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05100178F4 00 z� wp U UO CITY OFCUPERTINO �,r�'-��^? yny��aC�EFT •(s.;c•.*��w' ,1a"� ;y`"�k"df -`s-'.}�„• NV,0 Y' a'•' BUILDING DIVISION PERMIT 1C[iC A A� +v saC� BUILDING ADDRESS: 1551 POPPY Wy CUPERTINO PLUMBING PERMIT N005100178 NAME: PERMIT ISSUE DATE INER'S THOMAS FANG 10297 S DE ANZA 10/21/2005* E: SANITARY NO, CONTROL NO. (408)253-0618 ARCHGEC 7ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 Mm Nprovisionso reby affirm 1 are moved under provisions of Chapter 9 (commencing P with Section 70(10) of Division Sof the Business end Professions Code. and my license is COPPER REPIPE/WATE TER/WATER SERVICE L1efenlsefa�anderrem e sea Dau /; • ConuaMr ARCHITECTS DECLAR TION I undenund my plans shell he used as public recnr0 N01 LkenuO Pm(essionsl OWNER -BUILDER DECLARATION 1 hereby .(firm Net 1 1. exempt from Ne Contno Co License Law for the following mason. 71131.5, Business and Po(euiou Cade: Any city or county i erten U alms improve, or repair any tWerure which mqulsa a Permit re cores `�✓ hs 43t 0 h permitdersolmit,u prior m its issuance, also retinas Ne ismosant for Car permit m eor a signed statement Me limnsedPursuantft Sq. Ft. Floor Are Valuation p to (post comm. 7”)ofDislouofNeConuacmrsUcenmUw(ChaPm9 (commencing with Section 7 of Division J of Cede) or and Prormon. 1 I Me al eged axe Mynvi Net he V .tempt therefrom and Ne buss for Ne alleged exemption. Any violation of and /' V II Occupancy Type Section 70713 by any applicant for a permit subjects the applicant m a civil penalty of not man Nan five hundred doltsn (SRI} `Vf- ❑ I. as owner of Ne property, or my employees with wages as Neo sole compensation, e ns Required Inspections will do the wodt and the stsucture is not Nmnded ar offered for sale(Sese. 70th. Bulness and Professlau Code: The Comol Useme Law does net apply to an owner of q P property who bulldsor improves thereon, andwho doesaeheo rk himself or through his own employees, provided that men impmvemeau are nm Intended oroffered forsale. It. however, Ne building or Improvement Is mid within one year of mmplemn, the owner- buildu will have one burden of proving that he did Trot build or improve for purpom of sale.). ❑ 1, u owner of Ne property am exclusively contracting with licensed contractors k construct the project (Sac. 7044. Business and Professions Code:) The Contractor' LI. ceme Law date not apply in an owner of property who bunks or improves thereon. and, who conwcta for such projects with a contractor(s) licensed punum in the Contractor's License Law. ❑ Iomexemptunder Sea ,B&I'Cfmthisomm. Data Or WORKER'S COMPENSATION DECLARATION 1 hereby La m under penalty of perjury oro of the following deelaraliou: ❑ I ham and will maintain aCuufiate orcoment In sal( -Insure rerworkeh Compen. cation, u provided for by Section 3700 of the Labor Code, for de performance of the wok for which this permit ie issued. have and will maintain Workers Compensation Insurance, an required by Section 7700 of Me labor Code, for the performance of tie work forwhich this permit is issued. My Worker's Compensation Inman carrier and Policy number am: Cartier. Policy No.:� /9S? X _ CERTIFICATE OF EXEMMON FROM WORKERS' COMPENSATION INSURANCE (Thin section need net he completed inhe permit [store= hundred detlars (SIMM or leu.) I modify dust In the performance of the work for which this permit is ism d. I Mall not employ any person In my manneran u to become subject to the Worken' Compensation Law. of Callfaror m Data Applicant NOTICE TO APPLICANT. If, after making Nis CeniRcnc of EaamPlion, you Mould become wbjctt in the worker's Compensation provisions of Nc labor Code you most faMwilh comply with such provisions or this Permit shall N deemed invoked. CONSTRUCTION LENDING AGENCY 1 hemby, anirm Net them is a construction lending agency for the perroornmen of ' the work fm which this permit is issued (Sec. 3097. Civ. C.) ' Lender's Name , Lender's Address I mmi fy that I have reed this application and sum Wt the above information u correct. I agree N comply with all city and county on inmets and suss laws slating in building convection, and hereby mobodae representatives of this city to enter upon the shove -mentioned propeody fm Inspection purposes (We) .gree m tire, indemnify and keep harmless site City of CuPerOno agsiut wM1icheerytumysoyamusagsinstsudCuynenee of th.Bmntin fib it. DERS 1 DS LL COMPLY WITH ALL NON -POINT Issued by: Date ..2 /,p `/ V-6Re-roofs AME Type Of Roof xAZA SUR. Ne epplinnt or tutus build ng decupantsmre ohendlc hmallou material UsoccuL5ratme o Aa dcOned by the Cupertino M al Code. Chapter 9. 12. and dm HUMM and Safety .edea S.c6 .35533(x)7 All roofs shall he inspected prior to any roofing material being installed. ❑Yee Na If a roof is installed without first obtaining an inspection, I agree to remove W01 the applicant or future building Occupant use equipment at devices which emit haaudnu air contaminants u dcRned by the Bay Area Air Quality Management all new materials for inspection. Dimict7 ❑Yes u I have mW rwamamrids requirements under Chapter 6.95 of the Califor. rola Heal Salc COM, Safi 25505, 533 wh125534. l understand Nin ifNe building dos nal cunt y hoves m that h i y respouthility k nudfy tie occupant of the myulmmen '/ tpriarpncerdklwOfOccupmcy. Signature of Applicant Date All roof coverings to be Class "B" or better 0 No .gent Dote CITY OF CUPERTINO I0 3 of 3 PERMIT RECEIPT OPERATOR: suem COPY # : 3 Sec: Twp: Rng: Sub: Elk: Lot: APN - ........: 36615031.00 DATE ISSUED.......: 10/21/2005 RECEIPT #.........: 31691 REFERENCE ID # ...: 05100178 SITE ADDRESS .....: 1551 POPPY WY SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: THOMAS FANG ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-5306 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 10.00 -------------------- 90.00 ---------- 0.00 90.00 ---------- 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 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 ---------- ---------- 259.76 ---------- 0.00 259.76 ---------- 0.00 METHOD OF PAYMENT AMOUNT NUMBER ------------ - ---------------- CHECK 770.28 --_--------------- 1200 TOTAL RECEIPT 770.28 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 'a,-01 SUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building De artment JOB ADDRESS: /55/ PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR FAX # 253 6 co —7 3 I am not using any subcontractors: _ 42, -2-1 • 6tD Si a Date Please check applicable subcontractors and complete the following information Date 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 c AOL T' Date tt Cm o CUPERTINO CITY OF CUPERT][NO PERMIT APPLICATION FORM ( C -,-� 0 <51�017r N # Alla Date: 0. P.I .Os"Building I Address: Mailing Address (if different from building address): SS Owner's Name: Phone orrlas .#: 1/0a g $ a Contractor: Lu cy'Aino License #: L/?H t0� Contact:JJ Pho : 2 --5 i y Cupertino Business License#: 81x1 G(1 cam- Fax: Boiler> 500K to 1M Btu Building Permit Info: Bldg ❑ Elect CCY Plumb Mech Cl - Job Descripon: tip pc r 'Pee ,l7ee , W lAeaEer , W vice Residential10 Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Project: Occupancy Group: Construction Tax BUILDING Type of Construction: Please check this box if the project is a V Ili second -story addition: ❑ o'ect Size: Standard ❑ Large ❑ Major ❑ BUILDING 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 BCONSTA)MQ 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 Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of3 i*MPOW1 i CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee 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 BOVERTDAF, 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 InstaWAlter 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 BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace > 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 He ing CHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 j, CUPEI,TINO CITY OF CUPERTINO 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 Inection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Tem 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 s foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3of3