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04070145 CITY OF CUPERTINO BUILDING DIVISION PERNS CONTRACTOR INFORMN BUILDING ADDRESS: KUO HWA CHEN /T. C. WHANG 111I1N°04070145 74 ER'S NAME: PERMIT ISSUE DATE W N KUO HWA CHEW T. C ONE: SANITARY NO. CONTROL NO. ARCHITECTYENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ye;�ig 111 0 _oo LICENSED CONTRACTOR'S DECLARATION Ib DCSCr Y C 1 hereby affirm that I am limsed mOI nunder provisions°f Chapter 9(com encing p U with Section?")of Division 3 of the Business and Professions Code.and my license is TANIFINIU III III n�d immImmaondeffam. REMODEL KITCHEN/BATHROOMS >�j_ License Clea U1.as 90Z - - d3S zt4-� Date Centimeter a sARCHITECTS DECLARATION 1 understand my plans a ans shall he used is public records ®3� IA 3 G Licensed Professional OWNER-BUILDER DECLARATION .�<f I hereby affirm mot I am exempt from me Contractor's Licensee Law for me 00 following moon.(Saturn 7031.5,Business and Professionsco Code:Any city nr unty X m Pi which requites a permit to mower,alma improve,dcmdL h,or repair any summon 9000 prior W its issuance.also requires the applicant for such permit to rile a signed smmment t < that he is licensed funereal to dre,prowisiore,of kc Centimeter's Licaftean Law(chapter 9 Sq. Ft. Floor Area Valuation a $ (commencing with Section 7000)of Division 3 of NC Business and Profcssians Code)or y — Nat he is exempt uhertfrom and the Buis for the alleged exemption.Any violation of Secuon 7031.5 by any applinnt for a permit subjects the applicant m a civil peredy of 3 501llffi�erO0 Occupancy Type not more them five hundred dollars($500). 01,uownmoflMpmpmy,mmyemploycnwithwaguumeirrolecompenorlon, ,,ssa��s...ggq p will domcwons Con1c;and to Con isnotimcnded man Law red not apply.70,W.Business Required Ins LE® and Pm who bs Code:The Conlhilmon,and Law dues not apply ll an owner is q p propertywhobuildsvided met umereaeandwho don smhwork moff atthrough his haver cmployms,provided mase such impmsemenu are ne year of mpeered for ole. r- builder,the building or improvement soldwithinono year of completion,theeoncr- builder will have dm When of proving this M did not build or improve for puryase of salon SEP3e 2014 ❑1,as owner of the property,am exclusively contracting with licensed romractors m consumer me pmjcn(Sec.70Cd.Business and Profusions CadeO The Conuacter s Li- ccueLaw donrsnot chapply rjeanownerofpropertywhoWildsorarmtouCommeand BUILD tl who. aces for such projects withaconvanor(s)linnsed pursuant to the Conaanoss `®y tpCf� I@9yyp`Jtlryg see law. Clamemmpt dersee. .B&PCT renis rtuon oaf /r 1st Js&' W KER'SCOMPENSATIONDECLARA 1 hereby affirm under Penalty of perjury one of the following declarations: ❑I basin andwillmainend aCemfimm of Consent ro self-insureforWorkersCompen- ano.n,ss provided fm by Secuon 37W of dm labor Code.fee the performance of me work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,u required by Section 37W of the labor Cade,for the performance of Ibe work far which this permit is issued. My Workefs Compensation Insurance carrier and Policy number sre; Comer: Policy No.: . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need net W eomple.d if me permit is return hundred dollars(5100) or less) 1 eenify m me performance o!the work for which this permit is issued,l mall not cmployany ymanncr sea as o cc mcsubjecuo the Workers Compensation Laws of ca D 1+�-Yuri. Ap cant ✓ `��fY/� WN qE TO A" 1CAN:It.after makmg this Certificate of Exemption.you should p e subject w the Worker's Comp reemo r provisions or me Labor Code,you must .JO forthwith conn,Ywire such provisions or this perm it than l be memed revoked. Z" CONSTRUCTION LENDING AGENCY [-.� IWmby affirm met mart is a construction lending agency for the perfrmtarom of ".�> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Under'a Name 6s Landeri Address V1 anify that I have read may application and state mel the aW ve Informed.is {2..E' comcm I agree to comply with all city and county ordinances and sate laws relining m �U building conswmion,and hereby aumoriae repremmisuives of this city aro came upon the r� move-mentioned property for iurreelmn purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against F' ,I Iiebiliucajudgencncs.costs and expcuu which may in any way accme agama aid City U Z Aconsequence PLIC NT°of ft UNDERSTA°g of DS Ars Permit. ND WILL COMPLY WITH ALL NON-POINT Issued by: D �K?/ SOURC R11ATIONS VT' rC — i* Re-roofs Sign of APplic °mmum ate HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will me applicant or future Wilding occupant store or handle ha ardous material as ticfined by me Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Ca1c.5ccy25532(a)? m `J All roofs shall be inspected prior to any roofing material being installed. ❑Y Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air conmenimma in defined by the Bay Area Air Quality Management all new materials for inspection. DisuicR ❑Yrs �Nu 1 have mad me havamens mamrimarequiremenes under Chapter 6.95of the Califor- maHealm&Safely Code,Sections 25W5,25533 md25534.l undersand mat lithe Wilding door not currently hen+:a mnam,that it is my fcsponsibility W early the Oacupam of the requircmcm hie usrl t rwismanaafaccmOCamrif0m yr. Signature of Applicant Date or mrmca agtn All roof coverings to be Class "Bt'or better CITY OF CUPERTINO* CUPEt�F PERMIT APPLICATION FORM o `f �S APN # Date: Building Address Mailing Address (' d' erent o bu' ding address): 2 06 LI, Q 119Z)V, Gt f Owner's Name Plione #: c _ w! Contractor: 2V v License#: O l �'e k Contact:, Phone: 6531Cupertino Business License#: G✓�a� Fax: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Pe� u � nocrr gQ K' chi - Residential ® F �� ,d t��Co /mmerci lam❑l 7N d Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: fS� Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ 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 2- q / lof3 *CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEVINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCONSIE New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCONIW 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 WaterHeater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 clip MECHANICAL BREMAHUiAN 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 BRENU T A P Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL a BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Ap Hance ELECTRICAL 2 of 3 p- *ITY OF CUPERTINO * . CUP kTTYOF O PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 Insection 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 Change BMDING • 3 of 3 i � o � m o Ti � a J °'O@,QTMEN ------------ a r - . Qt - ' y, . ,E/.C� pr•�i�f �,v 14 f/v wEt V¢ -- w r4.1I llu ,tr W/ vvp J p�Cw��✓ yliuuorr A ROVED s N+ I ACCORDA E WITH CITY 0 PERTI DIN ES drrJllS .dr{ This �► pf Wens specifications MUST be 1 kept on the jo all times and it is unlawful C�Q1J I>LA�xj to make angel or alterations on same A houI en permission from the Building • Deo ent, City of Cupertino, ' eQ The stamping of this plan and specifications her , r,Pkpjoot 5 r, s4( SHALL. NOT be held to permit or to be an ti/ AP001„►! arroval of tha wn'-fi... p ;ny provisions of uaiance or State L,w. Tk �!{rOrIV L'>bJ GInC NIiC cl�AV � _-" co1L R{p4k L�{w"lf MoJ 'yi MAs� �L 13.E-r+}- 44t 1;,. ► �Ll, to�r+4 I�G�