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05080234 CITY OF CUPERTINO �„ BUILDING DIVISION PERMIW T ONT,"OTORAINFORMATION BUILDING ADDRESS: COLOA CONSTRUCTION, INC PERMIT NOO 5080234 OWNER'S NAME: PERMIT ISSUE DATE JENGHUNG CHEN 1671 CANYON 08/25/2005 NE: SANITARY NO. CONTROL NO. (408) 891-2449 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGUMB MFCH O PLO D C LICENSED CONTRACTOR'S DECLARATION job) ri tion I hereby affirm Net I am licensed under provisions of Chapter 9(commencing p gi with Section 7010)ofDiAmm3oftheBusiness andProfessions Code.andmylicense is j� �_ mfellI andeIT UPGRADE ELECT. j 2 Licence Lle.g u le l Oam Contracts, CHTITCTS DWILARATrOW I understand my plans Audi W used a public moms 1"'01- 2006 Licensed Professions .l OWNER-BUILDER DECLARATION 1.<I 1 hereby.affirm that 1 I exempt from the Contractor's s:My c law for to i p O following wan.Permit 170313.Business sed Nofessium Code:Any city or county which require•Permit re err s,she alma,hnproscard u dech wouli t a mash any ned tmenum $1800 prior Fz1^ thatImsliensedpalwmmthe thovisiosofthe Commrmit Loonso file a sLaw(utamcnl gg < (e.mendngsedpursuanamtheprovivWon3ofikEuacmYmdPmfmionChaptm9 Sq.Ft.Floor Area Valuation 2 $ (cmnmcnctng with Stttion 70D0)nf DlvWon Sof theBeincu and Profalom Cndc)ur 3 Nat he B exempt Ncreftam and the items for the Jlcged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than fin hundred dollars(SSOO). er Occupancy Type ❑I,as owncrofine property or my employee with wages as Oceanic compensation. will do the work,and the n uctum is notwu nded moneyed formic(Sec.70".Business and Pmresdom Code:The Conuamta License Law doe not apply to an owner of Required Inspections property who builds or improves thereon,end who does such work himself or through his own employee,provided that such improwemenuare not intended oroRertd for We.If. however,the building or Impmwmmt is said within one year of mmpledon,the owner builder will haw the burden of proving On he did rot Wild or improv for purpose of ale,). ❑1,a owner of to ptopeny,am exelusiwly contractor,with licensed conummn to construct the project(Sec.7040,Business and Profession Code:)The Commences Li. came law doe not apply to an owner or property,who Wilds or improv,themon,and, who contracts for such projects with a commomr(s licensed pursuant to the Communion License Lew. ❑1oro avert under Sec T.B d P C for this won Owner Dau Am WORKER'S COMPENSATION DECLARATION I hcmhy aRirm under pensty of perjuryane of the following dttlarulona: 1Nwand will mainnln,Ce flmwo(Cementtoal4imumfar Worker's Compen. lieui.n.a provided for by Section 3700 of the Inbar Code,for the performance of the wank for which the Permit u issued. ❑I hew and will maintain Worker's Compensation Imuran.as colored by Section 3700 of the tabor Code,for the performan of the wank fmwhich this permit is issued. My Workees Compensation Inaunnce errie end Policy mumbo,am: Caller. Polity No.: EMP ION FROI RRERS' COMPENSATION INSURANCE . fDtis auction reed not boeemplemd ifthe permit Is farone hum ecidallas(SIM) or less.) I[cosily that in the performance of the work for which this permit is issned,I shall not ' employ any Person In any sommorso as to Wcomesubjectto theworken'Compensation Laws of Csifomla.Dow Applicant NOTICE TO APPLICANT:If.After making this CeniBcam of Exemption,you should become subject on the Worker's Compensation pmidons of the tabor Code,you met 0 O forthwith with comply with such provisinor this permit shill be deemed moked. CONSTRUCTION LENDING AGENCY sa•n.N.. I hereby afRrm Nat then is a construction lending agency for the performance of a> tie work for which this permit is issued(Sec.3091,Civ.C.) Q Lemices Name ' a z Lander'.Add. L)Q I coNfy that 1 Mw rad this application and sum that the abow information is Iln cormct.I aS ew to comply with all city and county oNlnana and some laws mining to O building construction.and hereby mthodm repmsenutim of this city to cora upon the W abowtmeMoned propay far impeNan pugmses g1. (We)agme m on,indemnify and keep harmlen the City of Cupertino agdmt Uf/) inconsequence fthecow and expenses;which may in any way acme agsmt and City 7 A PLICANT of the Shorting of permit Issued by:9 2 �•t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Dale SOURCE REGULATIONS. _n �, <&0`13 t' Re-roofs Sign plicant/Can m bow HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future wilding twopaus om orhaedle lu ardoe mamrid as defined by to Cupertino Municipal Code,Chapter 9.13,and the Health and Safety Code,Schon 13333(e)7 All roofs shall be inspected prior to an roofing material beim Installed. ❑Yes ❑Nu p p y g g Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It hwardam air contsmimnts as defired by the Bay Area Air Quality Management all new materials for inspection. isukt? ❑Yes ON. I hoc mW the Wamous materials requirements under Chapter 6.93 of the Califon ole HmW&SsctyCOck.how4 tttomhat Itigm573and25534.1 wmamnd occurf ft Wilt,of ing ftsO a�v� doe not currently how a censor,that it h my rcspomiMllly m natl'y tM oecupant of rte requirements which most W met prior m Issuance of a CenifIcate of Occupancy. Signature Of pplieant Date — �� 'tom All roof coverings to be Class"B"or better Owner ser authomcd agent ' ore Community Development 10300 Torre Avenue iii aJCupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: PERMIT # 0-73s 14t, �0,/w&co w� r so OWNER'S NAME: NA . PHONE # GENERAL CONTRACTOR: Cb&e4 I,, FAX # /� I am not using any subcontractors: " )5:0 '� Signature Date Please check applicable subcontractors and complete the following information 60 SUBCONTRACTOR BUSINESS NAME BUSINESS-LICENSE # Cabinets &Millwork Cement Finishing Electrical 7 �-S-N 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 He Owner/Contractor Signature Date CITY OF CUPERTINO CUP WITYOF O PERMIT APPLICATION FORM Date: / BuildingAddress: Mailing Address (if different from building address): 73S RALv 'v0-00 W, Owner's Name: /r Phone#: Al/1 . GIfFi� �o GFcI�IG Contract' License : #: Ob Corm 7;?lb 3 . Contact: Phone: Cupertino Business License#: !`of Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: 6/G�ot Residential ❑ Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: O 0 Please check this box if the project is a second-story addition: ❑ Pro'ect Size: Standard ❑ Lar e ❑ Ma'or ❑ 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> IM 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 lof3 D� 2 CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMTTIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTINM Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE 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 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 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 Ap fiance, ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEfZiTINO PERMIT APPLICATION FORM Adak Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Seb 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, Teinp Dist Svcs ELECTRICAL BUSLIC' Business License BUILDING ELECTRIC Electfical 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 PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3