05120119 CITY OF CUPERTINO -o ry+- m�^"rK '-�' � '" `" �` ^" •-+
BUILDING DIVISION PERMIT CONTRACTOR;INFORMATION .a
BUILDING ADDRESS: PERMIT NO.05120119
iNAW1C'HI7ECTIENGINEER:
ER'S NAME: PERMIT ISSUE DATE
LORETTA & KEVIN JEW 12 20 2005
NE: SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
O M O !�
�Op LICENSED CONTRACTOR'S DECLARATION Job Description
w❑ I hereby affirm at 1 am licensed under provisions of Chapter 9(commencing P
iW wire Section 7")of Division Sof the Business And Profusion,Code,and my license is
in full force and effect. RELOCATE 2 WAS RSDRYERS,
t? Licene Class Lie.It
�� Date c1vr 4 OUTL�S� 7MB NG LOCATE
ARCHITECT'S DECLARATION
w< I uO&Osto l my plans shall he used a public mcords
SyV
Tut— Licensed Pmfcaskmal
cps OWNER-BUILDER DECLARATION
<F1 lonely affirm that I am exempt from be Comnctofs License law far the -
n o following mason.(Section 7031.5,Business and Pmfestions Code:Any city ter county
K m f which mquires A permit to construct.a1mf,improve,demolish,to repaif any structure
Lzi prior m its issuance,also require the applicant for such permit to file a signed statement
is
that he is licenced pursuant o the previsions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuatio 412
y1-� (commencing with Section 7008)of Division J of UC Business and Profassions Code)or
y $
that he u exempt Nertfrorn and the basis for the alleged exemption.Any vialadon of
Section 7031.5 by Any applicant for•permit subjects to applicant to a civil penalty of APN Number Occupancy Type
not man man five hundreddolim(soo). 37504030 . 00 P Y YP
❑I.n owner of the Property,a my employee with wags As thew sole compensation,
will do the work.and the structure is not intended or offered for sale(Sec.71314,Business
and Professions Code:The Conmetor's Licens,law,doe not apply in sn owner of Required Inspections
pmpeny who builds or improves thereon,and who dues such work himself or through his
own employee,provided thatsuch improvements arc not intended moRerG for sale.If,
however,our holding or impmvement is sold within one year of eamplction•the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sac.).
[3.L/ea r of me pmpeny,am exclusively contracting with licensed contractors m
construct the project(See.701 Business and Rotessians Code:)The Contractots Li- .
cease law does not apply In an owner of pmpeny.who Wilds or improve themon,and
who contracts for such pmjcets with aconmcmrts)liuned pursuant to the Contractors
License law.
El I nm eveIm�p under Sec. F'^L �/ B&P C fof mit recon
owner 1C`f?(.hLl 'Yf I L6 J-r Data 124,L '
WORKERS COMPENSATION DECLARATION
1 hereby affirm under,penalty of perjury one of the following declesnums:
1 Ism and will maintain a Ccnifmae of Consent toe se r-loatre for Warkcr's Compere
ation,a provided for by Section 3700 of the Labor Code.for the performance of do,
work for which his permit is issued.
❑1 have and will maintain Wmker,Compensation Inwnoce,a teyvied by Section
7700 of the labor Code,for he perform inec of the work for which his permit is issued.
My Worker's Compensation Insurance carrier and Policy number arc:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Thissectian need not W completed iftW permit is faonc hundred dollars(SIM)
or irn.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so ass he¢pme subjcn m tM Workeri Compensation
Lawsof Califamia.Date. - 112 /L>
Applicant f ,� �t� a—
NOTICETO APPLICANT:IL after making this Ccnifieate of Eartin ion.you should
become subject to he Workm's Compensation Provisions of the labor Code,you must
JAZ forthwith comply wish such Itomisinu of his Permit hall W deemed revoked.
ZOCONSTRUCTION LENDING AGENCY
'e~. I hereby affirm that then is a consttuctin r lending agency fa he Performance of
a the were for which thia permit u issued(Sec.3097,Co.C.)
W Lender's Name
z Lenders Address
V 0 1 mnify that 1 have read this application and sate hat he above inromutiuo is
COMM I agree to comply with all city and county onlinances and state laws elating to
0 V building consuuction,and hereby aumoriM repmacntatives of his City toe enter upon the
G atom mentioned property for inspection putMses.
(We)agree to nn,indemnify and keep harmless she City of Cupenino against
fn liabilitie,judgments,cols and caK.which may In any way sec.against said City
U in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2— 'LU_Q(
�Jl
SOURC U TIONS. 1 ,/k
Re-roofs
Signam of Applic VConDam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant,Chps nue orrand handle,ha alth and
As dcf Sed by me 32(a)?na Municipal Code.Chapter 9.13,and the Health and Safety
Code.Schon 35533(a)? All roofs shall be inspected prior to an roofing material being❑Yea � P P � Y g g installed.
Will mea applicant or future Wilding Occupant use equipment m deviate which If a roof is installed without first obtaining an inspection,I agree to remove
pp s v yuipmcn
it hanrdnus air contaminants As defined by the Bay Arca Air Quality Management all new materials for inspection.
men
Q Ycs Na
I ban mad the Wrardous drat iab requiemcnts under Chapter 6.95 of the Califor
n i a HIn.lh&SmletyCode,Sections 35N)5,75537 am12551a.I orderstsnd that iftle Wilding
u a
Joof rely have A smart.Nat it is my respomibilihy to notify Oneuccumm Of dm
equirct� which ,tWmet hot III iasuantt OrtcyryB�pt txapaney. Signature of Applicant Date
one ,oitho l., ens "l (C1 W. 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
UPERTINO
Building Department
JOB ADDRESS: PERMIT
Cv-eenaod PkIL l
OWNER'S NAME: 1110- T f-6r2 -,feV PHONE # (v�)683-Wz
GENERAL CONTRACTOR: Mew- C Coi-ttp6- t v FAX # (I«) 6&3- S&63
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
v Electrical
Excavation
Fencing
Flooring: Carpeting
An Linoleum/ Wood
1p Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
v Plumbing /1� C� r(w�l�c -4�cl(o
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
CU
CITY OF
No PERMIT APPLICATION FORM V � �
iJ
N4 bel -030 Date: I qa/?Och
Building Address: 2 Kp A Mailing Address (if different from building address):
Owner's NPhone#:
e:
i LtrC a --JEv� (S-(a) (Q3-SS6Z
Contractor: License#:
2 efiL q,7K(a/to
Contact: Phone: �io)6$3-8962 Cupertino Business License#:
14w—n -1 (V-e 4c, :1Cv Fax: (S-,o683-89(5
Building Permit Info:
Bldg ❑ Elect D Plumb Er Mech ❑
Job Description: {�2�UCcr(4. (JOA14 , 01rV p(umlyd 1e�cCzLp�.
Residential El Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
Cost of Pr0ieCt: Occupancy Group:
1,41 s� rZ-3
Type of Construction: / Please check this box if the project is a
/V second-story addition: El
roject Size: Standard 2'� 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 I 4:ECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANTICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Coinm/ 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 > I OOOA ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILD➢`'G
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; ( CITY OF CUPERTIN
CITMor PERMIT APPLICATION FORM
CUPERJINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing A4it. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNTJCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTBffi Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum . PLUIvBING
BPCESSPOOL Cesspool PLUMBING
BPERNIFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUI\4BING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLAINCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDII\TG
BPLANCKREP Plan Check Re eat Fee BUILDATG
BPREPIPE Rei e Of Fixtures PLUAESVING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRA.P Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pi2e PLUMBING
BPWHEATER Water Heater/Veut PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reins ection Fee BUILDING
BREMACOVER A/C Unit > 10,000 clip MECHANICAL
BRE1-\4A1PJL N A/C Units <= 10,060 cfrn MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREb4BUSWAP Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREI\4FURN Relocation of Furnace MECHANICAL
BREI\4FURN0V Relo Furnace> l OK btu MECHANICAL
BREIAU EAT Heater Installation MECHANICAL
BRENIIlNHOOD Installation of Hood MECHANICAL
BREMI\4ISC MiscApparatus ELECTRICAL
BREND RAP Rein Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BRMPIDIVER Power Device/Apparatus ELECTRICAL
2. BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREA4RELOCA Relocation of Hood MECHANICAL
Ak BREMREPALT Repair/Alter Heating MECHANICAL
BREI\4RESAPP Remodel Res Appliance ELECTRICAL
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nag CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmd] Signs Add Branch ELECTRICAL
BREMSIGNTS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Li ting Fix ELECTRICAL
BRENIVENFAN Vent Fan Single Duct Al-ECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISAIICOAI Seismic Commercial BUELDING
BSEISMiCRE Seismic Fee Res BUILDING
BSPECIAL Special lnsection BUILDING
BSWII\4 Swimming Pool BUILDING
BTENIP Temporary Power ELECTRICAL
BTENIPPERAI Temporary Bldg Permit BUILDING
BTEMPSVCS Tcmp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERAHTFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
ATERNIITFEE Mech Permit Issuance NlECHANTICAL
PPERAUTFEE Plumbing Permit Issue PLUMBING
PPL13G Plumbing Fce sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANTNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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