06060193 CITY OF CUPERTINO
BUILDING DIVISION PERMIT _CdNTItACTeQRI'N `OILMA; 'IO '
BUIL DING ADDRESS , GE D PAN Pr"MRN006060193
21075 FREEDOM DR
OWNER'S NAME: PERMIT ISSUE DATE
GERALD PAN 06/22/2006
NE: SANITARY NO. CONTROL NO.
ARCHI'ECDENGINEER: BUILDING PERMIT INFO
BQ ELECT PLO MECH
O
3Gp LICENSED CONTRACTOR'S DECLARATION Job DCSCrIpUOn
I bme affiw that 1 w Ikunmd under provWam or CNet"9(commencini
with Scotian 70(10)of Olviahon sof the Business and Professlom Code.and myliccnmu
+� inmBremeandeffnet. KITCHEN REMODEL, NON STRUCTURAL
j Z License Class Le.
rDau Contractor
IT
ARCHECTS DECLARATION
I understand my plans Nall W need u public neeonu
J�
k�_1 Licensed Professional
OWNER-BUILDER DECLARATION
9 1 hcmby efiirm Nat I am exempt from the Contracers License Law for the
O o fallowing reaana(Suction 703 1.5,Busiruss and Profuuou Code:My city or county
$ which mnuires a permit in construct,almr,Improve.demolish,or repair any structure $1()0()0
_Z> prior to its issuance.also requires the applicant for much permit On file a signed comment
thso.he is licensed partment to the provisions of the Contorchar's license Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Pretensions Code)or
that W la exempt 0ere(rom and the butt for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Occupancy Type
not mart Hutt five hundred dollars(g500),
❑I,uownv of tin property,wmyamployev with wgaatite4 role eampenution,
wiBdothcwrk.aedthestrovuret,notinmMedeolfemdlorau(Sec.7044,Businw Required Inspections
and Prowho W Cade:The Conhacefa License law duos not apply lf an ownor of �� q P
property lobe Wilds i ed that such Improvements
ts donssmh muck bimxlfa Utmughht, xx�,�
Own employcv,providedthatsuch Improrommuwnot intended oroffered fatalelL ityg:J—y',P'
bowery,theroveth iardnpravemw4hat sold eedid arc yen ofcanplotim,du ower.
builder W0 haw the burden of proving that M did rot Wild a improve for purpose of
vu.).
.m owner of the property,am exclusively contracting wish licensed contncera W 2000
construct um project(Sm 704.4,Business sed Profeemt code:)Tx Cmlramafs U- 0 4t 13
conte law does not apply u an owner of property who Wilda or Improves demon,and
who contruu far such project,with a conwsnoW Butted pvamm a rise Contaactofs
LkI me law. QQ ,}`ate f�
❑lam exempt under See .Bd PC far ilia cotton Is
er 40
Data 6 L�d NLT.'�L'f'apl
WORKER COMPENSATION DECLARATION
1 hereby affirm under purely of perjury am of the following declamations:
notio❑Ibsve and will for
etion3am of Camerae Code.fumfwlVohehCompen-
worle f r which
this
for by Section 3700 of the Ichor Cade.for the peAamanco a(dee
woh for xhich Nis pmnit is issued.
❑1 hate and will maintain Worker's Compensation homeless,as required by Section
3700 of the Labe Cade,for be performance of the work but which this permit is sound. '
My Workers Compensation maranm artier and Policy numb"w:
Caller, Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This mction need not W completed little penal is forme hundred deffan(glao)
or less.
I certify deet In tiro performance of de woh for which this pctmit Is issued,)shell nor
employ any person in any summer mdq
ss e became ubWct to de WarcYen'fCanpenmadm
Lawaaf Callfemla.DaL^
Applicant
NOTICE TO APPLICANT:I(.ageran ng the beftificatic of Exemption.you should
become subject in the Worker's Comperwdon provisions of the labor Code,you mew
Q O forthwith comply wish much provivens a this Permit"I W deemeed
d monfl .
z CONSTRUCTION LENDING AGENCY
(-rte I hcmby affirm that den U.,momucOnn Imch.Sagency,for the performance of
aithe work for which this permit is issued(Sec.3097.Civ,C)
W G Landers NationIL z ItedefsAddmss
U Q I cunify Its,1 bare fund this appliaum and sum that the above information Is
{p.F correct.I agree in comply with dl city and county oN foam,and site law mixing to
QU Wilding construction.and hereby audotin representatives o(this city to enter upon do
W ahove-memiuncd Properly for inspecdan Purposes
py, (We)ague in ave,indemnify and keep hannIM the City of Cupertino against
to Ilabilitim,jedgmcow.cash and exposures;which may in any wryaccme aienst old City
U'Z, in comequanco of the grandng of this Permit. �v n�.7il�r
^+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 67Date 4
SOURCE REGULATIONS.
Re-roofs
Signal of Appl)an ntncur Dam
HA-ARDOUS MATERIALS DISCLOSURE Type of Roof
Will de Applicant Or fuew Wilding uvupmtstae or handle huadom material
An defined by dee Cupertino Municipal Code,Chapter 9.M and the Hcald and Safety
Section 255324)7 O All roofs shall be inspected prior to any roofing material being installed.
❑Yee
Will do applicant of future Wilding occupant um component or devices Mich If a roof is installed without first obtaining an inspection,I agree to remove
emit haxardous air contaminants u defined by the Bay Area Nr Quality Management all new materials for inspection.
D suict7
❑Yes IQ,Ne--
1 have mad the hanrdms mwrials requirements under Chtpterd.95 ofthc Celifor•
nil Health@ Safety Cade,Srcts.25505,25533 an125534.I rode sumd thatifdo Wilding
4.not currently hero a want.that It is my rapon"Intlty a mdfy,the oceupent of do
mgdmmenu which most be mel prior be issuance of a CertiBcae aroccupmcy. Signature Of Applicant Date
L
Ownorwauthor'mudag Dam All roof coverings to be Class"B"or better
,CITY c CUPERTINO
BUILDING DIVISION PERMIT ?dl
TN1�UYiMATiO
x 'a?ed5' 'A'w' ..rl.e••c�.� PERMRNDU6O6O193
BUILDING ADDRESS: GERALD PAN
21075 FREEDOM DR
OWNER'S NAME: PERMIT ISSUE DATE
GERALD PAN 06/22/2006
SANITARY NO. CONTROL NO,
ONE:
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
j LICENSED CONTRACTORS DECLARATION
y I mmby.(firm Net I am IkamcO undo,provuiau of Chapur Y(mmmen=Ina, lob Description
oath Secrexand fleet.vWan 3ofNc Busnw and Profasuu Code.and mylkenau KITCHEN REMODEL NON STRUCTURAL
4 L full foce aria erred e
Z
Dom
Class Lin.Contractor.
p D01e DEC
7W ARCrail M.-S DECLARATION
� Y� I undcrstanJ my puns shall m used as punlic,amds
yU
LiccnscJ Pmkssinnml
OWNER-BUILDER DECLARATION
I mreby affirmthat I am
tae in s an the Contrafusam.Co Rema taw for du
2 o following mason.(Sayan]1131.5.Business and hafcsmnu Cod=:Any dry $county $1 O 0 0 O
$un whish its has a permit ro eonauuq eller.mpmw.demolish.1I repair any tWmum
Zi duek;umama,auent Le to de,Applicant,for such permit ham=eelaw(Chacmem FI. Floor Area Valuation
tC duimuc¢nsN Section
Ne of Division
of atemBuxurend ause Imitaw(Chapin9 Sq-
-$
that
ncepth Section?andthDiv(si is frortm Budnwatkon.My viCode)or
B— SeNmt 7871.5 by an yaapp applicant or a ppeermdlabjeeur the sihe appliced ant 10 a civil loladon of
Penalty of er Occupancy Type
_ nm mate dm nap hundred"Ince 450(f),
-
❑I,u owner of the ProPerly m my employees with sures as Nee man:comPeuad-.
i
ill do the work and the structure b not intended or offered rmwc(See.Ma,Business Re uired Ins ecnsd Pmrese(oes Coda Ter Gemstone,Loam law am net apply m an awns ofq Pmpmywm Wilda«impmwa ammo,rod wmdmsucbwork himWforthmuah his
wns employer,provided Thal such impnswmmta am notNunded oroReteA foraale.ll.
owever,the building or improvement Is mid within one year ofatepledom.the owner-
Wildest
wnerWilder win into,the Wtdan of prow(na that he did not Wild Of mmmen for purpose of
ale.).
ae owner of the properly am aclmivelY conuaolnL MN Iimnad mnuaoars m
muwo the prejeo(Sec.7004.Business and Pro@ailm Cade:)The CDDmaemra Li- I �/
seem taw doer m apply an an owmr of property who Wilda m improwa thereon.and.
who conmar for such prejeete with a eonwcmrts)licensed Pursuant m tha convectors
Lccm Law.
❑l am camps under See .B&P C for this mum
OwerDale 6 1,7-(d
�a COMPENSATION DECLARATION
1 hemby&M m mdcrpeadty o(pc*q ane of du following decleltelmor
,]1 haw and MII malnWn a Cutifigte or Conanlm u!f-Wort Ire Wodura Cmnpen•
scion,as provided for by Section 3700 of the Leben Code.for the P=rfarman a of the
work for which this permit Is Wad .
❑1 lave and will maintain Workers Compema lm insurance.a required by Seek=
3700 of N=labor Code.fa N=perl.,n of W work le which this peomil i iasu
My Workers Compamus an Wurarm curio and Pallry,number art:
Cesdcr: Policy No.:
ATE
CERTIFICOF XEEMP 10H FROM WORKERS
COMPENSATION INSURANCE
(Thisactim need Out W completed lion permit Is imam hundred donor(SI00)
orksa) I
I==nify that in the performance f the wok for which this permit is issued,l Nall not
=mployanypemom I.mymanmrmumbecomc subj tt Ne Woherf'tCompowdon
Laws of CalifmNa Dame, /s
AppBcant
NOTICE'O APPLICANT.If.spier ma nuc this Conine=of EmIrPOon,you should
become Subject N the Workers CompeaNm provisions or the lam,Coda You most
Oforthwith comply with such provvkel m this Permit shill W domed hawked.
(� CONSTRUCTION LENDING AGENCY
I hereby aMm that them is a comWDlWdn lending agency for the pmfmmasta of
'> the were for which this permit is issued(Sec.3097,Cc.C)
3 Lemim s Name
Landers Address
0 I canny that I haw mad this application and sum Nat the show information 6
^ catmm I.gra he comply with sl city and county ondinar ces and state law Mining m
SV^ building construction,and hcrtbyauNorim mpr=omaiwse City
Of m=nmrupon du
W above-memduned property for impecdon purposes.
(We)dame=o cows Indemnify erid keep harmless the City of Cupertsts agility
v y li.bllitieajudgmenu.costa and expenses which may in any nY.mucaailulsatd Ciry �
2„' in comegucnce of the arantina of Nu Permit. Date 6'.w[{Jr�iv(d
�-+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS,
Re-roofs
Signature of Appli ntramr °ite Type Of Roof
X RDOUS MATERIALS DISCLOSURE
Win N=appliant or run.Wilding user inanimate nr handk huardou material
u derided by the Cupertino Municipal Cade.Cbapm 9.13,and dm Health and Safety
Code,S.W..25533(s)? te, All roofs shall be inspected prior to any roofing material being installed.
❑Yu a
If a roof is installed without first obtaining an inspection,I agree to remove
Will Ota applicant of room building occupant me equipment Or dcvima which
It hnaAnm alr commehemla a defncd by Ne Bay Area Air Quality Management all new materials for inspection.
District? n�
❑Yes rY
I haw mad the hvardmsmamub lequlmmenuuncer Chat uri95 of theCelirar-
nuHmlth&Sof=tyCodc,Satiom35505,35333md35534.Imsdmwdth tifthc Wilding
dm amt currently haw•moue,that it is my mspend bilby u mdfy dap roup.,or Our
requirements which Was to met prim o issuuue of I Gourmet ofOecapwuy. Signature of Applicant Date
t All roof coverings to be Class"B"or better
Owner or mNasscd ag Date
• Application for permit for minor remodeling project
Building : 21075 Freedom Drive, Cupertino, Ca. 95014
Jobs to be done:
Kitchen remodeling
Two sky lites
Electrical : Update kitchenL
-eo2eG2r�T
Plumbing: Kitchen plumbing
Mechanic work: Skylites: ( p� 2 7,0 V q-0 p, r G rGu r�aY
APPROVE:U 2
iN ACCORDANCE WITH THE CITY 01 `
CUPERTINO CODES AND ORDINANCES
EDcilications MUS"" rGutit
This set of plans and spa
kept on the job at all times and it aw
la
lawful to make any changes or alteraticc
in same without written permission
ne building Dept., City of Cupertino.
The stamping of this plan and specificatlun,
HALL NOT be held to permit or tdovooru
approval of the violation of any V
c �
any City Ordinance 01 zeta taw.
� G OFFICE COPY
JUN 24X2006
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(WY OF CUPERTINO 0(00(-001C'5
C11YOF PERMIT APPLICATION FORM
CUPEI�TINO
lei APN# Date:
-53 -02
Building Address: / ryry,' Mailing Adddress (if different from building address):
2/ o �rl2o( Gtr. Lr E T/!�lJ 9S d
Owner's Name: Phone #:
Contractor: O License#:
Contact: /� Phon . Cupertino Business License#:
C ; Fax: 65
BuildingPermit Info:
Bldg L,Y Elect 2/ Plumb n_� Mech 29"
Job Description: Sfi"°rte
Residential 9 NO/JCommercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: /O // Occupancy Grf:
Type of Construction: I� Please check this box if the project is a
second-story addition: ❑
Pro'ect Size: Standard E5-� Large ❑ Major El
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
BCONSTAXB 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
Allh BINVESTIGA Investigation fee BUILDING
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i
CITY OF CUPERTIl*
CITY PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Grou •
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. HousingMit. 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
MIXTURE 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 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 Fumace 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 App liance ELECTRICAL •
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d OSTY OF CUPERTINO
CUP TY-OF O 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
2 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 Change BUILDING
•
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