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05030106 (2)CITY OF C[1PER'I'INO O y c .: 2 .yN. Qlender's � Q Fcooed. U W raja z ^� BUILDING DIVISION PER CONTRACT,ORINFORMr�ON BUILDING ADDRESS: ROBIN SUNG PERMIT 5005030106 NER'S NAME: PERMIT ISSUE DATE JI PHONE: SANITARY NO. CONTROL NO. 4 2 7- ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm shat l am Iimusee under provisions of Chapter 9 (commencing with Section 7")nf Division Sof to Business and'Professinns ode, and my license ix i OUp Lirens ammo arta caret.yLe DRYWALL ON GARAGE/REPLACE` WINDOWS (2) g License Conlramr START JOB WITHOUT PERMIT/BPERMFEE FEES DOUBLED / ARCHITECTS DECLARATION I undersand my plans shall w used az public remain Licensed Professional OWNER -BUILDER DECLARATION I hemhy affirm thm I am exempt from the Conuaesar's License law forme following mason. (Section 703 1.5, Business and Professors Code: Any city or many which requires a Permit m construct, alter. improve, demmb.sh, or repair any structure prior m its issuance. also requires de applicant for inch Permit 11 he a signed summcnt that he is licensed purivanuo me provisions of the Contractor's LJavns. Law (Charter 9 Sq. Ft. Floor Area Valua"200 (commencing wit Section 7000)of Division J of the Business and Professions Code) or Out he is exempt tci from mtl the basis far me ❑Lr,cd exemption. Any violation of APN Number Occupancy Type Section 7031.3 by any applicant to, aperoft subjects the applwanno a civil penalty of not mom than five hundred dollars (1500). 36226038.00 ❑ 1, as owner of the property, or my employees with wages as their sale compensation, Required Inspections will do the work. and the iwcturt is maintained or offered for sale (Sm.]014. Business and Professions Code: The Contractors License Law dues not apply to an owner of q p property who builds or improve termor. and whodoes such work himself or through his own employes, provided Out such improvements tie not intended m offered for sale. r- Manor - huilder thebuilding orimpmwmcntiisold within one year of completion, throw of builder will bare the burden of proving that he did not wild or improve for purpose of sure I. ❑ I, as owner of the , am ll.. ad contracting wit licensed armnctoa m See 7 Code:) The Coo aincons and cense Law coca not apply je an owner of protons who vesica or improve tenon, and can= a the es not (Sec. ]Obi, owner of and ny who who contracts for such projects with a contractor(s) licensed pursuant to the Contractors Lirenx law. I am ezwpt under Sea . B h P C for tis�nnreason \� V r Dale / , WORKER'S COMPENSATION DECLARATION 1 hereby aBion under penally of perp sy one of 0e following declaralione ❑ 1 have and will maintain a Certificate of Contin m self-insum for WorkersCampcn- rauon, u provided for by Section 37W of de Labor Code, for mm perfmmame of the work for which tis pcnnit is issued. ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 3700 of the labor Code, for dm performance of the work for which tho permit is issued. My Workers Cmmpeeauon Insurance anicr and Policy number arc: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE - (This section need not bee andcu:d ate permit is forone hundred Milan (Stait Mur Ims.) 1 certify Our in the performance of the work for which tis permit ls issued, I shall not employ any person in any manner sn as m wcome subject to me Workers Compensation Laws of Cnlifomia. Da¢ Applicant NOTICE TO APPLICANT: If, after making this Ccnificate of Exemption, you should ' become subject to the Worker's Cmnpca5odim provisions of me Labor Code, you must foMwith comply with nuc h proviainm or mu permit shall to deemed revoked. CONSTRUCTION LENDING AGENCY I that mem is a 3W7 lending agency for lM performance of dte work fur which mu pcnnit ls issued (See. 309]. Civ. C.) far which OU island (Sec. Name Lenders Address 1 coolly that 1 have mad this application and sum that the above informati n o 1 agree to comply with all city and county ordinaries and state laws relating to building convection, snit hereby summon arprescntatives of this city in enter upon me awvo-mentioned property for inspection purposes. (We) agree to saw, indemnify and keep harmless the City of Cupertino against liabililiesjudgmen t,cosu and expenses which may in any way acenm against said City in consequence of the granting of this permit. APPLICANT UNDE STAN ND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCL!AFZj �L I; � Re -roofs Type of Roof Signami. of ApplicanUConnonor Dam HAZARD MATERIALS DISCLOSURE Will On applicant or (MUM building occupant omni or handle haxarEous material az defined by the Cupenino Municipal Coe., Chapter 9.1; and me Health and Safety Section 25532(a)? AAA,,, p Yes ay Na All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the x,liant or fumre wilding..pan, Mae equipment or devices whim .mit basilica., air mmannimmis as defiled by the Bay Arta Air Quality Management all new materials for inspection. District? ❑Yes ANu 1 have mad me tioxodous materials mquiromenu under Chapter G95 of me Califor> IiaHe.]"Silly Code. Sections 25505.25533 and 25534.1 understand that it do Wilding docs not currently haw a truism, not it h my reapmsihility to notify the occupant of tc m wmmms bmustlm etpdormostiammofa Ccrohtic ar scup w_ Signature of Applicant Dale C 0' D Al: roof coverings to be Class "B" or better wmerMraammria<dasent Date • CRY Of CUPEINO Assessor's Parcel Number: Name of owner. V !%1 • is Project address. h pd Y k Contact person.Ro> il7 QSI/P Phone. C��/�yg —�72 / Fax. Net square footage of lot. Existin Square footage: First floor: Second floor: Garage: TOTAL: - Proposed Are there at least two 10 foot by 20 foot clear spaces inside the garage? Q- J N Is privacy protection planting required for the project? On what floor(s) is work being done? Brief description of work. f7 Y N Code editions: 2001 CBC (Y - N)2001 CFC (Y - N)2001 CMC 2001 CPC (Y - N)2001 NEC (Y - N) Effective 11/1/02 MAR 7 2005 Plan Review Process Work Book Page -8-Revised 4/28/04 �L(%llidi'G (Y- N) • 0 0 Vj ��IZI-� 47,7 PGJ,,ysZ (�Q CITY OF ® CUPERTINO kITY OF CUPERTINOP PERMIT APPLICATION FORM 26-2- 7� o� APN # Fee Description Fee Group Date: 3 _o J Building Address:,.,,Lt.. r MECHANICAL Mailing Address (i different from building address): r Ct. CL Ad -t ,,90. �/ Owner's Name:, Jin I n riC Boiler> 500K to IM Btu Pho e #: Ooh) -130-66-40 Contractor: Aok4 Sun Boiler> 1M to 1.75 M Btu MECHANICAL License #: 1 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax Contact: // Phone: — ,,7 Cupertino Business License#: O/Jl� (SZ//I Fax: BUILDING BCONSTAXH Building Permit Info: BUILDING BCONSTAXR Constax — Resi/Mobile Bldg Q Elect ❑ BELEC1000 Plumb ❑ Mech ❑ Job Description:Sp ,nq djyidv/ en yv-4y10,71/ -2- 3X3' (a po/I W i/i , Residential ® ✓ Elec Svcs 600V <= 200A ELECTRICAL Commercial ❑ Sq.Ft. Floor Area: BUILDING BENERGYADD $/Sq.Ft.: Cost of Project: j-1--pO r BINVESTIGA Investigation fee Occupancy Group: Type of Construction:V/VPlease check this box if the project is a second -story addition: ❑ Pro'ect Size: Standard ❑ Large ❑ Major ❑ 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 IM 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 <=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 ,#- 2-&g36 1 of 3 3/%.22