05100176 CITY OF CUPERTINOx.: .'t
BUILDING DIVISION PERMIT CO .TRAG-TOT.iWORMATION.
iwILDINGADDRESS: CUPERTINO PLUMBING PE'a....05100176
1017S MC LAREN PT.
W NER'S NAME: PERMIT ISSUE DATE
WILLIAM KAO 10297 S E ANZA BLV 30/21 /2005
qPMNE: SANITARY NO, CONTROL NO.
(408) 253-0618
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z,
LICENSED CONTRACTOR'S DECLARATION O O O O
u 1 hereby arfrm that I am Bmeed under provisions of Chapter 9(command, Job Description
with Section 7").f
Com, Lobo three and erect. C3L o COPPER REPIPE/WATER. t /�'ER SERVICE
Ll uccnaecrus tic.,
s— Dam lO. / COnlOcmr
ARC HLTF-CI•SDECLAR ION
nF
jw U 1 undersand my plans shall he used at public records N �•6
6 01 sa
G 5 Licensed Professional
OWNER-BUILDER DECLARATION LIQ[
E 0 0 1 herebyreason.
.(Sce that 1 1. exempt from doe f ssinalChd License Law for the
" ♦ 4 a//
E00 O following reason.(Section](131.5,Business and Professional Cork:Any city or county
m which requires•permit to ennswet alcor,impmw,demolish,or repair and structure 0
_ZT prformiaiensedprsu requiree movisiosof for such Contrunor's Li
eas Law(ned statemem
Ft:
that
commecingwitpSectiotwldcprovisionsofNcCommcwr'WccnscadonaCapder9 Sq.F[.Floor Area sp aluation
of t: that he 4memithtS therefrom and
th,basis
n3 themegBusiness eand on.Any iCMc)or
3-- that he ts exempt dMmfrom and th¢basis for the alleged exemption.Any violads,n of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofccur
-3 AIN r Occupancy T
not more man live hundred dollars(SSW).
Y YPe
❑1,as owner of the propersy,or my employees with wages as their sole compenution,
will do lde work,and the structure is not intended Or offered forklift(Ste.7064.Bud.
and Professions Coil The Canuxcud s Liana Law does not apply to an owner of Required Inspections
property who builds or improve thereon,and who does such work himself or through his
owncmploym,provided that such improvements are not intended aro@red foruk.If,
however,the building ter improvement is sold within one year of completion,the owner- '
builder will haus the burden of proving that he did not build or improve for purpose of
sale.).
❑1.as comer of the property,am exclusively contracting with licensed contractors to
construct the Pill(Sec.70x6.Business and Profcuimm Cade:)M Contractor's U.
cense Law docs not apply to an owner of popery who builds or improws demon,and
who concocts for such pmjeea wild a eonvactods)licensed puauanuo the Conuacmh
License law. -
t]1 no exempt under See. .B k P C for this reason
nor
Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pttjuty one of the following dalauticns:
❑1 haw and will maintain a Certificate of Consent to self-insure for WorYcr's Compen-
$Allen,u provided for by Section 3700 of in,Labor Code.for the performance of he
work for which this permit is issued.
hevc and will mainland Workers Compere+don Insurance,as myuirtd by Section
37W of the Labor Code,for the Performance of lde were for which this Permit is issued.
My Worker's Compensation lmumms carrier and Policy number are: �n
Carder:_�^'>'Y/J//!'3 Palley No.: A��� �'D✓
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thuuction recd nmbecmnplcmd lithe permit is(mune hundred dolers($100)
mr loss.)
1 amify thud in me perfs,rmance of due work for which this Permit u issued.I mall not
employ any person in any manner so as in become subject to tbe Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should ,
become subject to the Workcr's Compensation provisions of the labor Code,you most
.J•Z fordwith rnmply with such prmuiore or this Permit Mail be deemed rented.
'Z O CONSTRUCTION LENDING AGENCY
(-r (hereby an—mat memo aconstrucdinn lendings,cre,lar the aforman¢of
a the work for which his permit is issued(Sec.3097,Ci,C.)
D]0 L.cndcr's Name
z Lender'sAddress
J C) I codify that 1 haw read this application and sum that thc thew information is
LL E' corms I agree to comply with all city and county ordinances and sura laws relating u
O V building convection,and hereby eummis reprooduddiws or this city to enter upon the
W.
ed
pud,d
�^a bdub t tighten cosy for inspection expenses
which ms
I,•, (We)agree to ,indemnify and keep harmless the City of Cupcnino against
r'/3 liabilities, tighten 'gr regoifth emit. they in anyway accwc against said City
fJ,'Z me onsegve the gr 'ng of ld'-permit.
^ APPLIC NDE ANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date D��
$OU L NS. V
Re-roofs (�;
S awns ofAppiicanUC Dem
HAZA S MATERIALS DISCLOSURE Type Of Roof
Will the applicant w forum bur ding occupant stor<orharMk hvudous mamrid
as defined by the Counties,Municipal Code.Chapter 9.13,and the Health and Safety
Cade,Section 35532(a)+ /'� All roofs shall be inspected prior to any roofing material being installed.
❑Ye / t ,
Will the pplicant or future building col sew equipment or Jcvi¢s which
If a roof is installed without first obtaining an inspection,I agree to remove
a
emit hazardous air contaminants cfood by thus Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
I hevc maJ thehnallous rials requirements under Chapter 6.95 or the Caliror
ria Helm ASafctyCode ti 75305,355JJand255J4.luMcrsaMdiuiflhc Wilding
does not cwrendy he ren t t rs my ma nihilitY m notify tho oaupant of the
Mquimmcnrs which prir ;iss+an cenifcammr arode, Signature of Applicant Date
/'• Q
Owner or gem — perm All roof coverings to be Class "B"or better
Community Development
' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
JPCITY OF
ERT�NO Fax(408)777-3333
rG IV Building Department
JOB ADDRESS: A)1 -75- ry�eClare� p/ PERMIT#
OWNER'S NAME: t,(J, / p I PHONE # 0?Sa
GENERAL CONTRACTOR UpnFAX # t/cam X53
I am not using any subcontractors: Q 3
Signa Date
Please check applicable subcontract sand 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
Shee Rock
• T• e 1
ld no2/a 5
Owne C ctor Signature Date
CITY OF CUPERTINO
I� 1 of 3 PERMIT RECEIPT OPERATOR: seem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 31621049.00
DATE ISSUED. . . . . . . : 10/21/2005
RECEIPT #. . . . . . . . . : 31691
REFERENCE ID 4 . . . : 05100176
SITE ADDRESS . . . . . : 10175 MC LAREN PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WILLIAM KAO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2335
RECEIVED FROM . . . . : CUPERTINO PLUMBING
CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612
COMPANY . . . . . . . . . . : CUPERTINO PLUMBING
ADDRESS . . . . . . . . . . : 10297 S DE ANZA BLV
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 253-0618
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPFIXTURE UNITS 11.00 99.00 0.00 99.00 0.00
BPWATER UNIT 1.00 9.00 0.00 9.00 0.00
BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00
BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
BSEISMICRE VALUATION 0.00 0.00 0.00 0.00 0.00
EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 268.76 0.00 268.76 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
106 SEWER & WATER 202 UNDERFLOOR PLUMBING
301 ROUGH PLUMBING 302 TUB & OR SHOWER
502 FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
(L � CITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
N # 6qq o;2
Building Address: Mailing Address (if different from building address):
PL ,
Owner ��l arl-) !�/G�l d me: Phori/60) ZSZ X71 SZ
Contrac or: 11 License #:
-t-lno vlL ZyC/dy
Co ct: �^ ( Phone: ZSR 6018 Cupertino Business License#:
Fax: L5 ZLCie-t a
Building Permit Info:
Bldg ❑ Elect E� Plumb Mech ff?/
Job Description: Copper Repc�p6, jx,Jafer Ne.:Id-er, I,�Ja��a- S�T� 1CC
Residential Commercial ❑
Sq.Ft. Floor Area: Ofq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
0o•ect Size: Standard ❑ Large ❑ Ma or ❑
Quantity Fee ID Fee Descri tion Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILER1 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
BCONSTAX Ind/Off/Comm/ uasi 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 AAA Multi BUILDING
BINVESTIGA Investi ation fee BUILDING
1 of 3
Fes- CITY OF CUPERTINO
CiTM°F PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BNUSCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMIvIE New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comma 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 Cheek Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBOiG
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Tra PLUMBING
BP`✓ENT Alt of Drain &Vent PLUMBING
/ BPWATER Iustall/Alter Water Pi e PLUMBING
BPWHEATER Water Heater[Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reins ection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
BREMAPPLI Annlinncp Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREA'IFURN Relocation of Furnace MECHANICAL
BRE 2V
Relo Furnace > l OK btu MECHANICAL
BRENUMAT Heater Installation MECHANICAL
RENU HOOD Installation of Hood 1\�CHAiVICAL
BREIv MISC Misc A aratus ELECTRICAL
BREMNRAPP Rem Non-Res A liance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
Power Device/A aratus ELECTRICAL
REMRECEPT Rc t], Switch & Outlets ELECTREMRELOCA Relocation of Hood MEREMREPALT R air/Alter HeatinggiBREMEPOWER
REMRESAPP Remodel Res A liance ELECTRICAL
2 of 3
id CITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Si, s, Marquee. ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan ISin le Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUU DING
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 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 sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fa m PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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