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05100036 CITY OF CUPERTINO -�� 7 'a' n 7.ase BUILD NG DIVISION PERMIT ,CONTRAGTnR INFORMATION BUILDING ADDRESS: GT ELECTRIC PERMIT NO.05100036 10170 E ESTATES DR OW NER'S NAME: PERMIT ISSUE DATE HSUEH YEH 861 WINDSON HILLS CIR 10/10/2005 NE: SANITARY NO. CONTROL NO. (408) 362-9473 AR CHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 "Y lob Description pp LICENSED CONTRACTOR'S DECLARATION r❑ I hereby afnrm that 1 am licensed under provisions of Chapter 9(cnmmendng � W with Sectian]0(W)of Division3of dm Businea and Prafessiom Code. Mmylicense is nay in fullforceaodc �J �IIC „ S d Lm.* L UPGRADE ELECT. PANEL (200AMP) 5 a�Z Liccnm Clua n^W Data COnIrLLYOr�Gj J AR CHITECTS DECLAR ds t < I understand my plana shall h used u public records ' 5du r o y Licensed Pnsfcssional ` S OWNER-BUILDER DECLARATION I With,maxo .Priem on 1 vac cxcmne from an th Canon C s License Law far the o o which se mazoa.(Section 70211.5.Business, tar. and Rofeatians Cade:Any city ametwo county $E which mquiru a permit to mcuwen altar.impmw.JemolLah,m repair any atmnum $2700 ;y prior hs its issuance.also requircs Lou applicant for such permit to rile a signed statement < that he is licensed pursuant to the provisiouarMeComncmeiLima. aw(Chapter 9 Sq.Ft. Floor Area Valuation xI.z o (commencing with Section 1000)of Divi ion S of Me Business and Professions Code)or y that h u exempt Memfrom and the hull for Me alleged exemption.Any violation of Sectio^7031.5 by any applicant for a permit subjects Me applicant m a civil penalty of r Occupancy Type not mom Man low hundred dollars(SNA). I,u owner of the pmpeny,or my employcm with urges u Meir mlc comNnution, willdo Me work and Me structure u not intended Om@rad for sale(Sec.]014,Business and property Professions Code:The improves mr's and law doll not apply to an owner of RequiredInspections property who builds or ed Met such chicon,sad who daeesuch work himselfor"rough his AQyp■�47jp!/Q awn a however, Me ui provided Mac such improvements arc not ear of completion,oe pered for tile.Ir. however.sale Iill he.tie or impmvemem is hald within arc year of imp oar the Owner- builder ill have dlo burden of proving Mm h did nuc build m improve(or puroose of ❑1.as Owner of Me property,am exclusively contracting wish licensed contractors to Orr construct to project(Sec.7044,Business and Profusions Cade:)no Contractor's Li • cense law does not apply to an owner of property who builds or improves dtemon,and 00✓ who contracts for such projects wish a contmaor(s)licensed pursuant Me Conummes License Law. '� ;�• Iamexemptunder See. .B&PCfm Nism�an Owner Date �ryyj-V;I�d WORKER'S COMPENSATION DECLARATION 000 t?VY I'A\�3.+'Js 1 hereby M.under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent self-insum for Worker's Compen. solid ,as provided for by Section 31M of th labor Code,for Me paromaance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,u required by Section 37W of the labor Code,for the performance o/Ne work far which this permit is issued. My WorkerisCompensation Insurance carrier and Policy number an: Carrier. •�'fi l Policy Na: 'CERTI CATEFl OFEXEMPTION FROM WORKERS' COMPENSATION INSURANCE QTia suction aced not bceomplelod if ch permit is farochundmd dollars($TIX0 or less) I eenify that in Me performance of Me work for which Mis permit is issued.I shall not employ any person in any manner an as m become subject m th Workeri Compensation Laws of C.1ircionx Date Applicant NOTICE TO APPLICANT:If,after making this CeniGcate of Exemption,you should become subject as Me Workers Compensation provisions of the laMv Cadl ynu mass J;r fmMwhh comply wish such provisions or this ro m,shall the,deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that Mcm is a construction lending agency for Mc performs^aur 7 she work far which MI,permit is issued(Sue.nowt,Civ.C.) V-1 Q Lender's Namc , � Lcndcis Addm.< (,) 1 ttnify that I haw read this application and mine that Me show information is U 1 Correa 1 agree to comply wish all city and county andiunces and an¢laws relating to Vbuilding conmmction.and hereby monism mpresentsums Of this city to color upon the shove-mentioned property for inspection purposes '?`0. (We)agae to caw.indemnify and keep harmless Me City of Cupertino against rn liabilitiu.judgmcnta,custs and expenses which may in any way accrue against aid City U� in consequence of Me gnncing of this permit. e-a APP ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date l0—/d'—o 5 R REGULA aS. .0 U 11-Q Re-roofs Signature of ApplicaMContraaor Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Me applicant or future building Occupant smm or handle hraarcous material as derined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Ailijustic,Sonyion 25532a)? e All roofs shall be inspected prior to any roofing material being installed. Will Meapplicant�or future building uta a t use a ui mem or devices which If a roof is installed without first obtaining an inspection,I agree to remove Citg e^ 4 p it hrardnus air contaminants u defined by Mc Bay Area Air Quality Management all new materials for inspection. istrict? ❑Ycs Nu I have read Me harardnus materials requirements under Chapter 6.95 of Me Cali for nia Health&Safety Code,Sections 25515.25533 and 25534.1 understand that train,building Jars silly have a tenon,Mat it is my rcspansibility is,nntily the occupant of Me mgum`nn hichm el poor it)issuance of a Certificzlo0,Cu ancy. Signature of Applicant Date o ////ggg''' 0-f -w Ow amhonzedagent Date All roof coverings to be Class "B"or better Community Development c 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPE�TINO ®® Building DepIcutment JOB ADDRESS;_ PERMIT# 10[73 b� 0 OWNER'S NAME: PHONE # GENERAL CONTRACTOR: Z,, FAX # I am not using any subcontractors: � / K 4M 4.n Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical G G 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 La-10 CJ� Owner/Contractor Signature Date CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM N#jG y d 7 03 2— Date: Building Address �` Mailing Address (if different from building address): �sTc� e Owner' Name: Phone #: E w-s.e ke fit- o gR 7 Contract o License # Contact: Phone: Cupertino Business License#: (rlVKVVUSOl Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: r n Residential P01-4 400 —R> A S Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Pro• t: Occupancy Grou Type of Construction: Please check this box if the project is a second-storyaddition: El ro'ect Size: Standard ❑ Lazge ❑ Ma or ❑ 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 BBOMER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Cormn/ uasi 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 lof3 CITY OF CUPERTINO CUPEI�F PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMTTIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTME 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING IRV 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 cfm MECHANICAL BREAkMIAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREN FIXT 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 BREMRESAPP Remodel Res A liance ELECTRICAL 2of3 Itt0l ," CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM ' CUPEI,TINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs 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 MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERAUTFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3