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05010080 CITY OF CUPERTINO + BUILDING DIVISION PURI�i' 3 CONTRACTQR INFORIY:�ION BUILDING ADDRESS: CHRISTINA CHAO PERM IT N00 S O IO O 80 ERS NAME: PERMIT ISSUE DATE CHRISTINA PHONE: SANITARY 2 CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH =00 LICENSED CONTRACTOR'S DECLARATION IobDescrip[ion FCwith Se 1 hereby affirm Thal I am licensed muk,provisions Of Chapter 9(commencing iW ction70W)of Division 3afmcBar.and Proresswas Code,and in,license is - �„ in full force and effect. REVISION--IN HOUSE USE ONLY o reg Z License ClensLie.d own Dam Contractor NO NEW PERMIT ISSUE ORIG. #04080239 j ARCHITECTS DECLARATION �i I understand my plans shall h used as public records LyU Y v0 C Licensed Pmfcssianal OWNER-BUILDER DECLARATION v s s I hereby affirm met I oto exempt from me esmns Co e:Any Law for the no which moss..(S.I, trl]L5,cosines and Psafdwroli Cade:Any city or county OJT. Km wiort its snportio Inca the ammo Improve,h Perlia or repair my Structure - +t—m prionoin censed'e,Alsortu requires the sof for sucCionarm's Lier se signed mmhcincing it pursonm70th)of Division sheeBusiness Licenm Lew(Chapter9 Sq.Ft.Floor Area 7yaluatlo x115 SFO that M iscixem with Section7000)and tah basis f]of the egmi exampo and so.Any V1 Cock)or i�$ that W u exempt therefrom and sbe baso for the alleged exemption.Any sialasion of <- Section?031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type not more than ave hundred dollars(S50B. ❑I.azowncrofmm property,ormycmployruwith wageutheirsole campenatlon, 375531002 ' 00 will do tad work.and the nwaum is not intemled or oRemd foeaaw(Scc.7044,Business and Professions Cade:The Conuicmes Limo)Law most not apply to an owrw of Required Inspections ownenywhos.itmviimproveth impr andwhodoessuintworkdamselfad mmugh his awn employees,provided then vetouch int is sxmcros in ne yew deo mpleti ed thesate.own r- - huilder,Nebuilding orden of pmensissaidwithinone year of cprove foron,the builder will have me burden of proving that he did not Wild or improve far purpose of salt.). b1,as owner of the property,am exclusively contracting with licensed mnvaetum 10 construct the pmjca(See.?o4q Business and Professions Code:)The Contractor's Li- chom law doe not apply to an Owner of property who Wilds or improves Bmcreon.and. who contracts for such projects with a comnctor(s)licensed Paraaanl M the Convector's License Law. 0lam aTp 'Sid^er Sce —� .B&PC for this rtasan I! —"""' Dam Uro WORKER'S COMPENSATION DECLAR 1 helaby affirm under penally of pet o,arc of the rolbw tog tlalandans: - 1 have and will maintain aCcrtifica,of Consent to xlf-insum for Worker's Coupon- Sudan,as provided for by Section 3100 of the Labor Code.for me performance of on, work for which this permit is issued ❑1 have and will maintain Worker's Compensation Insurance,as required by Section ]]W of the Labor Codc,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance)artier and Policy number we: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE mossection need not be completed if the Permit is fmone hundred dollars(SI W) or less.) 1 certify that in the performance Of floc work for which this permit is issued.I shall not s employ any person in any manner so as m hccome subject to the Woke re Compensation Laws of California Data Applicant NOTICE TO APPLICANT:If,after making this CeriOcam of Exemption.you should became subjecs.,he Worker's Compen woo provisions of me Lahnr Code,you most wJ z forthwith comply with such provisions or this permit shall W deemed revoked. z O CONSTRUCTION LENDING AGENCY F+4 I hereby alarm that men is a cumsruminn lending agency for me perrurmam a of a 7 Ate weak for which this permit is issued(Scc.3097,Civ.C.) [[] Q Landes Name z Lender's Address r U O 1 cert.than I haus Siad this y ad con and sow that me above information.Oclis 0 U cartea 1 agree m comply with all city end countyonninsces and sou laws r upon t to pU above mentioned property hereby eumonprposesenmtives of miscity mcnvr upon me 6. erju agree w aavq indemnify and hick harmless w City of against against UZlie6il=qucceofthgrantidgmenu.costs ng upas pormicM1may in anyway accrvc against mid City C.)z in conuqucnec of the granting of this permit. '—' APPLICANT UNDERSTANDS AND WIL COMPLY WITH ALL NON-PO T Issued by: Date SOURCER�QULATIONS. 1 .V/6 i`CV,f��„Y I �/Z Re-roofs ` Sign of ApplicanUCanu eLm ._ HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof Will the applicant or future building oacupantstore or handle ba/arduus material defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety de.S)edon 25532(.)? All roofs shall be inspected prior to any roofing material being installed. 0Yes Nu Will the applicant or future building Occupant um equipment or devices which If a roof is installed without Salt obtaining an inspection,I agree to remove emit hadardous air consaminanli at dcfned by the Bay Arca Air Quality Management all new materials for inspection. District? 0 Yes 1 have read the harnNnus materials requirements under Chapter 6.95 of the Califor- nia Heal or&Safcty Codc,Sections 25505.25533 and 25534.1 understand that if me boudm docs not<u dX M1aux a tenant mat it u my respomi6ility w nmtily the rax pent to' m R u Sirm�' h must W me, m fo isman[ ( ra"" Q) q��( �t,/tAn'�`T �Zx;�t - 'P�ry d Signature of Applicant Date Owner or authorised a gent Dass All roof coverings to be Class"B"or better • CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng : Sub: Blk: Lot : APN 37531002 . 00 DATE ISSUED. . . . . . . : 01/12/2005 RECEIPT # . . . . . . . . . 28267 REFERENCE ID # . . . : 05010080 SITE ADDRESS . . . . . : 10800 JOHNSON AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CHRISTINA CHAO ADDRESS . . . . . . . . . . : 10800 JOHNSON AVE CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : LINDA LAINE CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : CHRISTINA CHAO ADDRESS . . . . . . . . . . : 10800 JOHNSON AVE e CITY/STATE/ZIP . . . , TELEPHONE . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW DAL ---------- ------------ - ---- ------ --- ------ - - - --- - - ----- BPLANCKREP HOURS 6 . 00 522 . 84 0 . 00 522 . 84 0 . 00 TOTAL PERMIT 522 . 84 0 . 00 522 . 84 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - ---------------- ------------ -------------- ---- OTHER 522 . 84 AMEX TOTAL RECEIPT 522,. 84 O SalCITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CU PEf�TINO oF--n APN # �J� / Date: Buildi ress: Mailing Address (if different from building address): o�ov Owner's Nap Phone #: C1/rCiri0. Contractor: License#: Contact: L; � L u� Phone: 4&-4 upertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential ❑ � t'"' 67'�t,�ia1 ❑ Sq.Ft. Floor Area: / a. S/Sq.Ft.: Cost of Project: Occupancy Group: ype of Construction: Please check this box it the project is a second-story addition: ❑ Project Size: Standard ❑ Lar e ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK 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 <= I OOOA ELECTRICAL BELEC1001 Elec 600V > IOOOA ELECTRICAL BELEC200 Elee Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 67 s-z2. 91/ e (� . CITY OF CUPERTIN81 CITYOF PERMIT APPLICATION FORM CU PERTINO Quantity 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 Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING 1 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 cfrn 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 Furnace > I 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 tlow BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 4PITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Grou BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical LightingFix 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 Insl5ection 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 , Mechanical sq. foot MECHANICAL MPERAIITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 CITY OF CUPERTINO r." «E s BUILDING DIVISION PERMIT �*CONTRAC,TR IIVEORMA'�ION ' ';BUILDING CHRISTINA CHAO PERMITNOO 5010080 POO iTOHNSON 7077, OWNER'S NAME: PERMITISUEDATE CHRISTINA JE: SANITARY NO, CONTROL NO. RCHITECfIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 uoo LICENSED CONTRACTOR'S DECLARATION Job Dl tion m❑ I bereby affirm that 1 am licensed under provisions or Chapter 9(commencing escrP iW with Secli 7WO)of Division 3 of the Business and Pofemom Code,and my Recounts A Limmsefull Class err«t. REVISION--IN HOUSE USE ONLY s,-y,_ Licenx Class Comb "-5 Date cnnmemr NO NEW PERMIT .ISSUED/ORIG. 404080239 ARCHITECTS DECLARATION e< I understand my plans shall he used as public records D., Licensed Profcssionsl I OWNER-BUILDER DECLARATION y 1 hemby M.that 1 am exempt from the Cmuredofs License Law for the p O following mason(Section 7031.5,Business and Pmreadmu Cade:Any city or county , $ which requires a Permit to construct.ober,improve,demuli q or mpir-any structure prior to to TSC issuance,also requires the applicant for such Permit to file a signed summenl that he is licensed Pursuant to the urviamns.f Mc Couraimm's License Law(Chapter 9 Sq.Ft. Floor Area Valuaticflj 15 nth (coremeneingwith Section70W)of Division3 drum Businessaral Proressionx Code)or Y `<$ that he is exempt Ihmefmm and dte basis for Ne alleged csemption.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty or AIN Number Occupancy Type not mom than Bw hundred dollars(SSW). . 01,o owner oftlm property,or my employees with wage,as their side compensation, 37531002 . 00 will do the work,and Ne sum me is not intended or offend for sale(Sec.7044,Businos and Professions Code:The Comment'sLicense law does net apply m an Owner or _ .. RequiredInspections propcny who bis i Ids or i mprome thereon,and who dons such work himself or though his own employes,provided But such improwmenu aremn intended oroffmcd forsale.If. ' however.the building or improvement is sold within one year of completion,the owner. builder will have the burden of roving that he did not build or improve for purpose of salt.). 1,as owner of in,property.am exclusively comnaing with licensed ecommu s,to Construct the pmjcm(Sec.ID14.Business and Professions Code:)The Canuacm's Li Cream Law docs not apply to an Owner of profs ory who builds or improves thereon,and who conuacu forauch projector with a conunctor(s)licensed pursuant m the Conuanosn -V License Law. - ❑lam/��%^p Idde,SSee .B&PCfmthismuon w r I Date Z- �� WORKER'S COMPENSATION DECLAR 1 hereby aRml under penalty Of perjury..of the followmg declarations: I haw and will maintain a Certificate of Consent to self-insure for Workers Comlka- ion,an provided for by Section 3700 of the labor Code,for Ne performance of thc work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance.ss re i ired by section 37W Of the Labor Code,for the performance Of the work for which this permit is issued. My Workers Compensation Insurance Cartier and Policy number an: - Cartier. Policy No.: - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ITms section need not he conplelul if the permit is form=hundred dollars($100) or less.) 1 certify Nat in the perfoommee Of the work for which this permit u issued.I shall not employ any person in any manner sun as to become subject to the Workers Compensation Laws Or California Date Applicant NOTICE TO APPLICANT:If,after making this CemliCaM or Exemption,you should become subjca m the WOdoN a Compensation provisions of the Lahnr Com,you must JO forthwith comply with such provisions or this permit shall he deemed revoked. PC CONSTRUCTION LENDING AGENCY [—� I hereby alarm that then is a construction lending apro,for one performance of W the wurk for which Nis permit is issued(sec.3091,CO,C.) W Q Lender's Name 6. Lander'.Address J Z O Q 1 certify Wt 1 have mad this application and sou that the above information is U. p mien.I agree to comply with all city and county ordinances and sou laws relating to 0 V building consuuction,and hereby authorim rcpresenutives Of this city to enter upon the r 0.Wi alum-mentiond property for impecuun purpoma (We)agree to save,indemnity and keep harmless the City of Cupertino against Fliabilities,judglncnu.Cos.and expenses which may in any way accmc against said City V Z in eorxugnenee of the granting of this permit. ^ APPLICANT UNDERSTANDS AND WIL COMPLY WITH ALL NON-P Issued by: Date SOUR CATIONS. J �. i ) sign npplianucnnuac�io� _ ���.se Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne applianr to future building..Part stem or handle bmardous material u defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and safety Coda.turn 25532(aSr All roofs shall be inspected nor to an roofing material being turn -<NNn P P Y g g installed. ), If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building Occupant use equipment or Jcvico which writ hmardous air mnumimnu defined by the Bay Arca Air Quality Management all new materials for inspection. isuicn ❑yes o In rtaJ the hvardnuxmateriaH rtyuimmenu under Chapter 6 YS of the Califnr- niaHdalth&Safety COM.Satioru 25505.25531 and25503.1 undcrsmnd thaif tM Wildin does not CY d he a tenant.Nat It u my responsibility ro notify Ne oec pmt of th rc vimm h moa be met t, m issuan or emfrca¢ Q w R � ti ` !�`y'/0 Signature of Applicant Dale owner or suthoRCd agent I � Dalte All roof coverings to be Class"B"or better