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05060013CITYOFCUPE TINO a +;nom€e 'e'a. r s ,y xzi4'7 shk, BUILDING DIVISION PERMIT fCONTRACTO RM1INFORMATIO.�N: BUILDING ADDRESS: 47e XTNrqRTJRY PT. HOMEGUARD INC PERMITNO, 5060013 OWNER'S NAME: PERMIT ISSUUE DATE CHIANG CHAN ONE: SANITARY NO. CONTROL NO. (408)993-1900 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH 0 0 0 0 i0 LICENSED CONTRACTOR'S DECLARATION JobDescri [ion J F 1 hereby affirm that I am litta¢d under provisions of Chapter 9 (commencing I3 'uj wish Section ]IXIU)af Divi 3aflhe Business uPruI eta Cndc, an//d my ensc is ire a z in(ulluchossdcRace Licenu Clua TERMITE REPAIR (PLYWOOD @ SUBFL) Dam Contractor -� ARCHITECTS DECLARATION EI understand my plans aball he used u public records u Liccnud Pmfcssional a 3 DECLARATIONeto Oat Y exempt from d Comns Licenu Law for the 1 hereby .(Teat that 1 I am exempt from O Cou Professions Co ds,: Any city or county 7031.5, Business and r following mason. 1. g Permit improve de m repair structure aper, est permit re mms whichrequiresits ' 5525 �y the h Ishmit t ed for such priono its issuance, also rcquireuhe applicant far such permiuo filcasigned statement is u n q:,FtFFloor-tlr Valuation ao -� NathcisliccnuJPursuanunthcpmvisiouofshcContumriLiccnu aw(Chapmr9 (commencing wish Section 7000) of Division 3 of this, Business and Professions Com)or C R.?+^++�a Nn he u exempt therefrom and Ns, pasts for Um alleged exemption. Any violation of 1 lam\/ ( s I-- 'I \ Pi�^Uf i Section7in=Fi}aundredicm.($500mit ublecu the appl¢antmacivil penalty of not mom Nan Bve hundred Callan (5500). 3'Srfl'3JJ[3tD1$Set00:- / ' J Occi pancy Type f[t y��,,,� �I Il ll� ❑I.uowner of she propcny, or my cmployco wish wagesu their tris, compcfwtion, {� // a u 1 N --� Li Regmred I[[nuuspec ions I will do Ncvvmk, and theswtture is not intended ora0emd for sale (See. 7044, Business law does and Professions Code: The Convacmh Licemne not apply m an Owner of property who builds or improves Nemon. and who doessuch work himeofor through his --- W own employees, provided that such improvements are not intended or offend for sale. If. however, the building or improvement is sold within one year of completion, the owner. builder will have dm burden of proving that he did not build m improve for purpose of salt.). ❑ 1, as moner of the propcny, am exclusively contracting with licensed conmcmrs to consumer the project (Sce. 7044, Basins and professions Cods,:) The Conuvamr's Li. / Genu law does not apply to an owner of Property, who builtls or impmau Neeson, and who contracts for such projects with a eorracuKs) licensed pursuant m dm Cannactots Lima. law. ' ❑ l am exempt under Sec. ,B&PC for this moon J Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby afrum under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to ulGinsum for Worker's Compen- ian. u provided for by Scotian 3700 of the labor Cade, fm the performance of Ne 7031.'W rk for which Nis permit is issued. I have axil will maintain Worker's Compensation Insurance, as mquimd by Section of Ns, labor Code, for Ne performamcc of Ne work for which Nis prmit is issued. y Works,' nsatiunIn msecartierentlPolicy num /rtier. m Policy No.: rzER C F A EXEMPTION FRO WORKERS' COMPENSATIONINSURANCE (Thusectom need nut becompleud if the North is foronehundred dollars (SIM) or less.) , 1 ccr ify that in Ne performance of the work for which this permit u issued. 1 shall not employ any parson in any manner set u to become subject to the Workcri Compensation _ Laws of California. Dam Applicant NOTICE TO APPLICANT: It, after making this Comficau of Eumptien, you should become subject to the Worker's Compensation provisions of to Labor Code, you must ,z forthwith comply with such provisions or this Permit shall be deemed revoked. 0 CONSTRUCTION LENDING AGENCY 1 bcmby affirm Nat Vert is a construction lending agency for the Performan a of the work (m which this permit is issued (Sec. 3097. Co. C.) Qlender's Name Lender's Address z I ttnify that 1 ban read this application and sum that the above information is f" comet. l agree to comply with all city and county ordinances and sure laws relating to CJ building Construction, and hereby aathonto representatives of this city to enter upon the D.1 above-mentioned prorerty for inspection purposes. C (We) agme to save, indemnify and keep harmless the City of Cupertino against N Z liablllties,judgmcnu,cosu andespenses which may in anywayaccme against said Co, in consequence of the of this /+ / ^ granting permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REG LATIONS, �' 6S Re -roofs Signewrc of xm CmI I.' Data e HAZARDOUS TERI DISCLOSURE Type of Roof the applicant Of home building Occupant store or handle hasndous maredal as derined by the Cuperino Municipal Code. Chapter 9. 12. and Ns, Health and Safely ,adliGode. Section 25532(4)? All roofs shall be inspected prior to any roofing material being installed. Yes❑Nu If a roof is installed without first obtaining an inspection, I agree to remove Will thea applicant or future building Occupant ase equipment or devise, which nr g e gaipr Quality s air amnumimnts ss defined by the Bay Area Air Quality Management all new materials for inspection. ist ict? District? D Ycs ON. 1 have mad the hasardous roomful, requirements under Chaplet 6.95 of the, Califor- nia Huish & Safety Code, Sections 255(15.25533 and 25534.1 understand mor irose building does not Currently hate a unam, Nat it is my responsihility, to noti I occupant of Ne 1th.e require em, which mum mMCI poor toissuance ofaCertificamo,pcOp.Cy. BS Signature of Applicant Date All roof coverings to be Class "B" or better 0 authomed agent Da f � CITU OF �UPERTINO '147.6 K',v�s b vfY OWNER'S N GENERAL CONTRACTOR: Community Development 10300 Torre Avenue .Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building De utment PERMIT # p S 0'K ea/l PHONE# FAX # I am not using any subcontractors: S' at a Date Please check applicable subcontractors and complete the followin>? information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical 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 Owner/ Contractor Signature Date l� CC��- CITY OF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM ,J4, °� APN #! D /0 Date: /f 6 Building Address u p Mailing Address (if different from building address): wner's Name: / A /v,CA/ N Phone #: ntr Coactor:. „ % License #: C, L ASC' V BBOILER3 fl N MECHANICAL Contact: Phone: 3 - /9 DO Cupertino Business License#: BBOILER5 Fax MECHANICAL Building Permit lnfo: Construction Tax Bldg I/ Elect ❑ Plumb ❑ Mech ❑ Job Descriptioi Residential �� / � WIt '674 "Ir Commercial El Sq.Ft. Floor Area: S[i F/,� 611' A7 ASER- 154 76 $/Sq.Ft.: Cost of Project: 5)5)-5 Occupancy Group: Type of Construction M n� �� Please check this box if the project is a ELECTRICAL BELEC1001 second -story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ BELEC200 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 BCONSTAXE Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING LJ 1 of 3 CITY OF CUPERTINO CITY Of PERMIT APPLICATION FORM CUPEkTINO 2of3 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 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pipe PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm 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 BREM.POLE Pole/Platform Fixture ELECTRICAL BREMPOWER 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 2of3 Sep CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM Quantity Fee 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 Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Tenip Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING t 3 of 3