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04090007 (2) r ITY OF CUPERTINO � � ,�a BUILDING DIVISION PERMIT 000NTRACT , R INFOR VIATION .. ILDING ADDRESS: PERMIT NO04090007 409000,7 ER'S NAME: PERMIT I SUEDATE OWN KEVIN YEN E: SANITARY N0. CONTROL NO. ARCHI=PENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH _op LICENSED CON`fRACTOR'SDECLARATION IbDescription F❑ I mmby of irro No am al I licensed under provisions of Chapter 9(commencing iW wide Section 7")af Division 3 drum Businruand professions Code.and my license is ^3y to Class hnxrtrtandercer'' Lie.? License REPLACE WINDOWS/FURNACE/GAS LINE TO COOKTOP � Dade Contracts, ARCHITECTS DECLARATION co I undersand my plans shall he used a public records ;yU a. Licensed Licensed Professional 3 OWNER-BUILDER DECLARATION 0 1 hereby,them that 1 1. eumpt from Ne Con.nmC's :Any c Law for the Q o following uiman,Permit t ]In sir Business and ere,de ons Cada:Any city or county K$ which requires a permit SO o cI st he pima improve,demolish,or a pair any structure te—w prionnits issuance. sedpro ...t uithe rovkims applicant for such Canto or Limme,Law auemcm that licensed pursuant 7")of Division of the eBuacwrind Professions (s Code)or Sq.Ft. Floor Area Valuation ��$ te,heis(commencing with Sanson s and t f Dimit f r of ted alleged oraand Professions Cade)of Net he is ezcmpt therefrom and Ne buss far the alleged cumpuon.Any violation of Section 9031.5 by any applicant for a permit subjects the applicant o a civil penalty of 3 SISNAQi3ih cr0 0 Occupancy Type not more than five hundred dollar($500). I,as owner of she property,or my employ=with wage as their sole compemvfion. will do Ncwork.and the samsms is not intended or offmeE for sde(See.7044,Busircss Required Inspections and Professions Code:Tbc Contactors e License Law does not apply to in owner of q P own etywho builds orimprovesch improvements who dss.h woe himselfor through his awn employees,provided demauch Improsold wit art net intended m learW f.via If. hander.the building or anofpmantishathwithino.year of completion.use ownuf builder will have de burden of proving Net W did not Wild or improve for purpose of ,c I,as ower of tie sec.propectq,am ezd ss and contracting with licensed rnntue. i ' conswet the es Out (Sec.7044.wner of and ry whtiom Cade:)The Contactors rad / come Law does rat apply a an owner of property who Wilds or improv demon,and who contracts for such projects with a contactor(s)liunse0 pursuant to deo Contactors e License Law. / C31 errs credit,under Scc. .B&P C far artazan 0 -'- Date 9 Df WORKER'SC ENSATION DECLARA ON I hereby air&=under of perjury o.of the foIIu declarations: Mw and will maintain aCenificate ofConunuo selfwnsum for Workai sCompcn- aation,m provided for by Section 3700 of the LO Wr Code,for the parturman.of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurmtt,a rtquimd by Section 3700Of Ne IOW,Code,for the performance of the woe for which this permit is issued. My We Compensation Insurance caniu and Polity number arc: Carrott: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Tbiaacetirso need not W completed!fine permit is forma hundred dollars(SI1ar or lem.) 1 ecnify Nat in the performance of the woe for which this permit is banned.I shall not employ any person in any mannerso as to become subjecOo the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.aper making this Certificate of Exemption,you should become subject in the Worker's Compensation provisions of the labor Code,you mind .J Z foMwith comply wish such provisions or this permit that W domed mvokcd. z Q CONSTRUCTION LENDING AGENCY [-. 1 hereby affirm Our there is a construction lending agcy for the perfurmance of the work for which this permit is issued(Sec.3!197,Civ.C.) C0 Lender's Nave =z Lcndcrs Address U O 1 ratify that I have read this application and sum that the above nomination is F correct.I agree to comply with all city and county ordinances and sate laws relating to C U Wilding construction,and hereby mountain repmunutivrs of this city to enter upon the W above-mentioned property for inspection Purposes. o)agree to side, and keep less City of inct ainst F-'f0.j3 habililluWjudgments,costs add eexpenses which may inmyway accrue against said City U Z in conaeq.nec of the Printing of this Permit. - APPLICANT UNDERS`rA D9 AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Gl _ 9( Of Re-roofs rWC gnazura fAppl':HAZA S MATERIALS DISCLOSURE on Dam Type of Roof Will the applicant or future Wilding Occupant store or handle haardous material az defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety We,SuctionYes 2ss3z(aYn �" All roofs shall be inspected prior to any roofing material being installed. ❑Ycs Will Nc applicant or fuwre building arupam tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove Ci havardnos air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. / surra? ❑Ycs 13'Nu 1 have mad the ho ssidous materials requirements under Chapter 6.95 of Ne Califor. nia Health A Safety Code.Sceuons 25505.25533 and 25534.1 undersand trillium Wilding docs not cumve rnlly haa ren hNa it is my..'and"ym ondl'y dm...pant of dee requirements wh¢ ma do,to issuance of a Ceruhcate of Occupa/rnfy. Signature of Applicant Date 0041.ra.mthorinda94— l '�Dol�CH All roof coverings to be Class"B"or better CITY OF CUPERTINO BUILDING DIVISION PER . ®ANI'INTRACTOR INFOR z aION iCING A•]DRESS: PERMIT NO04090007 NEIVSU NAME: PERMYT ISSUE DATE KEVIN YEN PHONE: SANITARY NO. CONTROL NO. ARCHMC IENGTNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 mop LICENSED CONTRACTOR'S DECLARATION Job Description UW 1 hereby afford that l am licensed under previsions of Chapter 9(commencing p r, p iso wire Section?000)of Divisum Softha Business and Professions Code.and my licenm is kf111h\ �q Li�evw oats aerfeed' uea REPLACE WINDOWS/dF'U�ZN'�C /,,GAS'S' LINE TO COOKTOP exp Dam Contractor assets nt H ARCHITECTS DECLARATION (rsr I understand my plans shall be used as public records J`� X' qo�� �iU I� '+C G Liccnscd Pmfassional g OWNER-BUILDER DECLARATION rte, DDDsss44A.. I hcrchy affirm that 1 1. exempt sant the Cmntom Co License c Low for the 6UQY B q q� � (( aC following rcasmn.(Smtiun?1171.5,Business and Pmfessinm Code:Any city of county ft1'{ �l�JJH (Hl�k\Vu' K g E which mquires a pconit m commanded,after,impmve,demolish,or repair any structure W—H prior m its issuance.also requires the applicant for such Permit m file a signed statement - ��a That he is licensed pursmnuothe provisions of the Comrxtora lJmnu Law(Chapter9 Sq. Ft.Floor Area Valuation QFC (commencing with Section 7")of Division 3 of the Business and Professions Cntle)or i $ that he u exempt therefrom and the dark for rte alleged exemption.Any= 'of Section 7031.5 by any applicant for a permit subjects the applicant acivil Penalty of 3909 0 Occupancy Type not mom Nan five hundred dollars(E5f10). 1,as owner of the property,or my employees with wages az their sole compensation, will domework ende:Ta Conaisnots License dos Out t Dinh Business arta Pmlessmm cane:The contactors License Law aces not apply la an owner of Required Inspections pr nsent'whobuilds i improvsuthereon,and who rum notchwork nimsdfor edthmugn his own ver.b Wilding than such improvements wit are not year dedof or leered for sale.owner. f. builds, thebuildingor improvementissoldwithin one yeti of camplcuan,NedomOf builder will have the burdrn of proving that he did not Wild tar improve for putpou of vlcJ. LJ 1.as owner of the propeny,am exclusively contracting with licensed contractors to ' construct be project(Sec.7014.Business and Professions Caa)The Canmmuce.Li- amu Law docs not apply to an owner of property who Wilds or improves themon.and who contracts for such projects with a contractor(s)licensed pursuant to be Contractor's emu taw. lore<vcmpd under Bcc. --T _.B&PCfar this rcazon _111 Date 9 Lr WORKER'SC b�ENSATION DECLARAT ONi 1 hereby a(ftm under pf It of perjury one oft¢folia tlttlarmm�s: ❑I have and will maintain aCer ifcam of Cooscm m self-inesum for WorkeraCoanpen- smion,as provided for by Section 3700 of in.labor Code,for am pammandes of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Scmion 3700 of the labor Cade,for the performance of be work for which this permit is issued. My Workces Compensation Inaurence artier and Policy number aa: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE rnosscction need not be completed if the permit is for one hundred dollars(SIM) or lesa) I cattily Nm in the Performance of the work for which this permit is issued,1 shall not employ any Personany manner u az to become subject to be Worked Compcnsaton lama of Califomis.Dam Applicant NOTICE TO APPLICANT:IL after making this Cad ifmzm of Exemption,you should become subject in be Worker's Cort penadion previsions Of the Lsbm Code,you anus �z kethwimcompywith such pmviximu,a,bis Permit shall Wdeemed mvoked. z O CONSTRUCTION LENDING AGENCY Ihereby M.that Nem is a construction lending agency for the performance of the work for which this Permit is issued(Sec.3097.Civ.C.) W — Under's Name = z Under's Add= U 0 1 certify that I have read this application and stem that be above infix nmion is W f•' correct.I agree to comply with all city and county on iner mics and stale laws mlating to �U building conswaion,and hereby aumoriu representatives of this city to enter a Pon the G above-mentioned property for inspection purposes (We)agrte m save,indemnify and keep harmless be City of Cuper irm against .F. N liabilities.judgments,costs and expenses which may in any way aecmc against said City of be of U z consequence rt Permit. APLCANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ISSUedby:S4��(a Date SOURCE REGULATIONS `� ��1 �` Re-roofs gnamretif ApplicaHAZA_OUS MATERIALS DISCLOSURE Dam Type of Roof will the applicant or future building occupant store or handle haardous mamrial defined by the Cupertino Municipal Codc,Chapter 9.12.and the Fistula and Safety tide Section 25532(0)7T J All roofs shall be inspected prior to any roofing material being installed. ❑Yes ted Will mea applicant future building occupant Wa e l or devices whim If a roof is installed without first obtaining an inspection,I agree to remove PP 6 Pan Area n emit harardnus air contaminants az Jcfinca by the Bay Arca Air Quality Managcmcnt all new materials for inspection. District? ❑ O ' Yes LI Nu 1 have read one haardous materials requirements under Chapter 6.95 of the Califor. nia Health k Safety Code,sections 25505,25533 arta 25534.1 understand Nat if One Wilding docs not currently have a tenant,mat it is my responsibility m nod I the Occupant of the mquitioncons roua=prionoissuance tufa Cerdfamof Occupan y. Signature of Applicant Date r��/cow O rmamhorircJagani% mm All roof coverings to be Class"B"or better 95ut y `l1.7, � cfe etc(Sf,w� ;r�r�;5���� CEjVED >I(L�ICiC� �'L+vNr+ct O ,Gct�rScs.-E�,v4� it �� /C SEP 0 2 2 BX: C40 YC a -' --- Los I y N It 4 APPROVE®. ` a,u IN ACCQRD CE, 'TH THE CITY OB 0 DE` 0 . NANC69 O !J U1 j a DAT, .: . .— •�,--' \ SIGNED h° q�1y This set of N�a��: �nd sUecifica� � )a kept on the job at all times and it is u9 ( � 0 lawful to make any changes on alters s i I on same without written permission om the building Dept., City of Cupertino. The stamping of this plan and specifications — n ; SHALL NOT be held to permit or,to be ar. ® ! approval of the violation Of any Vrowemn' Y Or.'At'e Law. �' ,1 4; vi � YCPA ® 7- 1b6, 1 1,wdy �e, vne RECEIV SEP 02004 B LL i i 7 1 0'U U e b � C-oe` E i IDA f w r al vG Z, nu'y Latae 3� .EIV 0 2004 ZZ mg � FT m z d ti T a M .,�.-__.____. _ .VLA y-• —.9.H {� ��II I II��77.II IIII nnIIII IIII \I� a(�qL f.9�4 .B T .910 1 g b C.5 H .G e (r T AL,6 .lt N w � r MdGI EJ `O W a m OCITY OF CUPERTINO* CUP TYOF O PERMIT APPLICATION FORM ° 7 APN # / 2 Q / Date: Building Address:: Mailing Address if different m building address): 2-1(0(1 1 Gi vials Z40e Owner's NarKC Phone #: � evi v� `t'e,� Contractor: to b 1, Vc,.$f License #: Povi lNC,l(aCe (Iclrwo , Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Bldg Elect ❑ Plumb Mech'Cl� JOKDescnptlo�J �P (ad^ cicrsfiry LJ,rf/ov s(aRt� esidentia] ❑^ `PGF2 FiAYNQv �ok'ty Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Projectg4 Occupancy Group: !9, 325— Type of Construction: Please check this bo e project is a second-storyaddition: ❑ Pro ect Size: Standar Lar e ElMa'or ❑ 7 Quantity 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 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING 13CONSTAX 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 Z� 1 of CL/ Jr (�<- OCITY OF CUPERTINOA • CUP TOF YO PERMIT APPLICATION FORM 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 IMF 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 cfm MECHANICAL BRENL IRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM 3USWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l 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 BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 - SCITY OF CUPERTINOW, CUP TYOF O PERMIT APPLICATION FOi:_M QuantityFee ID Fee Description Fee Group BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 Ternp 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 Plumbing Fee sq foot PLUMBING ZADDCHG Address Change I BUILDING 3 of 3 J Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 *UPERTINO Building De artment JOB ADD12E 2� 6 6 l Gi ndy LGvtc PE IT # OWNEWS N mut evt PHO # 65 --'7 Q- ?;LL GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information 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 Tile Owner/@;�ntr ctor Signature Date