06060155 CITY OF CUPERTINO �
•BUILDINas DIVISION PERMIT ;xC,ONTRAGT(TRTNFORMATI
BUIIDDLGADDRESS: SCL CONSTRUCTION CO. PERMITNo.06060155
929 FERNGROVE D
OWNER'S NAME: PERMIT ISSUE DATE
CONNIE WANG 1664 SAMEDRA 91 06/16/2006
NE: SANITARY NO. CONTROL NO.
(650) 678-8311
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB
MECH
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30o LICENSED CONTRACTOR'S DECLARATION IOb Description
hereby am.Nn I am lived under provision of Chapmr 9(commencing
nth Seedon 7000)of Diviaan 3 o(dto Buaoess and Profeasiuv Coh.and my license u
e� in Ern roreeam a@6 REPLACE SLIDING WQ S (2) AND PICTURE WINDOWS
p� Llata Claes rice rk as
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Data-ComDECL �t [+�
ARCHITECTS DECLARATION E®
lundensand my play slWlaused u public rtcorW
M
;w Liccesed Pmfessionel
OWNER-BUILDER DECLARATION
i01 herchy e1Rnn that 1 1. exempt from the Csid..Co License law far de, 1006
O O which ing renes a permit
i 703 1.5,a situs and roe. a mull Code:Any oily err[aunty l�
19 which its i ma•e,alm re convect.aline,nt ferment
nt cmM,or repair my structure $4000
_Z� poor els anedpursarequiru dm applicant the Consomme'
Livenso file Lmed stemmem
E€; thathclelmcesedpuwantlo heproaifiovaftheConuuwfeLhevelaw(ChaPtt9 Sq.Ft. Floor Valuation
s (commencing with Sudan 7")9 Division 3 of the Bonn=aM Pmfeaion Cade)rc guXURG
that he ts exempt u1s mfram and the basis for de alleged assumption.Any violation of
Section 7031.5 by any applicun for a permit sebjum the applizarst.a civil penalty of Occupancy Type
not roam than Rw hundred talion(5300).
O 1,u owner of the progeny,m my employm wW wages u Web role compmuadon.
will do the work,and the snmctum is natinanded"offered permits(Sm.704.1,Bulinus Required Inspections
and Pmfvam Com:The Contractors License law does hint apply m an manes,of q P
property who huddle orimprom thumn.Md who doessuchwork himselfmthrough his
own employees,provided that inch improvements are nntintanded artificial for sale.If.
however,the building or improvement is said within one year of(omple ami.ase owner-
builder will haw dm burden of proving that M did sea build or improve for purpose of ,
u ).
1,a owner of the property,am exclusivity connecting wild licensed anwemn w
co We pmjen(Sec.7044.Business and Professions Cade:)The Coamscums Li.
awe favi docs eat apply to Ln owner of prepeny who wilds as,Improves themes,and,
who convects for such projects with a cenwcwr%)licensed pusumt he the Comm�uh
License Law.
❑I am aempt under See'' 11 ,B d P C far Wier
Owoer W M.�
WORKER5COMD9 SATION DECLARATION
40 1 hereby Llano under penalty of perjury m of the following dcctuadmhr.
1 ham and will maintain a Cer ifhaw of Consent te self-insum for Worker's Compos
orlon.u provided for by Section 3700 of the Labor Code,fm the Performance of the
work for which this permit is issued.
❑1 haw and will maintain Worker's Compensation lasumses.as inquired by Scrim
3700 of the Labor Code.for the pcaarmmce aide,wink far which this permit if ismu.
My Woran's Compemaudon Ivurim a anis and Policy number roe:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(rhis sennas aced an,Ise campineG if to permit is form hundred do0us(SIM)
or lest)
1 cenify that in the performance or the work for which this Penni,u issued.I gal nd
employany person in my mewrspastobeca g stjeu aoat�ewabsun'Campenaton
laws of Callfo0 Dam
�f 60
Alm
NOTICE TO APPLICANT:If.ager mµ)g this CeniOcate of Exemption,year should
become mbba m the Workefs Com. nine provisions of the Lehor Code.you sun
.J 0 farNwiah comply with each provinces or this Permit shall W deemed revoked.
z^y CONSTRUCTION LENDING AGENCY
EI hereby Morro that these I. unswNtan lending agency par the perform.of
rY „ ash
�„ the wart for which this permit is armed(Ser.3097.Civ.C.)
4 Q
Lh Name
;0 Z Ladies Address
U Q 1 codify that i have read this appliadon and auto that the show ofomudun h,
IL F coma 1 agree to comply with all city and county ordinances and also,laws mladng w
0 building construction,and hereby authorire repmacoadws or this city to enter upon We
W .hove-mentioned property for inpcction purposes.
(We)agree to saw,indemnify and keep hu nieu the City of Cupertino agavt
h,y y Ififli idu,jodgmcno,cma u atexpenses which may In my way Lcaue agaivtated City
in consomence of the ntritiofU APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
c.J-•--- Re-roofs
Signuu.of ApplianVCantrsemr Date
HAZARDOUS MA"DISCLOSURE Type Of Roof
Wel the applicant or forum building occupant mart or handle haainNau materia -
u deOnul by dte Cupertino Murtict Cath.Chapter 9.13,and the Heath and Safety
Cah.Bud..25532(x)? a All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or raw.building Occupant use egmlpmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit beeschous air amummants as defined by the Bay Am&Air Quality Management all new materials for inspection.
District?
❑y.
I hew mad the ha manus materials reqme
ulmms under Chapter 6.99 afthe Calier-
.1aNcaWk5detyCede,Since.25505,35333 and 25334.I understand this lfhhe building
does not cumenly haw a wnam,that It u my respoesihility in notify the cuupnt of the
requirements which muse be met prior to!no=of a CerdOateof parry Signature of Applicant Date
�6 All roof coverings to be Class"B"or better
Owner or wthadad agent Dam
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
*UPEkTINO
Building Department
JOB ADDRESS: ( PERMIT #
r��ZNC7��d(
OWNERS NAME: rir tee. PHONE #(46,x )772- D 66
GENERAL CONTRACTOR: �Q FAX #
I am not using any subcontractors: �--� / �1 C11/2'`-�
Signatur Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
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Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
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Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37539057 . 00
DATE ISSUED. . . . . . . : 06/19/2006
RECEIPT # • • • . . . . . . : 34906
REFERENCE ID # . . . : 06060155
SITE ADDRESS . . . . . : 929 FERNGROVE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : CONNIE WANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CONNIE WANG
CONTRACTOR . . . . . . . : STEVE LAI LIC # 25726
COMPANY . . . . . . . . . . : SCL CONSTRUCTION CO.
ADDRESS . . . . . . . . . . : 1664 SAMEDRA ST
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087
TELEPHONE . . . . . . . . : (650) 678-8311
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 104 . 76 50 . 28 0 . 00 50 . 28 0 . 00
BPERMFEE VALUATION 4 , 000 . 00 104 . 76 0 . 00 104 . 76 0 . 00
BSEISMICRE VALUATION 4 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
BPLANCHK PERMIT FEE 104 . 76 139 . 80 0 . 00 139 . 80 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT .295 . 34 0 . 00 295 . 34 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 295 . 34 AMEX
TOTAL RECEIPT 295 . 34
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I I BUSINESS NUMBER 25726u �� SCL CONSTRUCTION CO. T (Cancel _ I
� •. CATEGORY 24 (CONTRACTOR -- GENERAL- _._._,___ ..__...—.,.—_. � quit
JI
+ LICENSE No. 25726 J BALANCE 105. 00.
STATUSIJJ PRIOR CATEGORY —J
"ISSUE DATE 07/12/2004 TRANSFER AMOUNT T O. 00�J
EXPIRATION DATE 06/30/2006f1 15T PENALTY AMOUNT, v O. 00�I
h UNITS . {; — 0. 00 2ND PENALTY AMOUNT 0. 0
FEE AMOUNT 105. 00 3RD PENALTY AMOUNT 0. 00
EXEMPT CODE. 4TH+ PENALTY AMOUNT `O. 00j
EXEMPT 'AMOUNT 0. 00�i LATE REGIST PEN
r
_..._._� PENALTY ADJUST
FEE ADJUSTMENTS _ 0. 001
BALANCE LAST YEAR 0. 0
-01
- — —
I AMOUNT- PAY
F_-T. 001
- - - - —
SAL. INSPECT. , FEES
ACCOUNT 'CD BYPASS J�
CLOSE
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"1�( Inbox-.,, tinamp Occup �tinamp,,.Ir Occupa `� y®b 3.55 PM 1�
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CITY OF CUPERTINO GW(10155
CUPERTF PERMIT APPLICATION FORM
APN#376— 37 oS7 Date:
Buildin Address: Mailing Address (if different from building address):
Owner's Name: Phone o��
vel -�) 7 Z 7 --
Contractor: o �G License #:
Contact: Phon &T77-01Cupertino B,gsiness License#:
�1L Fax: t 2 5.2 2 6
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Job Description: S fw sYs (2� �i C5
Residential Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Pro, ct: Occupancy Group:
cSLSv,a�
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro'ect 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> 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
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CITY OF CUPERTINO
CUPS 0 PERMIT APPLICATION FORM
uanti 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
BPFIXTURE Pb1g 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 -
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
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Mise 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 Appliance ELECTRICAL
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CITY OF CUPERTINO
CUPEf�0 PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
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 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
PPERMITFEE 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 Chane BUILDING
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