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CITY
' BUI DI G DIVISION NO
PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
924 OLD TOWN CT
GEFC CONSTRUCTION
02030096
OWNER'S NAME:
APPLICATION SUB DATE
KUO HUEI P AND CHIA C
4102 PLEIADES CT.
03/19/2002
FFIONE:
(510)760-8236
SANITARY NO, CONTROL NO.
ARCHITEC AINGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1=I - t LJ L__I
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions ofchapter 9 (commencing
tonin senlon nXrol nr niviaron3nrine Buamea nna Pmr<,,mn.c ate. ann my hanae
WINDOWS REPLACEMENT.
Lic<nye s. r�T LL I:.
'6Ji"!
t� pp � n t�
it � 9 �g A L to
CoN%atL�a<��
A HITECT'S 06QCARA'
I undmsian my plans mall nc u>cd as puhlic records
`F 'I %
SEP P 1 8 `002
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby off,. that 1 nm exempt room the Connector's License Law for the
following reason. (Section ]031.5. Business and Profession Cale: Any city or county
BUILDING $5000
which requines a permit to contort, alter, improve, demolish, or repair any structure
poor t .also req seem pplicant for such permit file a signed swemem.
--- -- -- - - -
thatbe lland puduanpq the dons of the Comractms License Law (Chapter 9
So- {'p t�ql p.�y�7• r-
Valuation
(eomnncng „th.Secr 9(X0, rDivision Sof the Business and Prgfcions Corel
.
or that he is' exempt therefidnin and the bais for the alleged caanPtion. Any violation
of Se<dnn int cs by.ny apprant rte. pmminabi«re the appfieant m a dvil pen.lty
'of not more man five hundred dollars ($500),
101`�PN 1` 1•DATION
�� � Occupancy Type
C 1, as owner of the propcny, or my employees with wages as their sole compenwtion,
1 09 - PIERS
' will do the work, and the structure is not intended or offered for sale (Sec: T}m,'-
•Business and Poofcs,ims code: The Canracmrs License Law does not apply to an
103 - UFER Required Inspections - ' � '
own r of pMpcoy Who builds or improves thereon, and x0a does such work himself
'
104 — REBAR
of through h owe employees, provided that ii improvements are not mmnrea or
or dr :1'Irnw m M1avet p r yemn
. eolJ wnbm one f
� " "'_. .. _— _ ..._ _.._. _. _. -. _.. ........ _
105 - ANCHOR BOLTS
the own<rbmWer w II have the M1urdcn of proving that he d d not bu Id or
icompletion,
mprove for purpose of sale.).
106 - SEWER & WATER
❑i awdeeorCn �6 sty: m xeiu.ivclyannrncunq.5numnscdaomreadsm
202 - UNDERFLOOR PLUMBING__
..'• ".
contract the project (sec. 704. Bu.iness and Profeasiom Code:) The Contractor's
icenselwwdoesnotapplytoanownerofpooped,whobuilds improv<amereon,
203 - UNDERFLOOR MECHANICAL .%: „r
. mM.wbo'Wronsem for. such prajau.with.v contmetoaa).licensed pursuont. to the
..__.... ... _.
204 -'UNDERFLOOR; FRAME- --- .___...._.... __...
ennamCataniaraiunde Sec
❑ I am unser sec. . R'& P C fin this mown
205 - UNDERFLOOR= INSULATION
own2r' "' "'•'' " Date -
301 - ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 - TUB & OR SHOWER
Ineeny arrmt under pcnahy of veriany iijewide mnnwmg eenamrinr
/°
303 - ROUGH MECHANICAL
I have and will Mai uuida Cinificat<bf Cnnent to self -insure for Workers
304 - ROUGH ELECTRICAL
Compensation, as. provided for by section 37W or the labor Code. for Ne
Performance of the work for which this permit is issued.
305 - FRAME
C 1 have and will maintain Worker's Compensation insurance, as required by Section
306 - HOLDOWNS
3700 of the Labor Code• for the Performance of me work for which this p<.ri, is
-
307 - INSULATION
Lowed My Wo kers Compen t o Insurance c d Policy numbs ere
u
r.
Cum No,s`
30$ .- SHEETROCK', _- - :_.•�............ :.
,) i " • ` •'' ai ^'
`-
CERTIFICATION OF�EXEMPTION FROM WORKERS
3 0 9 - EXTERIOR ,LATH'
" COMPENSATION INSURANCE'
..,.._._..:............. ...........
-
--- T RIOR-LATH....-. ;:;"., tit..
^'"'(TM1isieaiorine<dnathcomplacdifineMrmitisforonehundreddollars
. c
311 - SCRATCH COAT '
(slop) l )
..._ 313-.-...ROOF'NAIL-'-• _ _ ..
r, 1 cer fy ih t'n th penfo ane of the ink fo which th pen u uM I
shell t pl y yea w ,to hecom subjectot<workers
a. I!
501 - FINAL EliECTRI CAli"ENERGY '
Comps . eon LawI,t C I f m%a. D i5Yr �P
Appl cvnrruo+ir�ct-tlwi; p"-....
.502 ----FINAL PLUMBING ENERGY.....
503 - FINAL MECHANICAL ENERGY � "
•N toPPL A" a carmikids�ha C'mm mod a From, yo!"Whi
bebis to the Workers Cd =mutton pro visions of the labor Code, you must
roanwim <nrnply with w<h provi+inns pr ria permhshau be dames ranked'
_ 504_ -...FINAL. BUILDING.ENERGY_.__-
"' CONSTRUCTION LENDING AGENCY
505 - FINAL ELECTRICAL,
1 hemby affirm tint them is a construction lending agency forthe perfoddance
ardmwn,km,whiebthi,pernitisimdcd(s<c.'3o97, v. c.) ;';
.-. .
506 - GAS TEST
Lenders Namer•.:.....v-.b.... _.... ,_...........: .. .... •.. .. ..:
Leader. Address,- '-
_. _ _. ._... .-. _. __ .. ..._._ _._.. _. _..._ ..... _
507 - FINAL PLUMBING,.,, t
_
1 tinnily that I have read this application and state that the aboveinformation is
508 - FINAL
laws
wires I agree t comply m all fry and coo ry se d naves and stem le s eluting
GRADE
509 - FINAL GRADE
,hebuildingc cation dhmby- thio a mT.11ntativu ofthisctyt enter upon
bnominatedproperty peu0n pficarn
510 - FINAL PLANNING
(We) g ee io sine, indemnify 'ty anJ ke p hm tahe Cupeniino 5ga nn
de
514 — FINAL PU I C WORKS
in
fiabJnie,, j menta, enks and q,pe when may in any way same egamz,t said
may ny
Ciry in'c vena of the gmmin s mdt.
APP_IC UNDERSTAND,S'A O IL�sort YWTrIllACL'NON- INT'"
Issued by: r Date 3 ^/ -d L
I.' ULATIONS
nmmcof APplicvntl tmemr .' -' .. "'' Dow"'s-'
Re -roofs
HA RDOUS MATERIAL$ DISCLOSURE
Wnmapprem orfutue Wilding occupantst , handle Wimdo, mat'al
yp
T sof Roof...^tic-
Cdef st d by m C pen Municipal C d Chapter 9.12. and the Health and Safety
cna< s et n xss3a 1
„ °Y ` ❑N r - 4 -f' 1..All
roofs shall be inspected nor to an roofing ing installed.
p y g material be _ _
will the pplicam r r ren'Id gat p t, cqup t d ea ton h
"coot
If a roof is installed•without first obtaining an inspection; I agree.to remove
nit hazd air ts. d fore by theBay Area Air milk, Ma'ag<nnt
'tact
all new materials for inspec on Applicant understands and will comply with
_
CYes ° "°' 1
_ _
' all no -' point source reglu(J�s.,,''f
ad the hqdour i nsk q r u under Chaptererstan f the
Calf 11ections l55B5t the
esmet
It11 res Ws.1undcrsmnd
rifi,m the
thatismyrtoeof
-"-" -'-' --'
c pan f the rcqu re nts �J t be t p to u of Can Bca¢ of
C
lh
r C�
'e `y✓� / / /
Signature of Appy ant- Date,
All roof coverings to be Class "B" or better
ow irautnnn:ea gayI :�?�me
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CITY OF
tLIINFERNIIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
924 OLD TOWN CT
GEFC CONSTRUCTION
02030096
OWNER'S NAME:
APPLICATION SUB DATE
KUO HUEI P AND CHIA C
4102 PLEIADES CT.
03/19/2002
PHONE:
(510)760-8236
SANITARY NO. CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
IUJ I' -U LJ L,
LICENSED CONT'RACTOR'S DECLARATION
Job Description
1 hereby affirm that 1 am licensed under provisions or Chapter 9 (commencing
with Section 7006) of Division 3 of the Basines.ne Pmrest:ir�n4m cad�Ke. license
's in full or d,ff t.
WINDOWS
P
REPLACEMENT.
Lion e s as /a,/n_id—my
--7-n"`
HITECT'S DBFC7iRA —'o'er
v'
p g
FI999�8�G®
e
edd@�p
1 undertan y plans shall W used as public rtcords
SEP 1 9 2002
Licensed Professional
OWNER -BUILDER DECLARATION
the C taw for this,
I hcrtby ,Fain thin 11. uusin
f: Any
following teres.. (Section ]071.5, Business and Professions Code: Any city
s an ssions o c
$5000
structure
which tequimx a permit a tures t1m, alter, improve, demolish, or rtpa'v any onammu
pdonoir issuance. alsortquirta Neapplicam uoM1ratmr dsaapter9
_ _. ..._._ _---
safthe License
thn�beisfianted Lacefiles Law
pmDivisin
d"
--� pp;; pp
q pp..aa� . s Valuation
3 o the Buumis Cur9
(commencing wain Section 7000) of Division 3 of the Busitusa aM Prytpfessions Cade)
Section 70(k
is basis for Any
t'*: •, , • 3 O S.
-
1�.
6r-- CTP ?
-" '
or thrfhe exempt thercfromlid the the rl'dged cremptisd. violation
of Section 1031.5 by any applicant far is permit subjects the it,ticam to a civil penalty
of not mom than five hundred dollars (55W).
1014PN 1` *5L49DATI ON Occupancy Type
1, as owner of the pm rny, or my employees with wages as their sole compensation,
' will d0 the work: and the structure is not intended or offered for sale (Sec. 7/ ,-
'Bouress and Professions Code: The Convenor's license Law does nm apply m an
103 -
- - --
UFER Required Inspections,,
owner of proprny Who builds or improves thereon, and who does such work himself
or through his own mindthat such vement menr arc am intended or
-comple
104 -
REBAR
however,employees.the
for sale. IL however, the or improvement n sold within one ild of-
105 -
_ - _ _ , _ . _.. _.
ANCHOR BOLTS •• •
avt
completion, the ownervbuilder will have du burden or proving that he did not Wild or
will
impravero'pti"maf'.1c')'
106 -
SEWER & WATER
_...._....
with .. ....._ ..
uanud..convatomw
202 '-"-UNDERFLOOR
PLUMBING —_......._._....._.....
construct the project (Sec. 76". Business and Prateesmne
wCode:) The Connector's
License Law does not apply to an oner of pmpcny who W ilds or impmves Hre
eon,
2 O 3 -
.r
UNDERFLOOR MECHANICAL ''
. and, who,ri mmcu far such p,jects with a o mricumad.licensed pursusnLm the
2 04---
UNDERFLOOR- -FRAME
Contractors License law. ,
❑ l am a.pmpt order sec. .BS Pc fat reason
205 -
UNDERFLOORS -INSULATION
owner """"' " Date-
-
ROUGH PLUMBING
WORKER'S COMPENSATION DECLARATION
302 -
TUB & OR .SHOWER
Ihereby affirm under Penalty ofperjury one afthe fouawingdeclarations:
303 —
ROUGH MECHANICAL
❑ 1 have end will mountain'. Certificate of Co..., in self -insure for Workers
3 04 —
ROUGH ELECTRICAL
Compensation, u provided for by Section 37W or the Labor Code, for me
performance of the work for whim mit permit is issued.
305 -
FRAME
0 lave and will mainisa Worker's Compensation Insurance. as requited by Section
306 -
HOLDOWNS .
3700 of the Labor Code, for the performance of the work ror which this permit is
3 07. —
INSULATION
issued. My Workers Compensationen
Insurance carrier d Policy number are: '
"'
Camiec .i: n.A t .,... ;'-v'PolicY No.: ','
'; CERTIFICATION OF EXEMPTION FROM WORKERS"(
3 0 $' = ;
s t '' r I
9 -'
SHETROCK - ,i
'
.
COMPENSATION INSURANCE.,
3 0 -
3'10=.
EXTERIOR LATH'
.,...
:INT,ERIOR-LATH,.-..._...:-.,-
"'(77iiisectionneednotbecomplcudifinepermitisforonenundrtddolleta
311 -
SCRATCH COAT t
ISIO%or less.)
':Icamry�haiathaperfrrnddnaonnew�'ti'rorwnmri�nispe.''•iateal
shall not employ rn proam m any me r so S to accont subject c Worker'
"• -313 -
_
501
ROOF"NAIli.. .'_'.... ..-.. " ..".. .�
-
FINAL ELUMBINGAE ERGY
CompenamiooLr FCalifomiaD -
502. --
503 -
.
FINAL PLUMBING ENERGY.- .-.
FINAL MECHANICAL ENERGY
NO�TIC7 PL ANT: If. et maki m'�ec7 sof Ea rpimn. you Thoma
,became' bj .,heWcolme,Competition onpmvisioneof,hcLam, Code, y.amost
forthwith com.lywith such provisions orthis pannitshaBxdoomed revoked,
504.. -...FINAL
BUILDING.ENERGY. .-
CONSTRUCTIONLENDING AGENCv
505 -
FINAL ELECTRICAL,
1 hereby affirm that there is a convection lending agency for the performance
of the work for which this permit is issued (Sec. 3097, Civ. C.) "
506 -
'
GAS TEST
. Lenders Name .... .' .. .-.. ..
Lander, Address
507 -
.. ._ _.
FINAL PLUMBING
1 certify thin 1 hely teed this and sum thatthea above information is
508 -
FINAL MECHANICAL
l agree to comply with all city mw and sate lows
city and
orho
509 —
FINAL GRADE
acounty
t d rep;c,ordinances
enter
and hereby authorize u posenatives of Nil city m enter upon
to building crntoned pot
me aWve.mammnI ny for ify
510 -
FINAL PLANNING ( �
nd kepharue.
(We) age io save, indemnify and keep hirml<si Use City of Cupertino again.
save
liabilities, jvpgm rte, area .rad e.per M1mn may in any way .roma ageimt'.ia
514 —
FINAL PU I C WORKS
Cary in ca i py n. of the granting s pcmut.
APPLIC UNDERSTANDS A •D ILL COMPLY WITH ALL NON- INT'
I y
Issued by:
3
Date
so : uLAnons
natutc ofAppicanV r,ctor r Date
Re -roofs
' H OUS MATERIALS DISCLOSURE •_
Will do, Vplioam or future Wilding occupant store or nand'& haIDrdous material
Type of Roof
es defined by the Cupcnfgo Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25537(.)?
-
❑Yet ❑No
All roofs shall be,
inspected.prior_to any roofing material being installed.
Will the applicant 0, boom Wilding«c.,rntamequipmentordevices which
If a roof is installed without first obtaining an inspection; I agree to remove
emit huraidous air contaminants as defined by me Bay Arca Air Quality Management
DinnctQ
all new materials
for inspec 'on. Applicant understands and will comply with
Yes oNa
all no point source regul t S.
d the haass"a"m maudals oup"m errunder Chepa6.95 bf me&'Sa""Ce, Section2550515573 end 2553a.lundersandmaty
not ca endy have a arrant. that itis my ruponsiblity tonoti(ymcquimmenu
w ' muse W met prior m iuuence o(a CeniBute ofSignature
4d-
of App
t— Date
All roof coverings to be Class "B" or better -
;:ed gen, „&
OFFICE
C
m of
CUPERTINO
�CITY OF CUPERTIN6 1 0203,16
PERMIT APPLICATION FORM
APN #5) /' '
(�
_ 0 3 9
Date: 1
v 2
Building Address:
MECHANICAL
—
BldgPermits . foot
Owner's Name:
Phone #:
MECHANICAL
Contractor: 6 r—
License #:
O ` b
Contact:/- O
10 ` 7V
510
—�
Phone #:
-1�:6 0
-`� 2. 3 6
Applicant/Contract�Qr:
r
BBOILER5
Boiler> 1.75M Btu
ilding Permit Info:
B Elect
Plumb
Mech
escription:
Residential: 1\AA0jv&ti]
BCONSTAX
Commercial:
BUILDING
Sq.Ft. Floor Area:
Con. Tax for BQ Zone
$/Sq.Ft.:
BCONSTAXH
Architect/Engineer:
BUILDING
Valuation:
fi'q
k!peof Construction:
BELEC1000
Occupancy Gro *
-
Quantity Fee ID
Fee Description
Fee Group
BAPPLOTHER
Other Appliances
MECHANICAL
BBLDGFEE
BldgPermits . foot
BUILDING
BBOILERI
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/Quasi
BUILDING
BCONSTA)MQ
Con. Tax for BQ Zone
BUILDING `
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax— Resi/Mobile
BUILDING
BELEC1000
Elec 600V <= 1000A
ELECTRICAL
13ELEC1001
Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
BENERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
1 of 3
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