08010141 CITY OF CUPERTINO -
BUILDINGDIVISION PEPN T ,eC,dNTR.'i.CTQR.IAI Ir'�R� AT O, N,
BUILQIN9('sApD OCTOBER WAY JB ELECTRIC P�08010141
E/R's.NNAY$ME: PERMIT ISSUE DATE
SHAWN CHEN 4386 HILTON AVE 01/24/2008
PHONE: SANITARY NO. CONTROL NO,
ARCHRECTYENGINEER: BUILDING PERMIT INFO
200 AMP METER MAIN, 90 AMP BLDG EtF.CI PLUMB MECH
SUB PilldiEh
.00 LICENSED CONTRACTOR'S DECLARATION
1 homby affirm that I un lousing under provisions of Chapter 9(commencing lob Description
vd bt
m with Secdon 70011)of Division of Ne Business and Prafeaduna Code,and my license is
^< in full force ad effectv
Pe Licenso 1 s C —/C) IJc.g
eDate RCHRECrS DECLAR
Y ngoses. as P;s/�.,�u�ted�public mcoNs `
OWNER-BUILDER DECLARATION
DECLARATION
aI herchy.(Su a that 11. exempt from the f onlrasrCo e:Any c taw for she
i O o following moon. emit t 71171.5,Business and improve.
de oli Code:Any city or county
5
which n9uima•permit re cnrswc4 since improve,deermitt,rare pair ed swmure
Z�, pdwmiscensed issuance.ahum,to due Novisio Olfordie suchPermitmfdc=Law statement
that heli licensed Vanadium,7 the provision Oldie Conlncm/Wcensoiaw(C oca)or Sq.Ft.Floor Area Valuation
3
(commencing with urchro andtf basis for
of NeetedBusiness prion.Anynd violation
Code)or
that he s ezunpr Therefrom antl the hos for the alleged eumpdom Any violauon of
Suction 7071.5 by my applicator for a pmmir subject,the applicant m a civil Penalty of APN Number Occupancy e
ms more Nan five hundred dolWs ISM P Y Ty YP
0 1,u awder of Ilio pmpery,m my mploym withngu u Nub mlecampensadon,
willdorhework,andtheatnclumbImtinw doraff.md Tarsale(See.7044.Busimma
and Professions Cade:The Conlraemes License Law it=not apply in an an=of Required Inspections
prepeny who buildsorimpmxe,Iheman,and whoduessu i,work himself or Waugh his
own employees.provided Nal such Improvement,are not intended oro@real formic.Ir.
however.the building m imPmvnneat is to within oro year of completion.the owner-
bullder will have One burden of proving that h n did not bulhl or improve for purpose of
sale.).
0 1.as owrcr of the propenY•w exclusively conuuting with II¢nsed mnuumn in
mnatnum Ne Mines(Sec.7044.Damon;and Professions Code:)The Cosuamor's U. _
cense law dons at apply man owner of properly who builds or improves thereon,and,
who contracts for such projects what a marmosets)licensed pursuant in Ne ConuuYofs
Lice.Law.
❑1 oro exempt and.Set B&P C far this mama
Dam
WORKM'S COMPENSATION DECLARATION
I hereby dlBm under penslry of perjury mm of tite following deslarWou
❑INmend will mainWn•CmtiOess of Consenrmself-blurtfmWorkeYSCompen-
mrlon,g,provided for by Sudan 7700 of W tabor Code.for W performance of the
wart for which this permit is aimed.
0 1 have and will training WmYer's Compensation Insurance,as mqudedi by Section
]700 of On tabor Code,far W peRarmanee of the work far which Nb permit is mooed.
My Worker's Compensation lnsunsce esnim and Policy number am:
Cartier. Polley No.:
CERTIFICATE OF EXEMP TON FROM WORKERS'
COMPENSATION INSURANCE
(Odssmisn deed ml be composed B W permit Is foram hundred names;(3100)
nr kg,)
I cern(v Nat In am performadec of We work for which this permit Is Intend.1 shall am
employ any person in say mmZr u m bem�mb)eel to Ne Worker'Compensation
Law of CalifamiaDam�
Applicants G G
NOTICE TD APorANV 1,e r making Nis provisions
esm that
Exemption,you should
biome subject y it Worker's Compensation provision of Ne tahor Code.you mum
0 O foMwiN comply with such provisions or this permit shill bs damng mwkcti.
z^ CONsTgucnON LENDING AGENCY
F Ibueby afOrm Nat Nem is a construction lending agency for the Performance of
fx the wart for which dds permh is ismA(Sec.SIM,Civ.C.)
If1 Q Is nice:Name
aZ Landee Adalmss
V Q I certify that 1 have read this application and sum Nat No above information la
ly E correct I agree m comply with dl city and county modrunces and sure laws slg m
atin
0 rVbuilding construction.and hereby induction representatives;aides city in enter upon Ne
[U &hove-mentioned property for inspection purPmes
d (We)agree m save,indemnify and keep harming,the City of Cupertino against
W liabilities.judgmens.coca and expenses which may in any way acctue agdns,said City
U Z in eonsequmce of the granting of Nis permit
^' APPLICANT UNDERSTANDS AMD WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOEGULATION� // �
Signature ol'A�/ardruc ort{' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE of Roof
Will No applicant or forum building occupentuom arhandle lavndons mamrid
defined by Be Contains,Municipal Code.Chapter 9.12.and the Health and Safety.Section 25532(a)7❑Yes ON. All roofs shall be inspected prior to any roofing material being installed.
Will tiro applicant or future building amopant etc c9uipmenl of devices which If a roof is installed without first obtaining an inspection,.I agree to remove
emit laudations&I,cenuminans as defined by the Bay Area Air Oddity Managemrnt all new materials for inspection.
District?
Oyes 0N
I haw:mad the hararduus materials mquimmens trader Chapter 6.95 of the Califor-
nia Health&Safety Cade,Sengons 25505,25537 and 25534.1 undcnunal atat if W building
does not currently baso•as am.the It b my responsibility m runty On aceupmt or the
rap=ej which mumbbee/ Im'g,uu¢cafaCcrtifmamofOc ptanL�y Signature of Applicant Date
owner mmunanrea,- I I I {Dow — All roof coverings to be Class"B" or better
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36213035 . 00
DATE ISSUED. . . . . . . : 01/24/2008
RECEIPT #. . . . . . . . . : BS000003768
REFERENCE ID # . . . : 08010141
SITE ADDRESS . . . . . : 7918 OCTOBER WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . . -
OWNER . . . . . . . . . . . . : SHAWN CHEN
ADDRESS . . . . . . . . . . : 7918 OCTOBER WAY
CITY/STATE/ZIP . . . : CUPERTINO, 95014-4145
RECEIVED FROM . . . . : SOLOMON CONSTR.
CONTRACTOR . . . . . . . : JOON PIL BANG LIC # 29149
COMPANY . . . . . . . . . . : JB ELECTRIC
ADDRESS . . . . . . . . . . : 4386 HILTON AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95130
• TELEPHONE . . . . . . . . : (408) 515-2455
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 2, 000. 00 0.50 0. 00 0. 50 0. 00
1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
ITRAVDOC FLAT RATE 1 . 00 40.79 0. 00 40.79 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 82 . 08 0. 00 82 . 08 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 82 . 08 1140
---------------
TOTAL RECEIPT 82 .08
1
SIM CITY OF CUPERTINO
CUPER WO GENERAL BUILDING
PERMIT APPLICATION FORM
APN#
ua i s v� o
Building Address:
v/
Mailing Address (if different from building address):
Owner's Name: � Phone#:��g
c 973-
Contractor: ZnR G�l Phone:
l®)Y�63'l ZIIL Fax:
Contractor License#: 8-3�-92r 2
Cupertino Business License#: 2,q1
Contact: Phone: (44)
�O Y1 3a-vLa
Fax:
Residential Commercial ❑
Job Description:
qb ArAT
Building Permit Info:
Bldg ❑ Elect [ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, l lFR ❑ 11, 111, VAHR ❑ 11, 111, 1V V-N /Z, J
Valuation: O o�00 Square Footage:
® Project Size: Standard ❑ Large ❑ Major ❑
wo
CITY OF CUPERTINO
CUPEkTINO 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 da s
1BBOILERI 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)
1BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to &incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3 Installation/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
1BBOILER4 Installation/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
IMECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing& Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B
alfi
CITY OF CUPERTINO
CUCITYOF NO GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
1ACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1 CHDANEY Chimney B
1CHIMNEYR 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
1FIREPLFAB 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
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CITY OF CUPERTINO
CUPEi�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSPI O Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
SO 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
1 SKYL<10 SF Skylight less than 10 sf B
1SKYL>I OSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 so 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
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CITY OF CUPERTINO
CUPERTINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group IGENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows
1WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
1EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
IPPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
IPLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plaza Check (when no E/M/P) B
when not over counter hourly-stand alone
I 1BSEISMICR Seismic Residential B
/ IBSEISMICO Seismic Commercial B
- iTRAVDOC Travel &Documentation B
1BUSLIC Business License B
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