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04050072 CITY OF CUPERTINO BUILDING DIVISION PERMIT wONTRACTOR INktORMATION:.,, BUILDING ADDRESS: JERMY TUCKER AND JOYCE C g"'NO04050072 10364 CRESTON DR OWNER'S NAME: PERMIT ISSUE DATE Ighk JERMY TUCKER AND JO ONE: SANITARY 2 CONTROL NO. ARCHITECTMNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 +p+WULICENSED CONTRACnOR'SDECons of CON Job Description iWw❑ I hereby B.I' that I am IicenuO under provisions of sCedO. 9(commencing P with Section nd1U3of Diviaion3of dm Business and Professions Code.and myliccnse is �« imm�rare anderca GAS LINE FOR COOK TOP/ELECT UPGRADE Licenm Class Lie.a Z Date Conlratemr ARCHITECTS DECLARATION 1 undersand my plans shall W used as public records piU , 3 G(; Licensed Professional g OWNER-BUILDER DECLARATION eS 1 hereby maxo affirm on 1 am exempt from the Common's r:Any C Law fur the p O following reason.(Section 703 L5.Business and ws.de mu Code:Any city Of coumy m which requires a permit to construct.alar,impmw,demolish,Or repair any structure �1 Fie priofm itsissuana,aluantto res provisions or fors ommunitLkm Law(Chapter mm that he islicensed pursuanuothepmvrsionsofthcComrucmr'sLianalaw(CAap¢r9 Sq.FL Floor Area /6 anon yFp (commencing with Section 700()M Division 3 of the Business and Professions Code)or i Nat he is exempt therefrom and the base for to alleged exemption.Any violation of Section 7031.5 by any Finessed for a permit subjects Ne applicant to a civil penally of not mom than five hundred dollars(M). 3?l$'AIR etO 0 papcy Type �06-more of the property,or my employees with wages u their sole compensation, will do the work,and the smcrure is not intended or offered for sale(Sec.7814.Business and Professions Code:The Conoamors License Law does not apply In an owner of Required Inspections property who builds or improves themon.end whodaa nahwork himself orlhmugh his own employees,provided Nat such improvem rda are not intended or offered for.ule.If. however,the building or improvement is sold within one year of complcuon.the owMr- builder will haw the burden of proving that he did not Wild of improv for purpose of sale.). ❑I.as owner of the property,am exclusively contracting with licertsed em uacmrs to consumer the project(Sec,7044.Business and Profinumns Code:)The Contractors U. _ moue law docs not apply loan owner of progeny who Wilds or impmws Neon,and. who contracts for such projects witha mmur mor(s)licensed pursuant is due Contractors License law. ///��� C] I am exempt under Sec. B k P C for Nis mamn 7t Owne Dale / ` WORKER COMPENSATION DECLARATIONDate 1 hereby affirm under penalty of perjury one of to following declarations: 1 ban and will maintain aCenlflcme Of Com ent t0 Rif-Insume for WorkerSGompen- sation,az provided for by Section 3700 of the LaWr Code,for Lha perfomana of tW work for which this Permit is issued. ❑I ban and will maintain Worker's Compensation Insurance,as¢yuimd by Seedon 37W of use Labor Code,for the perfamance of Ne work for which this permit is issued. My Workers CPmpmtsauon Imm.nce canter and Policy number art: Cartier. Polity No.: _ CERTIFICATE OF EKEMPI'ION FROM WORKERS' COMPENSATION INSURANCE ('Ota section need not W complesed if the permit afmone hundred dollars(SIM) fir less.) 1 certify Nat in Ne perRmn of the ore for which Nis permit is issued.I shall not employany perso nanymannerm Wcom�mbjeemrWWorkeri Compensation Lama of Calif APPlicanl //i v— NOrICETO PLICANr:If,i@r making Nis Certificate or Exemption,you should bttomc in t to the Wan cr's Compensation previsions of me LaWr Code,you must ,J Z foMwiN miely with such prnaioons or this permit shall he deemed revoked. Z O71 CONSTRUCTION LENDING AGENCY [-. I hereby affirm that Here is a construction lending agency for the performance of !r the work for which Nis pemit is issued(Sec.3097,Civ,C.) W QUnder's Neme IZ Under's Address U Q 1 unify that I ban read this application and sum the dee aWw information is Uy E-' coma I agree to comply with ill city and county oh in rams and sues laws mlating to 0U building construction,and hereby auNoriu mprescnutives of this city to enter upon the above-mcntioned property for inspection purposes. (We)agree to on.indemnify and keap harmless dm City of Cupertino against fM fA liabilities judgmcnu,conts and calmoes which may in any way we=against mud City U 2 in eotsegancc of the gmming of s perms APPLICANT UNDER AN AND WILL COMPLY WITH LL NONPOINT Issued by: Date SO EREGUL TIONS _ Re-roofs S /� $ c/ are of APPlican omnmm Dam � v HAZARDOUS MATERIALS DISCLOSU Type of Roof Will Ne applicam or future building occupahN nt store or handle oaous material az defined by the Cupertino Municipal Code,Chapter 9.12.and rhe Hca Wt and Safety 'ill Semnn us3xa7 All roofs shall be inspected prior to an roofing material being pre, ❑Nu P P Y g ginstalled. win,,applicant fir mem building occupant use equipmem Or devices which -If a roof is installed without first obtaining an inspection,I agree to remove No Moth havardous air conummants as defined by the Bay Area Air Quality Management all new materials for inspection. DI]trlml? ❑Yes C]No I have read the hmarthms mamriols requirements under Chapter 6.95 of the Califor- nia Head"Safely Cade,Seen.255315,25533 and 25534.1 understood Natif the Wilding docv nor eumenlly bave a uenae,N it is my r pomibility m mml'y de acupam of the mquiremc whichmuy.Wme rtrtiazu enracerdficat "My Signature of Applicant Date OwauNari7,cdagent I k Del All roof coverings to be Class "B"or better Community Development {✓ CO0 Torre Avenue p rtinno CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building De artment JOB ADDRESS: IT # /43 4 CIZLdyo P✓' 10c? o S`o a OWNER'S N . H. C. z L1 C K0-r?, PHO # 4z 4� 73 2 G GENERAL CONTRACTOR: FAX # I am not using any subcontra ' rs: Signature Date Please check applicable subcdntractors 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 Oi�rner/Qopya7or Signature date OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. ZAll 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. 2- A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to '✓C CS1 t1111iC4 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 siide)4:f� Property Owner's Signature: ` Date: 2 D Job Address: /d3G fh C 9,- C J tkJ D✓- Permit# 0v / Z Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Deyartrnent. 401 City of Cupertino Building Department CITY OF 10300 Torre Avenue C'w I P E(?T I N 0 Phone: (408)777-3228 Dear Property Owner: 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 vrotect 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 goverment 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 on Rec clad Paper Printed Y Po - CITY OF CUPERTINO0 (� v CITY of PERMIT APPLICATION FORM CUPERTINO N # 2- Date: 3 v � ° � s- ia -o Building Address: Mailing Address (if different from building address): LD?SG 4 Ceea�oa bc- � Owner's Name: Phone #: t'2ane. 1.....e Contractor: License #: Contact: Phone: Cupertino Business License#: Fax: B ' ding Permit Info: Bld , Elect ❑ Plumb Mech ❑ Job �ption: p�p-p GAS c([,,, r--.�fL foclt TPPC� J - esidential ® Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Pr(M' : Q�as Quo / Occupancy Gro Type of Construction: Please check this box if the project is a G second-story addition: ❑ JJar roject Size: Standd COY Lar e ❑ Major ❑ 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 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 1 of 3 l� C CITY OF CUPERTINO CITY of PERMIT APPLICATION FORM CUPEkTINO 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 PFIXTURE 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 c$n 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 Fumace> l 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 2 of 3 � ! ° CITY OF CUPERTINO CUPEIZr PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Si s 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 MPEPN FEE 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 CITY OF CUPERTINO �em 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 2 Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 32637044 . 00 DATE ISSUED. . . . . . . : 05/12/2004 RECEIPT 4 . . . . . . . . . : 25524 REFERENCE ID # . . . : 04050072 SITE ADDRESS . . . . . : 10364 CRESTON DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER JERMY TUCKER AND JOYCE CHANG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1014 RECEIVED FROM . . . . : JEREMY TUCKER CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY JERMY TUCKER AND JOYCE CHANG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1014 TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - --------- -- - - - - - - ------ --- - - ----- --- - -- - - - - - - - - - ----- - - - - - - - --- -ENERGY PERMIT FEE 77 . 00 23 . 10 0 . 00 23 . 10 0 . 00 BPERMFEE VALUATION 190 . 00 77 . 00 0 . 00 77 . 00 0 . 00 BPGAS OULETS 1 . 00 5 . 00 0 . 00 5 . 00 0 . 00 BELEC200 METERS 1 . 00 27 . 25 0 . 00 27 . 25 0 . 00 BREMPOWER POWER UNITS 1 . 00 44 . 40 0 . 00 44 . 40 0 . 00 PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 11 0 . 00 1 . 11 0 . 00 BSEISMICRE VALUATION 190 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00 -- - ------- ---- - - - - - - - --------- - - - - - - - --- TOTAL PERMIT 249 .40 0 . 00 249 . 40 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER -- - - ------------- ------------ -------- - - - ------- OTHER 249 . 40 VISA TOTAL RECEIPT 249 . 40 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 202 UNDERFLOOR UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING