02090186 CITY OF CUPERTINO "
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
00R
BulfXro !Ii PDJITEATHERW00D DR NEE FU-YUAN AND HUI-MEI PERMETT2090186
-IE.LNAsfl'U-YUAN AND HUI-MEI APPLICAI"S(TUTE2002
PHONE SANITARY NO.// CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�00LICENSED CONTRACTOR'S UC:CLARAI'ION
I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing D
with Section 70g))of Division 3 ofthc Business and Promotions Cank,and my license REPLACE FIXTUR f�Sr1- AeTH$Q,— �
mfnluoreeandeffeel. CABINETS/TILE/LIGHT/WINDOWS
OZnZ Lieensc Class Contractor
DEC 0 7. 2002
rn�q Dam Cnn DECLARATION
As hall ARCHITECTS DECLARATION
1 understand my plans hall M used as public records
H18U
u3LL Licensed Professional Q11I1 YRBiI CJ"_
CiG OWNER-BUILDER DECLARATION BU L{�GI11G
i<Y I hereby affirm that 1 am exempt from the Contractor's License Law Int the
S 00 following reason.(Section 71131.5,Business and Professions CNe:Any city fir county 8 5 O(]
X which requites a permit m re
construct.alter,improve.demolish,Or repair any structu
w— prior in its issuance,also requires the applicant for such Permit to file a signed statement
�mim< that he is licensed pursuannn the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
WR (cmmnomcingwith Section 700X))ofDivision 3ofthe Business and Professions Code)Or 35928047 . 00
a�.. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civi l penalty of APN Number anC OCcn e
not more than fixe hundred dollars(s500). 1 O 1 - FOUNDATION P Y TyP
0 I,as owner of Ne property,or my employees with wages as their sole compensation.
mildothework.and the structure,is not intended reoffered for sale(Sec.7t ,Businev T.82 - PIERS—
and Professions Cole:The Comediennes License low dues nos apply m an owner of 10 3 - UFER Required Inspections
property who builds or improves memon,and who d^essuch work himself or mmugh his
own employees,provided that such improvements arc not intended or offered for ads.If, 104 — REBAR
however,the building or improvement is sold within one yew of completion,the owner-
builder will have me burden of proving Nal he did not build or improve fur propose of 10 5 - ANCHOR BOLTS
axle')' 106 - SEWER & WATER
01.as Owner of the propertyam exclusively contracting with licensed contractors to 202 - UNDERFLOOR PLUMBING
construct The project(See.70,14,Business and Professions Code:)The Comreemrs Li.
cense law does not pply to an amour of property who builds or improves lhemnn,and. 203 — UNDERFLOOR MECHANICAL
who contacts for such projects with a contractor(s)Reemsed pursuant to the Commetm i
Liao.¢Law. 204 - UNDERFLOOR FRAME
-I am exempt der Sce. ,B&P C for this mason 205 - UNDERFLOOR INSULATION
caner_ — Dam 0 30 ) 301 - ROUGH PLUMBING
YORKER'S COMPENSATION DEC ATION 302 - TUB & OR SHOWER
creby aRrm under penally of perjury one of The following declarations:
O]have and will maintain a Codficam of Comenuo self-Insure for Worker's Compere 303 — ROUGH MECHANICAL
cation,as provided for by Section 3700 of The Labor Cole.for the performance of rte 3 04 - ROUGH ELECTRICAL
work for which this permit is issued. 305 — FRAME
0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3 06 - HOLDOWNS
37N)of the Labor Code,for me finformanec of me mirk for which this permit is issued.
My worker's Compensation Insurance carrier and Policy number am: 307 — INSULATION
Carrier: Policy No: 308 - SHEETROCK
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE, 309 - EXTERIOR LATH
obieseclian needingMeomplemdifnM permit is fanmc hundretl dollars(511X1) 310 - INTERIOR LATH
It..) 311 - SCRATCH COAT
I certify that in the perfnrmence o the work for which Ibis permit is issued,l shall not 313 - ROOF NAI L
mplryany pers^ inoLImanner +as toMcnmcsuhicct lht30n)rkersbCompcnsainm 501 - FINAL ELECTRICAL ENERGY
�1 i.awsiir Cf 501 Rp I {
J rICETOAP TCANT:11.after making ThtsCcni¢amofExemption.you should 502 - FINAL PLUMBING ENERGY
become subject to the Worker's Compensation provisions of the labor Code,you must 503 - FINAL MECHANICAL ENERGY
OO fnnhwith comply with such provisions nr this permit shallMJecmeJ revoked.
z CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY
F .N. Ihereby aRrmthat them isaconstruction lending agency trthe Performance^( 505 - FINAL ELECTRICAL
C > the work for which this permit is issued(See.5A7,Civ,C.) 506 - GAS TEST
W Q Lender's Name
z lenrer:s Address 507 - FINAL PLUMBING
U O I certify that 1 have read this application and state that the above information is 508 - FINAL MECHANICAL
W U correctlagree onstruct comply hireellcithori minryrtadwnces and ante laws relating nr G�
Q bhow-mennslmniropert for
rposes.tivesnfreiscirylocm"'Po:i x 5 - FINAL GRADE
about-(we)agree
for inspectionpurposes.
(We)agrcemmvc.indemnify and keep harmless the City of Cupertino against 5 AN
I GN liabilities,judgments,costs and expenses which may in any way accrue against said City 5 L WORKS
U 7 in consequence of the granting of this permit. O
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOURCG GUI,ATIONS
0 Re-roofs
sate o ApplicanU nnsme Datc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle havmdnus material
refined by the Cupenino Municipal Code Chapter 9.12.and the Health and Safety
ale.Seeaon2553xa7 All roofs shall be inspected prior to an roofing material beim
❑Yes 'tk]No P P Y g g installed.
Will the applicant or future building Occupant use equipment ordcviccs which If a roof is installed without first obtaining an inspection, I agree to remove
unit hawrdous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Disricl7 ss..��
❑Yes [ No
\ I have sad the hamNous materials mquiM oil underChapter/.95ofthe Califor-
nialleapt&Safety Code,Secdme.255)5,25533 and 25534.1 docs dthm tM building
dms not cunenely haw a lenam,mat it is my responsihiliiy hs nod T 'c pant of the
requirements hichmwslMmmpriorurismancc oft CcniIII of cup z Signature of Applicant Date
1 , — �`a 9/30%
�edagent Dale All roof coverings to be Class"B" or better
CITY OF CUPERTINO
BUILDING Drvlslon
PERMIT F CONTRACTOR,INFOR TION.'-''
BmV1_9g,2)DgTEATHERW00D DR NEE FU-YUAN AND HUI-MEI PERMITT2090186
GWnE0ATU-YUAN AND HUI-MEI APPLICATt"SLS�TE2002
ONE: SANITARY NO.// CONTROL NO.
ARCHmiCDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
mr00 LICENSED CONTRACTOR'S DECLARATION
m w— I hereby affirm that I am licensed under provisions or Chapter 9(commencingD rl 10p,
with Section]f100)ofDivision 3of the Bnameasand Profession,Code.iindmylic..iREPLACE FIXTURL "I�i CATHS
fin? sumo Tone am effect. CABINETS/TILE/LIGHT/WINDOWS
Licc sa Clava Lica
Fy_p Dam Contractor
ARCHITECTS DECLARATION •� lG,
¢ I understand my plans shall he used as public memds
0.
LLa.o Licensed Professional l 1 H 1 O?/
OW BER-BUILDER DECLARATION �I
d"r« 1 hereby affirm Ilial I em exempt from the Contractor's License Lew for the 1� /'
ii�p o following reason.(Sorbian 7031.5.Business and Professions Cod.:Any cry or county `
X
m which requires a permit to construct.short,improve,demolish,or repair any structure 8 5 0 0
prior m its issuance,also requires the applicant for such permit file a signed Statement
ti< that the islicensed pursuant to the provisions ofNCContractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
Wt-$ (commencing with Section 7")ofDivision 3ofthe Business and profcssi.,aCocke)tor 35928047 . 00
y that he is exempt therefrom and Nrbuis for the alleged exemption.Any violation of
Semon]m L5 by any applicator fora permit subjects the applicant o a civil penalty of APN Number
not mora than live hundred calls.(scan). Occupancy Type
ZI 1,as owner of the progeny.or my employees with wages as their ante mmpemetion. 101 - FOUNDATION
will rip rise work,and the
aysent.isnot intended or offered for a.],(See.]035,Business —
PiERS
and Professions Code:The Convectors License law does not apply to an owner of 103 - UFER Required Inspections
property who buildsor improves Boston,and who does such work himmlfor through his
own employees.provided that such improvcmcn¢ase not intended oroRered for sale.IL 104 — REBAR
however,the building or improvement is sold within one year of completion.Be owner-
0
will hive Ba burden of proving that he did not build or improve for purpose of 105 - ANCHOR BOLTS
ask')' 106 - SEWER & WATER
❑I,as owner of the property,am exclusively contractors with licensed contractors to 202 _ UNDERFLOOR PLUMBING
can Ue rocket($ .]thio.Business and Professions CodcJ le iCpntracwYa Li.
cense taw docs not pply wan owner of property who builds or improves thereon•and 203 - UNDERFLOOR MECHANICAL
who contracts for such projects with a contranor(s)licensed pursuant to the Contractor's
Lcrina,Law 204 - UNDERFLOOR FRAME
lam exempt der Sec. B&P C for this reason 205 - UNDERFLOOR INSULATION
Otvrcr — Dole 0113O02- 301 - ROUGH PLUMBING
YORKER'S COMPENSATION DEC ATION 302 - TUB & OR SHOWER
baby arm under .Or,of perjury mor of the following dcclaralions:
❑l have and will maintains Cenircete ofConsenuo self-income for Workcr'scompen- 303 — ROUGH MECHANICAL
cation,as provided for by Section 37W of Be labor Code,for the perv
rormme of de 3 04 - ROUGH ELECTRICAL
work for which this permit is issued. 3 0 ME
5 - FRAME❑1 have and will maintain Workers Compensation Insurance,as required by Section 306 5 - DOWNS
3700 of the labor Code,for Ute p mormance of the work for which Bis permit is issued.
My worker,compensadnnInsurancecamerandPnrcynumberme: 307 - INSULATION
Carrel: Policy No: 308 - SHEETROCK
CERTIFICATE OF EX EMPIION FROM WORKERS'
COMPENSATION INSURANCE 309 - EXTERIOR LATH
(Thissectibm need nmh.courPlcted irthc peorelisforonchundeddollars(klotl) 310 - INTERIOR LATH
I'c.bif' 311 - SCRATCH COAT
Imploy any
erthe inanyperformance r th nresurwhich this permitisissued.I=hullnot 313 - ROOF NAIL
_1` employ any parson in any manner sawbecome subjecun the Workers Compensation
unto orc____� —`��-3F'Fob
r,n, ., a.. , 501 - FINAL ELECTRICAL ENERGY
.TrICE TO AP ICAW.If,after making this Ccni�rere of Exemption.you should 502 - FINAL PLUMBING ENERGY
Mcomc subject to the Worker's CompensationthsPermit
of demedrvoke you must 503 - FINAL MECHANICAL ENERGY
O ,Z
become
hcomply with such provisions nthis pPro itionsoche Labor
Coadcd.
zo
r ( CONSTRUCTION LENDING AGENCY 504 - FINAL BUILDING ENERGY
F kfor
whichthiBatUereis.construction leading agency buthe Performance or 505 - FINAL ELECTRICAL
a > Bcwor,Nameichlhisremail isissued(Sce.3(197.Civ.C.) 506 - GAS TEST
fs) 0 tender's Nam.
Lenderess
r's AddOC 507 - FINAL PLUMBING
U 1 agree that I have nod thisapplication
and coup and sura that the above information is 508 - FINAL MECHANI CAL
(L F covecL I agree d comply will all city and county ordinances and slate laws relating w —
O U building construction,and hereby authorize representatives of this city w corer upon th. 5 - FINAL GRADE
W
shove-(we)aeU property for emnifyan keep ea. —
(We)agmc in save.indemnify and keep habmkss the City of Cup.nst s admin 'S 0 FIN I G
F" P] liabilities.judgmcnRscuts and cxpenuswhich may inany way attmcagainctsaidCity 5 N L WORKS
U 2 in consequence of Be granting of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE GULATIONS
Too Applic n onvactor ODam ° Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wd1 to applicant"rfuture building occupant store or handle handrachrow,mncral
as defined by Be Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(s)? 1
All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yes •�k)'
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 hasardom air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? si��
cYes pJNo
\ I have read the havardous materials requirements under Chapter 6.95 of the Cali for
nia Health&Safely Code,Secdomz5505,z5533and25530.lunders clod thebuilding
does not currently haw a tentmL BID is is my responsibility w nods c pant of the
equiremenu hick mustMmcl prorwissuanee ofa Certifcam of 'cup c,- 36 ° Signature of Applicant Dale
Vr or Aunionwea ascot Date All roof coverings to be Class •'B"or better
1_
5 r10U12�' ,�
c RI
Cl
9v 300
a . a jd =
0
m �.
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N
Wive OW 33% >
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bCGp�- *CITE' OF CUPERTIN# 2o
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Alk
3S- '/ Date: ,, 30 / .:�vO-
Building Address: h t l ,L `'-e4�-0T ova Dy, C QYt n 6
Owner's Name: N Phone #:
M� - Mit Nie- 8- ms1 . - 3708
Contractor: v W License#:
Contact: V \ Phone#:
u�t �- � 4Q- -�)- - 370 `
Applicant/Contractor: Fax #:
Build ng Permit Info: �.
Bld Elect Plumb =ech
Description: fit e< -cfw�s z 641.1=
Residential: j:le_ i 2L�a/S P Z /Gaks Commercial:
Sq.Ft. Floor Area:' $/Sq.Ft.:
Architect/Engineer: Valuat• n:
Type of Construction: r Occup c Gro
uanti Fee ID Fee Descri tion Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX . Ind/Off/COnun/ 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 Ener BUILDING
BENERGYADD Ener Add Multi BUILDING
BINVESTIGA Investi ation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMTTIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric, ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
1of3 �kVVO