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03060090 • CITY OF CUPERTINO dF % «IPe`�+ 7 r•sL�>r nr • BUILDING DIVISION PERMIT y,, Orr 9AG-TOR INFORMamI BUILDING ADDRESS: HENRY CHAO /EILEEN VOON PFRMITN.03060090 a OWNER'S NAME: PERbtIT SsffD/ 1'12/ZOO 3 NE: SANITARY NO, CONTROL NO. ARCHITECTyENGiNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Sop LICENSED CONTRACICR'S DECLARATION rd(Y 1 ba by"ren that 1 an Related under provisions of Chapter 9(commencing lob Description B z with Section 70y)of DIAmm 3 ofdte Busman had Pmfcubm Cakl.aad my ficallma n< in full force andeReeL Cn— D�nm ChisContractor NEW GAS LINE TO COOKTOP JUN 4 3 2003 S ARCHrTECrS DECLARATION 1 undersand my Flans shall W hand as public man,& p 5^� Licensed Professlontl OWNER-BUILDER DECLARATION BUILDING 21 Waby affirm that 1 em exempt from tee Common's License Law for the o O following maven.(Section 70313.Business and Professions Code:Any city or county 5$ which am ulre,a Permit to ennsuucL alar.hnpmw,demolish,or repair my structure S^ priors its imumce.elm regwres the applicant for such permit to rile a signed statement �< met M Is licensed pursuant w the prevision of the Canonical's Lkentan Law(Chapter 9 Sq.Ft.Floor Area $Velton zC9 (commencing with Section 7000)of Division 3 of the Bushman and Profcasione Code)or 3 that he is exempt therefrom and the basis for she alleged emmpulon My violallm of Section 7001.5 by any applicant far a permit subjects the applicant an a civil Faulty of 3 2&&UibfnUcr0 0 Occupancy T ant mane dun Ow hundred dolor,($500). p yy '� ❑I,aa afthepropmy.mmymplaycawithngesutisirmiccompemdm. willdo the wort vol thesrm um,hs mtinurucd a offend foram(Sm.7044,Bust. iUb — md PmfWIOn Lade:The(manctaY,Lt..Law dams not apply in m owner of property who builds orimprom therson.and whodoessuchwak himacifortivaugh his 202 — UNDER C9 UMSING own employees,provided mat each improvements sm ml intended aroffered intends.If, 3O1 — ROUGH PLUMBING however,the building or improvement is mid within our your of completion,the owner- builder will haw the burden of proving that W did an,build a improv fm purpose of 302 — TUB & OR SHOWER u1o')' 502 — FINAL PLUMBING ENERGY ❑1,as owner of the property,am amminly consuming with Ilecomm contractors to construct me pmjm(Sec.7W,Business and ProfeWon,Code:)The Comrmar's LI- 506 — GAS TEST «tee paw docs am appy to m owner of property who Wilds or improm themm,and. SO'J — FINAL PLUMBING who conncts for such pmjecss with acmumar(s)licensed puwnt w the Contractor, .Licam paw. Ian tee tptmda Seef(sur�mi,�w�on I Dan 6 , IV 2 OR ENSATION(jE RATION �� I Wreby Nim under Family of perjury arc of the following decluationac 1 haw end will malnuin a CatiOcam ofcouent a anif-iuum fa WaccesCampen. sadden,u provided for by Section 3700 of the Labor Code,for tis perfamlmce of the work for which this permit is issmQ ❑I law and will maintain Worker's ComPenatlon Instanntt.u required by Section 3700 of the labor Code.for the performance of the work for which thin permit is issued. My Workers Compensation Insurance ismer and Paltry number art: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE milsmaim need ant W completed time permit aforooa hundred dollus(SIM) or late) I certify that In the perfmmunce of the work for which this permit is issued,I Nall not employanywasanin Aly n mu membjectatWwa Worken'Comp0on law,of Cal P ate Appll NOT E / PLI AI IL a making this Cedifl aw of Exemption,you should born Jen m Irk Walker's Compensation provisions of ted Labor Code,you must .,O foMwith comFly veil I such provisions or this Permit shall W demand rumkcd. zCONSTRUCTION LENDING AGENCY I Walby affirm that dart is a construction lending agency for the performa ce of Z> the work for which this permit is island(Sec.3197,Civ.C.) - 1 Q lenders Name =z Lendee,Addw J O [,.city also I Mw rand ma applicatim anti ante Nn the aWw mfotmNm I. t i I"' roue,1 apo in comply with all city and county ordinances and sum Ian relating to Wilding cool auction,ad hereby salmon rtPrtannutim of this city to enter upon me �+a above-mentiomd propeny for inspection purposes. F (Wc)a:me to saw,indemnify and kecp lu ellen the City of Cupertino again V5 liabilities,judgments,cons ad expanan which may in my ray ammo sSam,said City C.3 Z in consequence or the emoting or this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:. Date SOURCE R ULATIONS. t / ! ser -- Re-roofs of pplic ✓ 6 CaSm AZA OUS MATERIALS DISCLOS a Type of Roof Will the appli®np or fuwrt Wilding oecupmt stem or handle hamardous material as d firmd by the Cataluna Municipal Code.Chapter 9.13.and the Health and Safety 0M, Dy. No A]No All roofs shall be inspected prior to any roofing material being installed. Yes Will the appficmt o r�uture Wilding accupant ate equipment a davicns which If a roof is installed without first obtaining an inspection,I agree to remove B hma hate air cmwninma a defied by sen Bay Ama Air Quality Mwgemcnt all new materials for inspection. Isminl7 ❑Yea 1SYNu It ve mad me hamlou,materiatsrnqulmmenu under Chapmrd.95 orris Califor. nu Heapal&9afetyCodc,Seedwa35503,35533md35534.1undersundthaifale Wilding duh nal currently have a anent,met it is my responsibility to notify the occupant of tis mquirtmc whicbmu metpnorwinumceafacenficamofocmpmay. Signature of Applicant Date caner sur suthorid sem , 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. CET 2. A state licensed contractor will be hired to do: JUN ] 2 20 A. _ All of the work B B. _ A portion of the work (complete section below Contractor Address/City Phone # Stat icense # Type of work to be performed • 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 Signature:✓' Da 6 z GOT job Addre 0 223�� urra-r�,�o �a /ki27/nro Q bl� Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. � CITY OF CUPERTIN �� ci i�O _ 1 2 2003 CUPEI�TINO PERMIT APPLICATION OI ___ BX: a v o N# Date: � 3 Building Address: 22334 CCAft-on P0 D 0 OA. �6t Owner's Name: AMM 67377 4& Contractor: License#: Contact: Cupertino Business License#: Building Permit Info: Bldg ❑ Elect ❑ lamb Mech ❑ Job Description: 7 Residential e 7 �Comm:�ercia?&Jldp Sq.Ft. Floor Are : $/Sq.Ft.: Cost of Project: Cab Occupancy Group: Type of Construction: AILr- Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEEBldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K 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 BMITIGATC Comm. Housing Mit. Fee BUILDING Iof3 ZZ�33 ar CUPEfs,TINO i= CITY OF CUPERTINO �'n° 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 Multifamil Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCONE M New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTDa 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 hiterceptor 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 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL. BREMFD{T Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace 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 Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ' ELECTRICAL 2of3 :; CITY OF CUPERTINO 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 Rmdl 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 Insection BUILDING BSWRA 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3