05120107 CITY OF CUPERTINO
BUILDING DIVISION
PER �dITG �1L2 T1 � 1X *IONV
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BUILDING ADDRESS: ZIMING ZHOU PERMIT NO.O 5120107
79.'A HTINTRTnr.
• OWNER'S NAME: PERMITISSUEDATE
ZIMING ZHOU 12/19/2005
NE: SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDO EIECr PLUMB MECH
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LICENSED CONTRACTORS DECLARATION Job Desc: 'on
1 hereby affirm that l am licensed under and
Prol ss of LConn. 9(commencingsis
< with Sectldn]01g)ofDividonJaf the Business and Profcsainm Code.and my license is
w� mmRto=badeffccl REPLACE 1 ELECT. OUTLE HEN)
i in Licence Clue Lk.R
L
Dam.Com
nil
fg- ARCUsed be daHIn DECLECL
DECLARATION
1 urWcmalW my Ilan ad a Panic recordsG�,�� '
7
Tor,G Licensed Professional /
OWNER-BUILDER DECLARATION
QE 1 herchynaso affirm Thar I 1 exempt from We fession C s License law for the 1p
p o following reason.(Section]0313.Bsalmu and Ro@uidu Cade:Any city at county 0
$ which mqulro a permit to cmanmct,alter,fmprove,demalLth.or repair any swclure $50
prior to its issuance,also requires the applicant for nch permit in file a signed stammenl
FF
that he is licensed pursuant to the provisional ofthe Contractor',Lice=Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y�$ (commencing with Section 7000)of Division]of be Business and Professions Code)or
Net he is warrant therefrom and the basis for the alleged eaemptian Any violation of
Section 7031.3 by any applicant for a permit subjects the applicant o a civil penalty of P Y Type
more Nan live hundred dollars(53007. r s CCU anC
❑Las owner of rhe Property or my employees with wages u their sok compensation,
willdo the wad:and thestnmom is not intended or offered Waste(Sec.7044,Business
and Prefessiona Code:The Commetar',License law does ant apply to an owner of Required Inspections
property who Wilda m improves themon,and whodoessuch work himselfor Through his,
ownempioyoes,provided thatsuch improvements arc nolintended maffered fmsale.if,
however,the Wilding or impmvemem is sold within am Year of campkdon,The owmn
builder will have the burden of proving that M did net Wild or improve Its,puryna of
Z'1,as owner of the progeny,am aeluaively contracting with flamed commemn to
construct the pmjen(Sec.7044,Business and Profession Code:)The Consomme,Li.
mace law does not apply in an owner of propmy.who Wilda or improves thereon,W.
who contracts for such pmjeets with a sora sor(O licensed puissant to the Conuauora
License Law.
❑lUneaem nd Sec. B/I'�Cr'ea}!fi't. on
Owner � �Dau
WORKER'S COMPENSATION DECLARATION
I hereby alftmm under penally of perjury am of the fallowing dcchustmm:
I have end will maintain a Cerfifiate ofCmmm11.¢If-imum for WorteYs Compc t.
satian,an provided for by Sealed 3700 of The Labor Cade,far the perfarmame of the
work for which this permit is issued.
❑1 have and will maintain Warkcfs Compewtion Insurance,u required by Seaton
J7Me[The labor Codd.for Ole pufmmance of the work forwhich this permit is instant.
My Worke(a Compensation Inuuance carrier and Policy number am:
Gfrler. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This recllm need not he completed If the Ismail Is fmamhundred dollars($101))
or lead.)
I certify that in the performance of tie work for which this permit is issued,l"I not _
employ any perron in any manner WV vel jj!;;�lB I�e�m1mri Compensation
Laws of Callfamla.Date 11
Applicant A —
NOTICE TO APPLICANT. ,after making this Cabcam of Esemptmn,you should
become subject to the Workers Compensation previsions of the labor CSNe,you moat
.J 0
E forthwith comply with such provision re
or thin permit that be decreed revoked.
M CONSTRUCTION LENDING AGENCY
[—ice IWrebyallirm That there ins contraction lending agency far the perfomnwe of
C the work fur which this permit is issued(Sec.3097,Co.C.1
QLuck's Name
Q z lander's Address
f,)Q I unify that 1 have mad this application and sum this the above information is
E~- caner 1 agree to comply with all city and county ordinances and sum laws relating in
Q U building contraction,and hereby authorize mpoanmivecdfthiscitytoenter upon the _
tTl above-mentioned Property for inspection pugmset
p1. (We)agree to eve,indemnify and keep harmlea the City of Cupertino against
In Ilebilitia.judgmenu,cases and expenses which may in any way scene against amid City
f)7 in cdnagsenee of the granling of lhb permit q r1 0
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date LL' I,
SOURCE RE CATIONS.
1 Re roofs �4
SlfinatunkrofApplicamVCommuclear Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII The applicant o(alum building k.Chapter
ofand the
h eallon material
sa dcOned by the Cupenina Munici at Code.Chaper 9.13.and die Health and Safety
Cade,Section 25532(0)7 �� All roofs shall be inspected prior to any roofing material being installed.
Oyu ❑No
Will the applicant at future Wilding occupant um cquipmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
fl hanrdam air contaminants as dcfimd by One Bay Ams Air Quality Management all new materials for inspection.
1nxi
aurel?
❑Yu �dlar
I have mad mum
the hddusuerials requirements under Chopler6.95 drive Califor.
.is HmlthB SaictyCodo,Swd.25505.25533 aamuM e W
125534.1 undcthutfThilding
a ml currently haw m mnan4 that it is my responsibility to oddly tint occupant of the
aicomnewhichmyUbemetimormisa��enRaamora'Pan7lr L 1SignatureofApplicant Date
e
owner or alma degcnl gum All roof coverings to be Class"B"or better
OWNER-BUILDER VERIFICATION
1. (Check one) I'or my immediate family (parent, spouse or child) will perform
A. v All the work authorized by this permit
B. = A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2 A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City. Phone # State License # Type of work to
beperformed
3. I will utilize unlicensed person(s) other than my immediate family to perform all or
• portions of the authorized work- I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
PersorVFirm Address/City Phone Number Type of work to be
erformed
............................................................................................................................_.......................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (rev side).
Property Owner's Signature: Date:
job Address: —714 Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
City of Cupertino Building Department
OCIF 103OD Torre Avenue
CUPERTINO '° ` '773
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply
if you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs)is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors,then you may be an'employer.
if you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers compensation insurance,disability insurance costs,and unemployment compensati
one
contributions.
There may be financial risks for you if you do not carry out these obligations,and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the US.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed iA
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1020 N Street;Sacramento,California 95614.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino
PdMed on Recycled Pepe,
Sol- CITY OF CUPERTINO -
CITY OF PERMIT APPLICATION FORM vel 2- 0107
CUPERTINO
N # Date:
Building Address: Mailing Address (if different from building address):
Owner's Name: Phone#:
Contractor: License#:
Contact: Phone: Cupertino Business License#:
O 1 i r e Fax:
Building Permit Info:
Bldg ❑ Elect )�3/ Plumb ❑ Mech ❑
Job Description: e c w CIVResidential ❑ CZE 6 G`v\ke 0 tiq. r-d L �� Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
Cost ofProiect: o Occupant 3ouu:
Type of Construction: Please check this box if the project is a
(_/4-- second-story addition: El
ro'ect Size: Standard ❑ Large ❑ Major ❑
uant ity 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 1,75M 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
I of
Ohl CITY OF CUPERTINO
cuPEr�nNo PERMIT APPLICATION FORM
Ouantitv 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
BP13ACKFLOW 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 PLUAMING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rink]er/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 Reins ection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cim MECHANICAL
BREMAiRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY .. Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BRENIFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMU-IEAT Heater Installation MECHANICAL
BREAEMOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPONVER 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
CUPEI�TINO 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 Insection BUILDING
BSWIM Swimming Pool BUILDING
BTENIP Temporary Power ELECTRICAL
BTEAIPPERA4 Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMTTFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals .foot hfCHANICAL
ATERMITFEE A4ech Permit Issuance MECHANICAL
PPERNIITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Commel Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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