05090043 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT G"0N TR4CTl R,M,C1 VIr"I'10N`
BUILDING ADDRESS: YING LIU PERMIT NDfl 5090043
, 8971 NEWSOM AVE
OWNER'S NAME: PERMIT ISSUE DATE
YING LIU 18971 NEWSOM AVE 09/07/2005
NE: - SANITARY NO, CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0 0 0
uO0 LICENSED CONTRACTOR'S DECLARATION Job Descri tion
1 hereby affirm Nat 1 am licensed under provisions of Chapter 9(commencing P
with Section 7M)ofDivision 3 of the Business and Professions Code.and my license is
InmRrorceandefteet. UPGRADE ELECT. PANEL (200AMP)
5: License Class Ue.As
Date Contractor
ARCHITECTS DECLARATION
Ky 1 understand my plena road M used As public meorda
D U
c Licensed Professional
`y OWNER-BUILDER DECLARATION
g; I hereby affirm that I am exempt from the Contractors License Lew for the
O O following moon.(Sedan 7031.5,Business and Professions Code:Any city or county
$ which requires a permit In construct,alter.improve,demolish,or repair any stmctuat $500
prior w is Wuenee.also mquies the appliamforsuch permit to ale eaigned statement
<
that he is licensedpuruantlnthe powimmutofNeCannanore,Licenselaw(Chapter 9 Sq.Ft. Floor Area e Valuation
W;g (commencing with Section 7000)of Division 3 afthe Business and Professions Code)or
�.. dist he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fora permit subjects the applkanuo Advil penally of QC p2flCy Type
.at more than love handed dollars(5500). /�
❑I,uawna of ton property,army moploycu with wages:theb Wlc wmpew0on;
willdo the work.and theaVumue lsnotitanded uroQered forsale(Sec.701,Business Required Inspections
and Profession,Code:The CWWxud's License Law doss not apply b an owner of q (p
property who build,or improve,thrown.and who doss such work himsel f or through his
awn employees,provided that such improvements am oat intended oroRered for We.if.
however.the building or improvement is sold within one year of compledon,the owner.
Willer will have the burden of proving that he did not I Mid or improve for purpose of
ask.).
N1
. a owner of the property.am exclusively contracting with licensed contranwra to
0 mct the pmjeci(Sec.7044,Business and Professions Cade:)The Contractor's Lt.
come Law duca not apply in an owner of property who builds or Improves thereon,and
who contracts for such projects with a contnctor(s)licensed pursuant in the Com censor's
License Lew,
❑1 oro exempt under Sec. .B&P C for this mann
Owner 1 l YtQ Data atx�
ORKE S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury am of the following dalantians: -
I hem and will maintain a Certificate ofConscnt to kelf-imue far WmkefsCompen-
sation,As provided Ter by Section 3700 of the labor Code.for the performance of the
work for which this permit is Issued.
❑I have and will maintain Worker's Compensation Insurance,u mquimd by Section
3700 of the labor Code,for the performance of the work for which this permit is Issued.
My Workers Compensation Insurance carrier and Policy number are: r
CA
Policy No.:
CERTIFICATE OF EXFMPT70N FROM WORKERS'
COMPENSATION INSURANCE
(Thh swoon need not b omeopIcted lithe Permit is fnow hundred dollara(SIN)
nr lana.)
1 entry that In the performance of the.,it for which this permit is Issued.I shall not
employanypesonninuannyymn n pom
!Wwt cwbj=tt.iMWarken Compenadon
Laws of Califs V. ate
Applicant
NOTICE TO APP 7CA)Ir:If,after making this Certificate of Exemption,you should
became subject In the Worker's Compensation provis om of the Labor Code,you must
vJ O forthwith comply with such Provisions or this permit shall he domed mvokad.
.Zi CONSTRUCTION LENDING AGENCY
I hereby affirm that tee is a construction lending agency for the performance of
a the work for which this permit is Issued(Sec.3077,Civ.C.)
W Q Landers Name
n7. z Lcndere Address
U O 1 certify that 1 lave read this Application and stave that the above information Is
{>r correct.l agree to comply with all city and county ordinances and stata laws aiming to
O building construction,and hereby WthOAM MPmMnmives of this city to enter upon the
fla abovemendmcd property fm impaction purposes
gg� (We)agree in save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,calls and expenses which may In any way same against Mid City
U x in consequence of the granting of this permit.
"-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 7 1 •I
SOURCE REGULrONS. a '
gf7l� Re-roofs
Signature of Appture of Apph>� r Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant Noce orhandlc haurdous material
As defined by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
lDislricO
de,Sactior25531(D7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes XNo
Will the applicant or future building Occupant use equipment or devices which If a roof isinstalledwithout first obtaining an inspection,I agree to remove
It hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes I'jkrla1 have mad the huardaunnuarials wqulmments underChapwr6.95oftheCalifar Hcahh&SMclyCodc,Swtiom 25505,35533 and 25534.1 understood thN If the building
a not currently haw a want.that It is my responsibility w rally the Occupant of the
uirement,which most be met poor h)issuance of a Certificate of Occupancy. Signature 0f Applicant Date
Y 15w t ^,y 9171 g am
Owner ur authods degcnl Date I All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS:. the~o Sam �� PERMIT #
OS oti3
OWNER'S NAME: j l�ri PHONE # 2
GENERAL CONTRA OR: FAX #
I am not using any subcontractors: `_? t
Signature Date
Please check applicable subcontractors and complete the following information:
60 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
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
A. the work authorized by this permit
B. A portion of the work
C. — None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City, Phone # State License # Type of work to
vc caa vauactt
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City . Phone Number Type of work to be
erformed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse ide).
Property Owner's Signature: f Date:
Job Address: _/ F97Z /1 04 c�Zai Rue Permit#
Any changes to the informationyrovided on this form shall be submitted to the Citv of Cuyertino Build
Department.
City of Cupertino Building Deparbnentdffikr
CIN 0 10300 Torre Avenu
C U p C kT I N 0 Phone: (408)777-3
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs)is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation•
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit.will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino
Pnnfed cn Recycled Paper
1 " CITY OF CUPERTINO
a a
cuPE1�T1No PERMIT APPLICATION FORM
Ah
N# — .! Date:
Building Address: Mailing Address (if different from building address):
18171
Owner's Name: f Phone#:
2
Contractor: 1 License#:
1. Leu
Contact: Phone: Cupertino Business License#:
Fax:
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description:
Residential Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
'16 01-0D omp
Cost of Project: Occupancy Group:
LTypeotISCionstruction: Please check this box if the project is a
second-sto addition: ❑ze: Standard ❑ Laze ❑ 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
B130ILER3. 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<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
i BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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o� O
CITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM
-QuantityFee 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 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 HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfin 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 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 Appliance ELECTRICAL
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CITY OF CUPERTINO
CUPEP.,TINO PERMIT APPLICATION FORM
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 Scb 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 Ternp 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-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
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