08040023 CITY OF CUPERTINO
BUILDING DIVISION PERMITC01�1TRACTUR�IN.E'ORMATIOIV
4 ,.gW
aln 187�D��LOREE AVE TBD - TO BE DETERMINED PERMIT08040023
OWNER'S NAME: PERMIT ISSUE DATE
LAN CHU 04/04/2008
PHONE: SANITARY NO. CONTROL NO.
CHITECUENGINEER: BUILDING PERMIT INFO
UPGRADE 200 A PANEL JOHNNYBlm ELECT PLUMB MECH
O O O O
'zEffiHeTRIe FE) BUS il
LICENSED CONTRACTOR'S DECLARATION
e FFy 1 Mosby amtm WI 1 w licensed under prevision croupier 9(commencing ,^^^^ Job Description
n 6 wiN Sadon]OIRO of Division 3o(the Buainegi and Pa cssloos Code,and ylicenseis
EEE in full roan and effect.
Lienee,Lt. Lic.0
Date T'
e ARCHRECS TnDECLARATION
e I understand my plans Nall W used as public records
26
guy Licensed professional
S Oat I am caampt fr m DECLARATION
C O 5 hcmhy.hire om 1 1 uempt from die Cantr+naos :Any C law for the
I§O following masa.(Sectim 7 Cont, t,si shot.
u and Pmfcle Lam Cade:Any cm m county
S$lea which its issuance,
n permit m i muwcr.pier.improve,da permit
i ri minor sig ed mature
�Ny
prim miuigivamurwemquimm the pmviskmof forthe Conch permitmiccow Law(Cha mem -
�p
that he is licensed pmemtmthepmvisisi=3of Conmcmr'u lJc rmiw(Chapkr9 Sq.Ft.Floor Area Valuation
(commencingmpt t Srntiore7000)of Division3 th the Bosinoseand Profeta vi Cede)or
$ this he k exempt thac(mm and the basis for the alleged uempdom Any violation of
section 70313 by any appirem,for a permit subjects the apphCWL e a Civil Penalty 01 APN Number Occupancy Type '
not mart man five hundred dollars(SSW).
❑1,as;owner of the property,or my employees with wages as their sic compengidon,
willdothewerk.andlhc,mcmrtlan,llnendedaroRemdfaraale(S".M".Busiws Required Inspections
and profession,Code:The Comm uses Lion¢Law dors ml apply k m e Mae,of q P
property who builds m impmvn thercon.ane who does such work himself or through his
Own employes,provided dist such impmvemenu are not intended chartered fmade.If,
however.the building mimPmvument Is sold within one Ycar ofmmpleuon,the mvnm
builder will have the burden of paving mal he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am aeluaively contracting with licensed continuous in
construct the pojrtt(Sec Man.Business and Professions Cade:)The Commucar's Lt. -
cone Law does not apply to an owns of property who builds or improv thereon,and,
who comets for such pojcm with a contnamr(s)licenced punu+m On the Commences
License Law.
❑l am ea51mpt under See /� ,B A P C for this won
Owner 491 ?94 IQ4
KIEScORI Date
ol N DECLARATION
1 hemby crpajray ane or de fallowing declarations:
INhave and will maintain aCeNOwu of Consent in self-ituum for Wo lms'sCompert-
m,u provided for by Section 3700 of the Labor Code,for the performamc of the
W&for which this permit is issued.
rl 1 have and will maintain Worker's Compensation Landrum,u required by section
3700.1'the labra Code,for the perlomance of the work fmwhich this permit is issued.
My Worke,C,mpeosauon Immune carrier and Policy number aw:
Cartier. Policy No.:
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
mrlaiaman need Witte completed if the permit is Intend hundred dollars($100)
or mus)
1 anify that in the performance of the wait for which min permit is momd,I,hail am
,mployany n In my mamehsgi k become subject m the Worked'Compenudon
Laws o(C If TO
ppl -
NOTICE 1
NOTICE TO APPLICAN�f.ac making cob Lesions o of Eubor Cou you should
Obecome rub s ampeOt INS previsions h seri Labor Code you mea
foMwith comply with such Provisions m this permit shall b:deensed rtwkcd.
,z.," CONSTRUCTION LENDING AGENCY
[.r► Ihemhy,Mm that them is a comtructinn lending agency for the perfurm+nce of
�i the work for which this permit is Lound(Sce.3(yI7,Civ,C.)
LL7 Undoes Nano ,
IutdaYs Adds
U O 1 certify mat I have read Wa application and auk tha the above Iafomation U
Uy ^ Corton.I agree in Comply with all city and county ordinamu and mu bws r,laung in
.0 building building construction,rudhembyauthoneerepresentativesofthiscitytoenterupnte
[27 above-mentioned property for Inspection purposes
(We)agree to give,indemnify and keep harmless the City of Cupertino against
Iiabilitim judgments,costs and eepaua which may In my way ammo agdmt said City
U Z in come panim of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. n
S�LIn.y / Y'C. IIA16,efIll Re-roofs
Signa um 0(Applicam/Canmcmr Data
H -MATERIALS DISCLOSURE Type of Roof
Will the iipplicarmm future Wilding omu uouclore or mar dle hagirdom material
as defined by Lie Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
coda.section 27537(+)7
❑Yos 0 N All roofs shall be inspected prior to any roofing material being installed.
Will dm applicant or futum building occupant use equipment ar tkvima which If a roof is installed without first obtaining an inspection,I agree to remove
It haumnm tar comamin+nu u defined by the Bay Ada Air Quality Mmigement all new materials for inspection.
i ct7
❑Ys ON.
I has mase the hvsrdouu mandidso quimmmus under Chmu r6.95 of the Califor.
nit.Health h Sufcty Cada,Sectic.215x15,25533 and 25534.1 ondcrmand thaifde building
doe
a keret
,that cumndy haw e ,Wt It h my mapondhility k mufy the occupant nr m,
mqulmmC which mea bo CO.,Prior rem. .of a Ccnilke f OCm�r
O4 J 6 Signature of Applicant Date
26'1 All roof coverings to be Class'%W'or better
Owner er ansdagcm Dak'
CITY OF CUPERTINO
• 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37515024 . 00
DATE ISSUED. . . . . . . : 04/04/2008
RECEIPT # . . . . . . . . . : BS000004359
REFERENCE ID # . . . : 08040023
SITE ADDRESS 18780 LOREE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT. AREA . . . . . . .
OWNER . . . . . . . . . . . . : LAN CHU
ADDRESS . . . . . . . . . . : 18780 LOREE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : KENNY HOANG
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . .
TELEPHONE . . . . . . . . :
• FEE ID UNIT ---- QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 600. 00 0. 50 0. 00 0. 50 0. 00
1BUSLIC FLAT RATE 1. 00 110. 00 0. 00 110.00 0. 00
1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
1TRAVDOC FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 192 . 08 0. 00 192 . 08 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 192 . 08 VISA
---------------
TOTAL RECEIPT 192 . 08
•
aw
CITY OF CUPERTINO
CUPEk INO GENERAL BUILDING
PERMIT APPLICATION FORM
-- Q U 0023
APN# -575- �S 2`1. 60 Date:
Building Address:
i �-fw Wge,E AVS C�UPEKTItiIp Ca ASO /¢
Mailing Address (if different
from building address):
v
Owner's Name: Phone#:
L.AV CIO U (4�s 6 - 6 9
Contractor: ! Phone: 66`7- L(-(//KEN IV
/V `l +f Fax:
Contractor License#: $�
Cupertino Business License#:
n
• Contact: Phone:
Fax:
Residential M Commercial
Job Description: wp 2-oc-) A-
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-lHR [:] 11, 111, 1V V-N (2---3
Valuation: 6,� Square Footage:
�-o v
Project Size: Standard Large ❑ Maj or ❑
•
CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BTEMPPER Temporary Building Permit (good for B
30 days)
1 BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h 29.3kw
1 BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3 Instal lation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
IBBOILER4 Instal lation/relocation of ea M •
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P
_(per hour •
1MEETINGIHR Application Meeting B
arms CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
ACOUSTICAL
REVIEW
lACOUSFDW SFDWL/DuplexNew B
lACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1 CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
IFIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRN Pile Foundation Driven (steel, pre- B
stressed concrete
3 of 5
CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONR
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSP10 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high(up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1SIDESTBK Siding, Stone &Brick Veneer B
interior/exterior •
1SIDEOTHER Siding all other B
SKYLIGHTS
1SKYL<10 SF Skylight less than 10 sf B
1 SKYL>1 OSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'1 B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 so B
additional stucco application
e
4 of 5
C� CITY OF CUPERTINO
CUPEf�F GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1 WINREP Replacement windows/sliding glass B
door ea 8 windows)
IWINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck(hrly) P
I STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B
when not over counter) hourly-stand alone
1BSEISMICR Seismic Residential B
IBSEISMICO Seismic Commercial B
1TRAVDOC Travel &Documentation B
IBUSLIC Business License B
5 of 5
affl-
Community Development
1300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
g-7 S a -ee 1 6 C-0 K 0 ,:5-2-
OWNER'S
OWNER'S NAME: G,,l I PHONE # 7 — Y c C l
GENERAL CONTRACTOR: oUn 4 FAX #
I am not using any subcontractors: _Le�xm
SignaturV Date
Please check applicable subcontractors and complete the followinginformation:
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