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04060135 t CITY OF CUPERTINO BUILDING DIVISION PERMITry-�-- CC1RAiCQi,2INTUn Mr1TI(gN.,, `i BUILDING ADDRESS: ' PERMIT N004 0 6 0 13 5 10487 LOCKWOOD DR OWNER'S NAME: PERMIT ISSUE DATE JASON SHEU 06/16/2004 NE: SANITARY N0, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH (� uoo LICENSED CONTRACTOR'S DECLARATION Job Descrip 1 hereby affhm that I am licensed under provisions of Chapter 9(commencing with Section Onald of Division Sof the Business and Professions Code,and my license is NNALL infall force and effect. ELECT SERVICE UPGRADE S5�� Licenx Class La.N Dam COMMCIM AUG 3 0 2004 QQ ARcHmcrS DECLARATION 1 understand my plans shall he used a public records j�u r4 Licensed Pm(casional 6 U I L®I Gy OWNER-BUILDER DECLARATION +� I hereby elErm that I em exempt from the Consramo/s License Lew for the x p O following reason.(Section 7031.3,Business and Professions Cade:Any city Or county $ which requires a Permit to Convect,ater,improve,demolish.or repair any structure $2000 prior to its issuance.else requires the applicant for such Permiuo fie a signed suument < that he is licensed pursuanun the previsions of the Contractors Licenx Law(Chapter 9 Sq.Ft.Floor Area Valuation e�$ (commencing wide Section 7000)M Division 3 of the Business and Professions Code)or ey.. Nat he is exempt Bannerman and the basis for dee alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil Penalty of ar Occupancy Type not mom than ftw hundred dollars(5500). ❑1,as owner of the property,or my employees with wages as their sole eom came tion, will do the work,sad the swcmre is not intended or offered for sde(Sec.7044,Business and Pretensions Cade:The Contracmr's License Law done not apply be an owner of Required Inspections property who builds or improve thereon.and who does such work himself or through his own employees.provided thaeuch improvements arc notimended oroRered for sale.If, however.the building or improvement is sold within mm year of completion,the owner- builder will have the burden of Moving that W did not Wild or improve for purpose of sale. L u owner of the property,am exclusively contracting with licensed contractors to co wet the eject(Sec.7044.finance;and Professions Code:)The Connector's Lt. come law doe nal apply to an owner or property who Wilds or improve deemon,and, who contracts for such pmjccu with a contractor(s)licensed pursuant to the Constar`s License Law. ❑l me exempt under Sec. B@ P C for this reams. 0 nor Data 1 E COMPENSATION DECLARATION 1 hereby affirm tlhdar penalty of perjury one of Nc(allowing.dedveuons: I have and will maintain a CCrtIRCdto of Consent to self-insure for Worker'sCompen- sation,as presided for by Section 3700 of dm labor Code.for the performance of dee work for which this permit is issued. ❑I have and will maintain Wmkcr's Compensation Insurance,a required by Section 3700 of Ne Inbar Code,for the Performance of the work far which this remit is issued. MY' y Work,es Compensation lomernee carrier and Policy number are: Cartier. Polity No.: ' CERTIFICATE OF EXEM MON FROM WORKERS' COMPENSATION INSURANCE This section need not be completed if the pewit Isfor one hundred dollars(5100) ar loss.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in my manner an as w become subject to the Workers'Compensation Iowa of California.Dau Applicant NOTICE TO APPLICANT:1C after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must .7Z forthwith comply with such provisions or this permit mail W deemed revoked, OCONSTRUCTION LENDING AGENCY (r (hereby alfirm that them is a construction lending agency l'or the Performance of M Bee work for which this Permit is issued(Sce.,3097,Civ.C.) Q Lender's Name =z Lender's Address V 0 I certify Nal I have mad this application and sum deet the above information is / L,P correct.I agree to comply with all city and county ordinances and sum laws relating to V Or, building convection,and hereby authorim mpmsenmdws of this city in enter upon the W a1Wvcroemioned Property for insectian Purposes. (We)agree m ave,indemnify ad keep harmless the City of Cupertino against isy liabilities,judgmens.cosh and expenses which may is any Way acerae against aid City V V in consequence of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WIT ALT!/N-VO NT Issued by: Date SO RCE REGUWIONS. / l6/ Re-roofs own can on Date A2AB000S MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle havardous mammal As defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Ode,Section 25531(ayi All roofs shall be inspected prior to any roofing material/being installed. ElYca a Will the applicant or future building Occupant use equipment at devises which If a roof is installed without first obtaining an inspection,I agree to remove coil harmdnus air ennuminants as defined by dee Bay Area Air Quality Management all new materials for inspection. District? Yes 1 have mad the Weardons materials requirements a ukricl tpu:r6.95 of the Califor- Ana HealN@SafetyCode.Sections 15505.25533 md15534.1 understand OmtifNe Wilding does not currently haw a Imam,that it is my rnpomihiiity in notify the occupant of the requireme hie bcmelpB ceofaCCwficam f cup cy. Signature of Applicant Date , or out <d a i Dam All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 UPERTINO Building Department JOB ADDRESS: $gRMIT # / 0 ! '04r-9liDCkVJ6-0d. Ox, #/-qO ((-o � OWNER'S N s S PHONE GENERAL CONTRACTO • 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 Sheet Rock Tile `.. _ vvOwn /Signature Date CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM N#,?� , > Date: "/ G o Building Aeess: Mailing Address f diff rent frm building address): Owner'sN,5: Sam sj Phone Contractor: /� /tel License#: Uw Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Descriptions C Residential ❑ � f Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: a 000 . Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ IRL Project Size: Standard ❑ Lar e ❑ Major ❑ 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 BCONSTAXH 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 / 2c 1 of 3 F CITY OF CUPERTINO CUPEI� TINO 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 PbIg 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 rinklerBackflo 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 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 Mise 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 CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMSIGNAD Rmdl Si 's 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 Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary 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 Plumbing Fee sa foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 CITY OF CUPERTINO m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 34229009 . 00 DATE ISSUED. . . . . . . : 06/16/2004 RECEIPT # • • • • . . . . . : 25920 REFERENCE ID # . . . : 04060135 SITE ADDRESS . . . . . : 10487 LOCKWOOD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JASON SHEU ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2666 RECEIVED FROM . . . . : SITYH-JYE SHEU CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . : , TELEPHONE . EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- -------- -- ---------- ---------- BELEC200 METERS 1 . 00 27 . 25 0 . 00 27 . 25 0 . 00 BENERGY PERMIT FEE 1 . 00 23 . 10 0 . 00 23 . 10 0 . 00 EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35.. 52 0 . 00 BSEISMICRE VALUATION 2 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 86 . 37 0 . 00 86 . 37 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ------------ ----- ------------ ------------------ CHECK 86 . 37 1376 TOTAL RECEIPT 86 . 37 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 103 UFER 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL