for which this peon;,is issued ISce,3097,Civ,C.) Lender's Name Lender's Address J Q 1 ecnify that 1 have read this application and sme that the awve information is s. F' correct.l agree to comply with all city and county ordinances and state laws relating to Z)U building construction,and hereby auditions representatives of this city to cover upon the above , dgmentioned pmpc costs for i expenses which may (We)agree to save,indemnify and keep harmless the City of Cupertino against N hurt I in of nU, granting eapcsscsmit, they in any way accrue against said City J z in conwquencc of UNDERSTANDS of this permit. UPLICANTRCERE UNDERSTANDS AND WILL COMPLY WITH AL ON-POINT Issued by: Date .. 5 URCE REGULATION . / . It L 0 Re-roofs Signature of Applic omncmr etc HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future wilding occupant store nr handle hileammus material az defined by me Cupertino Municipal Code.Chapter 9.12,and the ficalN and Salary cote.OY.255J2(a)? No All roofs shall be inspected prior to any roofing material being installed. Will the a scant or future building recti equipment If a roof is installed.without first obtainingan inspection, I agree to remove PP 6 Pam use a em or devices which p g i,hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. cl? t]Yu ri('Nu I have mad the wvardnusmatrials requirements under Chapter 6.95 of me Calder. ria Health h Sol ety Code.Secueas 25915.25533 and 2553a.l unJersmnd that if me wilding cots not currently haus a tenant,that it is my responsibility m and the occupant of m, requirements who ustwmelpdenuissuanccofa Ccmficawof cupency. Signature of Applicant Date G wrier or ed agent Dare All roof coverings to be Class "B" or better OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform: A. All the work authorized by this permit B. A portion of the work C. _ None of the work If B or C is checked,complete 2 or 3 below. SEP 6 2003 2. A state licensed contractor will be hired to do: BY.. A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be performed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signatures ate: 0 G Job Address/ C/I Permit# G Any changes to the information provided on this form shall be submitted to the City of 42ertino inild Devartment. 11 02 City of Cupertino Building Departent CITY OF 10300 Torre Avenue CUpET'NO Phone: (408)7m2 Dear Property Owiler: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect vourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensation• contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors'State License Board in your community or at 1020 N Street,Sacramento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper D- CITY OF CUPERTINO CUP TYOFINO PERMIT APPLICATION FORM 63 0 APN#� Date: d.Z Z O 0?/2 1 Building Address: r X86 C�Rsf," 'Pr. Owner's Name: Y Phone #: r ¢08 A S K - 6 a a \ g Contractor: �� License#: Contact: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect6l ElectPlu Mech ❑ Job Description: Residential ❑ Com erc al Sq.Ft. Floor Area: IS/Sq/Ft.: Cost of Project: Occupancy Group: Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS 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 <= IOOOA 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 1 of / CITY OF CUPERTINO CUPEYOF PERMIT APPLICATION FORM Quantity 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 BUILDING 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BRENMXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res A2pliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2 of 3 C CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO 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 Rmd] 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 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 MPERNIFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3