08050204CITY OF CUPERTINO
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BUILDING DIVISION PERAUT
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BUILDIN44AggRRRE55:
].OSb3 JUDY AVE
TBD = TO BE DETERMINED
PERMIT NO.
08050204 ,
NAME:
PIILMTT ISSUE DAIS
VWNER'S
JANE WANG
05/27/2008
ONE
SANITARY NO, CONTROL NO.
ARCHIIEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
P -
1 b achy art,. that 1 w fr¢nscd under Provisions of Chapter 9 (commcrem,
with section lDO))orDivision] ofthe Business grid Professiam Code. and my license is
ELECTRCL PANEL UPGRADE. GRAY ELECTRIC PD FOR BUS
in full force and eRec OSg,ty-�
1 Clan. Lk.g �J
LIC 5/27/8 '
Goness
Dem -S —Contrawor
ARCHTECTS DECLARATION
1 undersand my pkns snail w and v public mcorda
Liccnaed Professional
l OWNER -BUILDER DECLARATION
I hereby alarm that I am exempt from Ne Conuactoes Uccoa Law for the
following msson. (Section ID] 1.5. Business and Professions Codc: Any city or county
which re4uirm a permit to conduct, alter. improve, demolish• or repair any strut um
! prior to is issuance. also requires twapplieat for such permit in fikastgrted swcment
' he u licensed to the of the Contractor's lJttme Law (Chapmr9
Sq. Ft. Floor Area
Valuation
that puruam pmvisiom
` (commencing with Section ]BOD) of Division y of the Business and Profmsions Code) w
$1900
• Nat he is everopt Nereram and the basis for the MintedesemPdOM MY Violation of
Number
Occupancy Type
rt sub ecu the appl ant m a civil Penalty ofnot
Scame N rK n ndrreed
in= dollars (isai
3 7 5 0 8 0 5 0 .)ff
wi 1,a sawmrofter papery,. wplenva withmyu uNeoaleemnpensiness
Required Inspections
will do and the sternumurotintended w awift forsak(Sec.i Business
is
fewort
to
as Rofesslons Code The Conuamra License Law amu Out apply m an owns of
propenY who wilds w imprnvea thercon, aM who doex sum Werk himself or tNaugn hk
ownemployees.proNded fer
mplaerta
midcomplains. owmer.
rmyear ofbatsmatim, Neown
you
however. Ne building or dere
maelsashe
Of
builder will have the wrdert of pavin6 Nat w did not build a impaw for puryoa of
Of did
.
sok.).
0 1, as owner of Ne papery, am exclusively contracting with licensed mmassa m to
construct Ne Mica (SCC. 7044. Business and Professore Code:) The, Courteous U.
cense Law does oot apply in an ewer of property who builds or impaws thereon, and.
who contractsfor such projects with a contracar(s)Resumed pu..art in rite Cmussictora
L - law.
For, exempt under See . B k P C fer this reran
.or Date
WORKER'S COMPENSATIONDECI RADON
1 hereby aRm under penalty of perjury one of the following decimations:
1 bow and will maintain a Certificate or content to self -insure for Wormas Compen-
anion, u so,idal for by Sudan 37M of the Labor Code, for the perfonnarsw of Nc
work for which Nis permit is issued.
0 1 haw mal will maintain Workers Compensation Insurance, u mqu'ued by Section
Slam of the labor Cods, for Ne performantt of the wort for which this permit is Wood.
'
My Worker's Compenextion Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
from scum rrad act he completed it Ne permit Is for one hundred dollars lS IM)
or
1 ceriry Wt to Na perfumame of the work for which Nis Permit is earned. I slWl our
employ any person in my in ss/d M.m.poryJ<cW nyeivarken' Compensation
Laws of Caltfomia. �yaT2
Applicant
NOTICE TO APP CAANT'It. afar 'ng Nu Certificate of Exemption, you should
become subject be the WorkcYs Compensation previsions of the Tabor Cade, You most
foMw4b COMPlY with such PowWOM or Nu permit shall on deemed revoked,
1
CONSTRUCTION LENDING AGENCY
1 hereby M. that Nem is a construction lending agency, for the performance of
the work for whim this permit is Wood (Sec. 5091, Civ. Q
Lenders Namc
Lenders Address
1 century that 1 haw read this application ane sate Nat the Now m(amatim is
.
arnica I agree In comply with all city and county oNinmcm and sate law mining to
building construction, and hereby authorize repmaenauvcs of Nu city to enter uPrn Ne
'
above-mcnuonedproperty for
expnion
(We) ag— m Aw. uncannily and lair harmlea the City Of LLpertmo against
Ilabiltties,juegmc whichpurpa,,
cosy and expenses; which may in anyway accac against aid City
the
""'MNegras' of A Permit
APPLIC DER DS AND WILL COMPLY WTf}f ALL NON -MINT
Issued by: Date
SOUR ULATI
Re -roofs
Signa of Applica✓Con Dam
HAZA DOUS MATERIALS DISCLOSURE
mow/
Type of Roof
Will the applicant w future building occupatsione OF hamik harem ous m,abI
ss defined by the Cupenim Municipal Code. Chapter 9.11. and the, Hems and Semy
ark, section
on 155I1(a)t .
Yes No
All roofs shall be inspected prior to any roofing material being installed.
Will the applicat or utum building occupant ata equipment or dcvim which
If a roof is installed without first obtainingan inspection, I agree to remove
P $
craft hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
DiaukQ
0 Yca No
Ihew mol the bora mucriabmquimmena unrkr Chapter 6.95oftiteCalifw-
ni. ulNkSarely Code.Seedrmn5o5.ss5llan 25534.1andcrsand Nutfthe wilding
dna not current how ae that it u my responsibility as ratify este nesupat or Ne
requimmen Fattens,metpdormissuacearacertirteak rr Lkmpacy
Signature of Applicant Date
o��
All roof coverings to be Class ';W' or better
OwerormthoriFedagent D,
• 4 ITEMS OF 4
•
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37508050.00
DATE ISSUED.......: 05/27/2008
RECEIPT #.........: BS000004899
REFERENCE ID # ...: 08050204
SITE ADDRESS .....: 10363 JUDY AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
192.08
---------------
192.08
REFERENCE NUMBER
----------
VISA
OWNER ............:
JANE WANG
ADDRESS ..........:
10363 JUDY
AVE
CITY/STATE/ZIP ...:
CUPERTINO,-CA
95014
RECEIVED FROM ....:
CHRIS P GRAY
CONTRACTOR .......:
TBD - TO BE
DETERMINED
LIC #
00096
COMPANY ..........:
TBD - TO BE
DETERMINED
ADDRESS ..........:
CITY/STATE/ZIP ....
,
TELEPHONE ........:
FEE ID
----------
UNIT QUANTITY
-----------
AMOUNT
PD -TO -DT
THIS REC NEW
BAL
1BSEISMICR
-------
VALUATION 1,900.00
----------
0.50
----------
0.00
----------
0.50
----------
0.00
1BUSLIC
FLAT RATE 1.00
110.00
0.00
110.00
0.00
1EPERMITFE
FLAT RATE 1.00
40.79
0.00
40.79
0.00
ITRAVDOC
FLAT RATE 1.00
40.79
----------
0.00
40.79
0.00
TOTAL PERMIT
192.08
----------
0.00
----------
192.08
----------
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
192.08
---------------
192.08
REFERENCE NUMBER
----------
VISA
•CITY OF
CUPEkTINO
•
•
dio50 toy
CITY OF CUPERTINO.
GENERAL BUILDING
PERMIT APPLICATION FORM
APN #3 7,5
.3 75 04? D50 , C)
Building Address:
/0363 7S'��A
Mailing Address (if different fforn building address):
Owner's Name:
Ph ne #:
SC.�VL�. �0.✓L
Contractor:
Phone: yo g
Fax:
Contractor License #: 83o gy7
Cupertino Business License #:
Contact: Gk 1 S /'
lS
Phone: </0 0
Fax:
Residential Commercial
Job Description:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B Q--
=1
Valuatio t? DO Square Footage:
Project Size: Standard ❑ Lar e ❑ Major ❑
Revised 5/21/08
au
CITY OF
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1GENCOM
1 BTEMPPER
Temporary Building Permit (good for
B
30 days)
IBBOILERI
For the installation or relocation of ca
M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1 BBOILER2
Installation /relocation of ea
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3
Installation/relocation of ea
M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
1 BBOILER4
Installation/relocation of ea
M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ca absorption sys over
1,750,000 Btu/h
I BAPPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP
Other Electrical Inspections (per hour)
E
1 MECHINSP
Other Mechanical Inspections (per
M
hour)
1PLMBINSP
Other Plumbing & Gas Inspections
P
(per hour)
1MEETINGIHR
Application Meeting
B
Pi
CITY OF CUPERTINO
CITY GENERAL BUILDING APPLICATION
• CUPEkTINO FEE SCHEDULE
F_
L
4
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW
SFDWL/DuplexNew
B
IACOUSRESAD
SFDWL/Duplex-Addition/Alteration
B
IACOUSCOM
Multi-Family/Commercial
B
CHIMNEY'S
ICHIMNEY
Chimney
B
1 CHIMNEYR
Chimney Repair
B
FENCES
1FENCE>6FT .
Non -masonry, over 6 ft in height
B
I FENCEMAS>6
Masonry, over 6 ft in height
B
FIREPLACES
1FIREPLMAS
Fireplace Masonry
B
1FIREPLFAB
Fireplace Pre-Fabricated/Metal
B
I FLAGPOL>20
Flag pole (over 20 ft in height)
B
I MODUSTRU
Modular Structures
B
FOUNDATIONS
1 FOUNDREP
Foundation Repair
B
1 PILECAST
Pile Foundation Cast in place concrete
B
'
1 PILEDRIV
Pile Foundation Driven (steel, pre-
stressed concrete
B
3of5
S",
CITY OF
CUPERTINO
CITY OF CUPERTINO '
GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY)
1 RETSTN
Standard (up to 50 ft)
B
IRETSP310
Special Design, 3-10' high (up to 50 `)
B
1RETSPIO
Special Design, over 10' high (up to
50')
B
1 RETCRB<
Gravity/Crib Wall, 0-1O'high (up to
50 ft)
B
1RETCRB>
Gravity/Crib Wall over 10' high (up to
50 ft)
B
SIDING
1SIDEST/BK
Siding, Stone & Brick Veneer
(interior/exterior)
B
1 SIDEOTHER
Siding all other
B
SKYLIGHTS
1 SKYL<l0 SF
Skylight less than 10 sf'
B
1 SKYL>1 OSF
Skylight greater than 10 sf or
structural
B
1STAIRS
Stairs -first flight/ea addt'1
B
STORAGE RACKS
1 SRACKS<=8
Storage Racks 0-8' high (up to 100 sf)
B
1 SRACKS>8
Storage Racks over 8' high (up to 100
st)
B
1STUCOAP
Stucco Applications (up to 400 sf)
additional stucco application
B
4of5
•
•
CITY OF
• CUPERTINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Group
Permit Type
1GENRES or
1GENCOM
1 WINREP
Replacement windows/sliding glass
door (ea 8 windows)
B
1 WINMEWSTR
New Window -structural shear
wall/masonry (includes plan ck fee)
B
I EPERMITFEE
Electrical Permit Fee
E
1MPERMITFEE
Mechanical Permit Fee
M
1 PPERMITFEE
Plumbing Permit Fee
P
1 ELCPLNCK
Stand Alone Electric Pln Ck (hourly)
E
1 MECPLNCK
Stand Alone Mechanical Pln Ck (hrly)
M
1 PLMBLNCK
Stand Alone Plumbing Pln Ck (hrly)
P
1 STPLNCK-(3 Hr Min
when not over counter)
Standard Plan Check (when no
hourly -stand alone
/
IBSEISMICR
Seismic Residential
B
IBSEISMICO
Seismic Commercial
B
1TRAVD0C
Travel & Documentation
B
/
1BUSLIC
Business License
B
5of5
E
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS
036 „�.
PERMIT #
D��SD2v
OWNER'S NAME: }moo. j H 3�--r- U4,lq
PHONE # /O - o'
GENERAL CONTRACTOR:
BUSINESS LICENSE #
I am not using any subcontractors: ' S-2 -7-528
Signatihee Date
Please check applicable subcontractors and complete the following informatinn-
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
f•0.
O y
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date