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04060126 CITY OF CUPEO CLINTRACTQR3jNTQRMATION ., BUILDING DIVISION PERMIT BUILDING ADDRESS: YEE TAT KAI PERMIT Nc04060126 7485 KINGSBURY PL PERMIT LSSUE DATE OWNER'S NAME: YEE TAT KAI 06/15/2004 SANITARY NO. CONTROL NO. tE: BUILDING PERMIT INFO ARCHITEC BINGINEER: BLDG ELECT PLUMB MECN 0 _Oo LICENSEDCONTRdunder$oEConsnfCON Job Des ripJ m Thereby ."Bunn that 1 am licensed under provisions of Chapmr 9(commencing < with Sectim 70Muf Division 3oftheBusirren and Pmfessium Code.and my license is mmumroeandeffect. REMODEL HALL BATHROOM ;g= License Class Lie.A AUG 17 1004 Z— Dam Cumracmr ARCHITECTS DECLARATION I understandmyplans shall M1c used as public records O ❑ D�p D��'rr��\\ t� /�r� ;us MUMS II\\III! — o Licensed Professional U \VVI\\S OWNER-BUILDER DECLARATION 1 hereby Mason,(Sect that 11. exempt s an the Contras Co Lironm Lew for the O4 following measa (Section]NLS,Business and Professions Code:Any city m county $6000 $� which requires.permit n)construct,alter.improve,demolish,or repair any structure Fiy prior to its issuance.also mquims the applicant for such permit to file a signed sammem Valuation that he is licensed pursuant m the pmvisions of the Contractor's License Law(Chapter y Sq. Ft. Floor Area RE, s (commencing with Section](I(IO of Division 3 of the Business and Professions Code)to w. that he is exempt thcmfrom and Ne basis for to alleged exemption.Any violation of Section]031.5 by any applicant for Apermit subjects Ne applicant to a civil penalty of a Occupancy Type AM mart Nan five hundred doll..(S500). t]L as owner of the proputy,or my empleycu with wagu m Melr sole compensation, will do th sah ms Code:d The Cum eCoMes Lieco or ace dos not apply to an Business Re uired Ins ections and Profusions ldsoThe Cnntncton.Lienee dace does not apply l(an owner is q P own Property s,builds i un proventhereon.andwho does inch work himself carNrough his empl�yees,provided that such improvementsare car ear of m llferttl for sale.sL builder thebuilding or of pmentiscoldwithinoneyear or completion,thenwn or builder will have the burden of proving that he tlitl not build or improve fur purpom of sale.). [:]1,es owner of the property,am uelosively contracting with licensed contract.a to c usnuo the project(Sec.7044,Business and Professions Code:)The Contnemr's U. ecom Law docs not apply to an owner of p mpcny who builds or improves Merton,and who contracts for such projects with a cartoonists)licensed pursuant to the Contractor's License law. I am exempt under See. B At P C for this reason u/fnuy Owner L1°` ' ?tet ` C— Date I� WORKER'S COMPENSATION DECLARATI h"1 ercby anirm antler penally of perjury one of the fallowing Jeclar.tioni: save and will maintain a Cervi fico¢of Consent to set f-insum for Worker's Compere .ren,As provided for by Section 370E of Me Labor Code.for on,performance of the work for which this permit is issued, ❑1 have and will maintain Worker's Compensation Insurance,ss requited by Section 370E of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance camier and Policy number am: Caller: Policy No.: ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the pevnit Is foronc hundrtd dollars($100) or less.) 1 cervi fy Mat in the penharm.nee of the work for which this permit is issued.I shall MA employ any pc irsotUA an54n " b annerm �mr¢subicn to the Woolmor CennKrIation Laws of Calihmta.10gam any _f II //(( Applies t NorIC TO APPLICANT:If,aper making this Canities¢of Exemption,you should become ihject m the Worker's Compensation pmvisions of the labor Code,you..it ,JZ to comply with such provisions or this permit shall the decided.vnked. Z O CONSTRUCTION LENDING AGENCY [. 1 hereby am.Mat Mere is a construction lending agency or performance of Cd > the work for which his permit is issued(Sec.3097,Civ.C.) 44 Q Lender's Name =Z Lender's Addrom U C 1 certify that 1 have read Nis applien,mo and state that he above information is D.P ami I agree to comply with all city and county oNininces and some laws mlating to 0U building mneuuction.and hereby authorim mprceentstives of this city to enter upon the W shovnmcntioned property for inspccuun purposes. (We).,me to save,indemnify and keep harmleas to City of Cupenino against liabilities,judgmenls.easis and expenses which may in any way accme against said City Ali U Z in consequence of the granting of this permit ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATION'. Wry Bd if l.� Re-roofs SAt.. fAp,ImaMJCAAt1AcIm Dom HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle harallous material u defined by the Cupenine Municipal Code.Chapter 9.12.and the Health and Safety Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. p Yes )!9 No Will the applicant or fumrc building rinnimant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hvardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. fl Dy. I[]Nu 1 have read he haranlnus mamriale mqultuments under Chapter 6.95 of the Califon ma Heald&Safety Code,Sections 25515.25533 and 25534.1 undersand that fine building , docs n t c orntly have a tenant,that it is my responsibility A notify the.xupant of the rc taiyy d.hicbmustbcmctriermismanceof.cerufi of Lkeuanc. y ; p �(trfov Signature of Applicant Date V72,�� lv Owner or aumari.cd afcnt Dam All roof coverings to be Class "B" or better Cl'PY OF CUPERTINO z n, Bulwary c DIVISIONPI;RMI'� C. I8ACTQ,I,t7Nk'ORMA ."� BUILDING ADDRESS: YEE TAT KAI PERMIT N%4060126 7485 KINGSBURY PL PERMIT ISSUE DATD OWNER'S NAME: YEE TAT KAI 06/15/2004 lr SANITARY NO. CONTROL.NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH uo0 LICGNSEDCONTRACTOR'SDECon,a(CON 7obDescriphonR(\NAL �D U w 1 hereby affirm INS1 am CONTRACTOR under prDEC A of Chapter 9(commencing Illi u\\V�I ILIL, wan seddl,n7fxxn nroroiaon3 bone BMaocaa ana Promarinns code.and my Bonsai REMODEL HALL BATHROOM in fail fora and effect. n�Z Liccnsc Class Lic.N d y S Date Cmumclor J ARCHITECTS DECLARATION AUG 17 2004 Ota I understand my plans shall be,Mind as public remods 0a 3 o ti Licensed Promeanarl �II��� ❑ !1 OWNER-exempER DECLARATION Cona ON II tl D t� .'�a S I M1erchy affirm that I am exempt from the Contmnar's License Law for me D U IILII7 i\\ 0 o following reason.(Section 7,31.5,Business and Profesions Code:Any city ar county Illi K m which requires a permit to contain,alter,improve,dcmnlish,or repair any struclum �:' 0 m"^ priorto its issuance,dial,rcquims the applicant for such permit rile a signed statement that he is licensed pursuant to the Provisions of the Cooberelm"License Law(Charter 9 Sq.Ft.Floor Area Valuation �Fo (commencing with Section 9000)of Division 3 of the B mucus and Professions Code)or i� that he is exempt therefrom and Ne basis for Ne alleged exemption.Any violation of Section 7031.5 by any applicant for a Permit notip o Ne appllcanuo acivil penalty of C Occupancy Type at,more Than five handled dollars($500). 0 L as Owner of the prepeny,or my cul with wages a their sole compensation, mill do the work,and the sbamure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Consranor's License Law does not oPPly In an owner of q P rproperty who builds or improves thereon,and who does such work himself or through his employccs.provided War such improvemenu are automated morzcrnd Rustle.if. nowevcq the building or improvement is sold within one year of completion,Ne owner. builder will bave the burden of proving ran be did not build or improve for impose of sale.). ❑1,as owner of Me properly,am exclusively contracting with licensed canbocors to construct the project(Sec.7MPL Business and Professions Code:)The Contractor's Lb chase Law does not apply to an owner of property who builds or improves dreeon,and who contracts for such projects,with a conbamor(s)licensed pursuant o Ne Cambodian's License Law. 'Q l am exempt under Sec. ,B&P C for this motion 9'> Owner WORKER'S COMPENSATION DECLARATI hereby affirm under penalty of perjury one of the following declaatimed have and will maintain a Contractile of Consent to self-insumfor Worker'sCompcn- nation,as Provided for by Section 3700 of Ne Labor Code,for the performance of the work for which this Permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,a regvired by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance canfcr and Policy number am: Cerner. Policy No.: I CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This anion need net he complced if the Permit is far ane handled dollars(SINE fuss.) I cloudy that in the performance of the work for which this permit is issued,i shall not employ any person any{rlanneap e m hump subjfn to the Workers'Compenmtinn Laws of California.03m' ( / Applied t NOTIC TO APPLICANT:If,atom making this provisions of of Exemption,you should _ neame uhjen to the Worker's Compensation Proinions ne,do labor Code,you must Qz forth t comply with such provisions or this permit shall he deemed revoked. Z CONSTRUCTION LENDING AGENCY 'ps I hereby afbm Nat More iso coasboaion lending agency fo the Performance of �i the work for which this permit is issued(Sec.3097,Civ.C.) _ W Q Lender's Namc z Le den's Address / V 1 certify Nat I have read this application and sate(bar the above'mfl,m+miun is H coned.l agree to comply with all city and county ordinances and state laws miming to DU building constuction,and hereby authorize mprcandedivcs of this city to cote Open the ,� W above mentioned property for inspccium purposes. C7. (We)agree to save,indemnify and keep harmless the City of Cupertino against z N liabilities,judgmen¢,cosls andexperues which may in anywayaceme againstsaid City of the granting of V z APPLICANTeUNDERSTANDS AND rpermit.his DateCOMPLY WITH ALL NON-POINT Issued by: Dale _ SOURCE REGULATIONS. 61(%—YO LP « ' Re-roofs S marcRApplicanVCortmcror Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant tar future building escaper shoe to,handle hazardous material as defined by the Cupenino Municipal Code,Chapter 9,12,and the Health and Safety Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. DYea JS No Will the applicant or from building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove t havaNean air emmminanls as dcaned by the Bay Arca Air Quality Management all new materials for inspection. ' ❑Yes �Nn I have read the hoeirders materials requirements undcr Chapter 6.95 of the Calif.r- his HcoM to Safeycode.Secdoa M05,25533 and 25534.1 understand Moultrie building does n t cunendy bave o enznt that it is my msponsihilhy o unity the occupant of the qa+,m ewMnn neat be me pril,rh iaraoncc Of ceNBdaf Odnupandr. Signature of Applicant Date (lrl a'f All roof coverings to be Class"B" or better Cwnerl,r an@odzcd Isnot Datil ,� - CITY OF CUPERTINO C/ o 2 � CITY dF PERMIT APPLICATION FORM b c �' CUPERTINO dL N # / Date: Building Address: Mailing Address (if different from building address): 7495- ()Iti&C 1 C 9S-Wy Owner's Name: Phone#: Yee 7A 1 (moo ?) �(-u6 i z7�p Contractor: License#: Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: ❑ Elect ❑ Plumb Mech ❑ Job Description: Residential © Re o, tr 64)rwwt ( Hca( Qat W *) Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Projec . Occupancy Gro : �pb000 Type of Cons ction: Please check t the project is a second-story addition: ❑ roject Size: Standaf8<1 Large ❑ Major ❑ QU ntity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERl Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL BB0ILER5 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 Elee Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING *� zS� a7 1 of3 /M1 �,?-o , 3 `-Ir' CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM QuantityFee 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 BOVERTEVIE 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 Intercel3tor 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 Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit > 10,000 clip MECHANICAL BRENL IRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > 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 Devi ce/Ap paratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL Ah BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 d CITY OF CUPERTINO CITY CUPEI�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmd] Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Mar uee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISA11COM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Tempormy Power ELECTRICAL BTEMPPERM Tem ora Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbin Fees foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 1 I�Ct�i �'esic�8oac� r . e eCI•�.A14en^s IL+... p rimes and iL e� `'�• „_<a r-.1 Changes awi sli�re:Lo^s erniss'sez of Cupertit c tha ,m]din this plan and specifics' t;a sirr. ir permit or it tfs co, d a14s2!9 CSO; es held fA 3py,,�a9 c3 tl's violation of �7 z9N w eldfnance Og Sim L' t f � Y 1 f� 4� 1 RI n a a5 CITY ® CUP�9� �9J6Qnimr- nr.PARPk ENT �l ,9' 11'/IIY� \s \VtI C'Y IC Nn� ��N� V151N