04060144 CITY OF CUPERTINO11T 'F' wW
BUILDING DIVISION PERM _ CO,N'TRACT(7R N:�,_
BUILDING ADDRESS: CONSTRUCTION TECHNOLOGIES PER"BT N004060144
7666 RAINBOW DR
OWNER'S NAME: PERMIT ISSUE DATE
ti . HELEN CHEN 969: G EDGEWATER BLVD 06/16/2004
7ARCHITECTIENGINEER:
SANITARY NO. CONTROL NO.
(650) 315-6250 BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC"
0LICENSED CONTRACTOR'S DECLARATION1 hereby afrirm Nat I am licensed under provisions of Chapter 9(commencinglob Description
ZSection 70188 of Div' on Sofshc Busin and Professions Cod ,and my license is
gfo evade et, O G. ADD 1/2 BATH & W� nuC Lic. .—
Da ARCHITECrg DECLA ION w+
a� lunderstand my plana shell he maJupuhlic recuses SEP V / 104
oat
;0G Licensed Professional -
S OWNER-BUILDER DECLARATION
<S I hcrcM1y amrm that I am exempt from the Contractor's License Law for the
i OO following mason.(Section 8131.5,Business and Prolessiuns Cole:Any city or county
A Q which requires a permit to construct,almc improve,demolish.ar repair any suucmm $4300
mew prior to its issuance.also rrquimsthe applicant for such permit to file a signed statement
that he is licensed pursuant o the provisions of the Commemri License Law(Chapter 9 Sq.Ft.Floor Area Valuation
2FG (commencing wish Section 7")of Division 3 of the Business and Prefesturs Code)or
c that he is exempt therefrom and Ne basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects to applicant to a civil penally of 2%KWAteru Occupancy Type
not more Nen live hundred dollars(5500).
❑I,as owner of Ne property,a my employees with wages a a their axle compensation,
will do the work,and Nestructum is not intended oroffered forsalo(Sec.7044,Business
end Promasi ers Cade:The Comracmri License law does not apply to an owner or Required Inspections
property who builds orimproves thereon.and who doessuchwork himself orthrough his
own employees,provided that such improvements arc notintended oroffered for sale.If.
however,Ne building or improvement is sold within one year of completion,Ne owner-
s builder will have the burden of proving that he did not Wild or improve for purpose of
as".).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
consumer the pmj¢u(Sec.7064,Business and Professions Code:)The Connotes Li.
rue Law does not apply to an owner of property who builds or improves thereon,end
who contracts for such pmjecss with a con"clor(s)licensed pursuant o Me Comuctofs
License Law.
[j 1 am exempt under Sec. B&P C for this reason -
Owner Dam
WORKER'S COMPENSATION DECLARATION
Us affmn under penally of perjury one of Ne following declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
5W,se provided for by Section 3700 of the Labor Code.for the performance of Ne
work for which this permit is issued.
❑1 have and will maintain Workcrs Compensation Insurance,as required by Section
3700 of the labor Code,for Ne performance of Ne work for which this permit is issued.
My Work4er's//9��n/m/pena¢¢�r007'on lnsurencc eartier and Policy numbcrare:
Carrier:/rs'Wv Aa�i� Policy No.:(7y4Sf�-6J +
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not hccomplesed if the and,Isforonehundred author(5100)
or less.)
I certify that in the performance of the work for which this permit is issued,l shell not
employany onm ny mannose as to become subject Ne WmlocrS Compensation
Laws of Coliform am
APPIi n
NOT APPLICANT:IL after making this Certificate of Exemption,you should
• btte subject m Ne Worker's Compensation provisions of Ne labor Code,you must
JO forthwith comply with such previsions or this permit shall he decreed mw1unt.
.Zi CONSTRUCTION LENDING AGENCY
`
(hereby option Net there is&construction lending agency for Ne performance of
Cl> Ne work for which his permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
z lender's Address
U C) I minify that 1 have read this application and Stan,that the above information is
ly H counsel.1 agree to comply with all city and county ordinances and sate laws relating to
pU building etrawction.and hereby mahmimre,macnmtives of this city to enter upon the
W above-mentioned property for inspection purposes.
Ly,gy (We)agree to save,indemnify and keep harmless dm City of Cupertino&Seoul
(.�N liebilities,judgmcnts.costs and cxpcm us Is wayaccmc agaiastsaid City
t)'/ iAoPPLuqucnccofDERSTANDStarting of thr P WIL 0 WITH ALL NON-POINT Issued by: Date e(ecc�9
m� S C GULATIONS.
' Re-roofs
mgname of PPIinHAZARDOUS MATERIALS DIS SURE ontruclor Dam Type of Roof
ill W ripplicam or(umre building oce.p.nixtrum.,handle hamnishis materiel
as defined by the Cupertino 1471 Code.Chapter 9.12,and the Health and Safety
Inde,Section 2ss3xa)7 All roofs shall be inspected prior to an roofing material being Installed.
❑Yrs P P Y g g
Will the applicant or future bti g occaVant use equipment or deices which If a roof is installed without first obtaining an inspection,I agree to remove
mit behemoth air contaminants cfineJ by tha Bay Arca Air Quality Management all new materials for inspection.
uvict7
❑Yes Nu
I have a idousmamrials mem oder hapmf6.9SofMcCalifor-
niaHcai afct otic,Sccdons15505, 3�anJ 534. ndcrstsnd thwifthc building -
doe of curtw y have a mnank that is
my es
��+p ly re notify Nc occupant of the
m u(c s hich muss be m t prior iss are,yy{(Certificate of Occupancy.
P Signature of Applicant Date
Owner or stir,,icd agent bate ' All roof coverings to be Class"B" or better
I
i
r
7�(0� �o tom. LUQ Dr
I VJ�v�dovJ ��
F---
14" 8" ----� 4 W FICC CRY
N x- 23 h2-
�
a.
s h I
s T 1- ,• 1n� s�� ll°LOT PLANS
11 C 0 I Y' Y.
or-
11-/7
Q � � f � ED I �6,AN\'llYG D
T (�,U1A.
/
1.
CITY OF_C:UPERTIN®
'^ ElCA NJ
9 .,a,°3 ! i �— --- 3UILDING OF_PARTM�NT APPROVED
�"ccoAoa�aMwrtNn�crrr�
SIGNED=iIof p1mas
IGU�T be
04 kbpt on the job at d bw w d it is unlawful
p = ° td make OY dranges or abm bns on same
*.hour written permissbn from the et.�in
�panrnent,Gty of Cuperfnro. g
`
The sj�a'Prg of thispi
(Zppw� ALL NOT be held to pemfd or to be an
nrOval of the violation of any provisions of
C. :...anbe or State Law.
1
/ms' s r�
o a . .
E
a N _� „nl e�QERTIN�
qkITY OF CUPERTINO*
CU T PERNO PER APPLICATION FORM
N11 / / / Q 3 Date& / G — 200
Building Address- I Mailing Address (if different from building address):
f7(66(o o,-Lw2
Owner' Name: Phone#-
'A - -eK. 65V) ,S?1 /6e,
Contra5an.
o� /v_ T�G� License#: ,7O2
¢ G 9
Co tact: . Phone: Cupertino Business License#:
u,e a r Fax: /-/46
Building ermit Info:
Bldg Elect Plumb Mech
Job Description: I
�A/J-f2 6j'( Al/)0 G J
Residential ❑ 4 c d a/ b-, 14 1w v a Commercial ❑
Sq.Ft. Floor Area: v $/Sq.Ft.:
lib
Cost of Project: C Occupancy Group:
pD
Type of Construction: � Please check this box if the project is a
v olcli ��aw second-sto addition: ❑
Pro'ect Size: Standard Large ❑ Major ❑
Quantity Fee ID Fee Description 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/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
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of
1
WITY OF CUPERTINO*
cuPEkTWYO 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
BPINfERCEP 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 StomVRain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER InstalVAlter 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 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace MECHANICAL
BREMFURNOV Relo Fumace > l 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
2 of 3
OCITY OF CUPERTINC*
CUPEI�TINO PERMIT APPLICATION FORM
QuantityFee 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 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 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 Fees foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACT,ORINF,p®ItMATION,
BUILDING ADDRESS: CONSTRUCTION TECHNOLOGIES PERMIT N004 060 144
7666 RAINBOW DR
OWNER'S NAME: PERMIT LSSUE DAM
HELEN CHEN 969 G EDGEWATER BLVD 06/16/2004
E: SANITARY NO, CONTROL NO.
pr (650) 315-6250
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O
O
Z, LICENSED CONTRACTOR'S DECLARATION O O O
ZdF 1 hemhy option Nat I am licensed under provisions of Chapter 9(commencing Job Description
MSxad..701)10ofDiy(on 3alum Resi;r Prafcssioru Code,and my license is
'� Imm�mhpaaa k _Is_� o ADD 1/2 BATH & WINDOW IN C /Cl ��D
5ga uansec ua r" Vfla�
De ARCHITECTS DECr ON
[understood my plans,hall be used as public recnruls
3; Licensed Profmaional SEP 0 7 1004
y OWNER-BUILDER DECLARATION
Z I hereby affirm on 11. exempt from din Gaamam/a Licence law(or the
O O
fallowing reason,($CaYan](fd1.5,BaslnC[f and Pmf[itiartf COJC:Any Clly or Cnaaly
s g which requires a Permit to construct,altar,impnw,demolish.or repair any structure III MINIMQ O
prior m its issuance,also mquiues the applicant for such parent to file a signed abnormal
� that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.F[. Floor Area I t
$ (commencing with Section 7")of Division 3 or Oe Business and Prorcalam Code)at .
Nat he Is exempt therefrom and the basis for the contraption.cuption.Any violation of
Section 7031.5 by arty applimm for•permit subjects the applicant to a civil penalty of
not nota man row nonmed dollars($5400). er Occupancy Type
❑I,as owner of the property,or my employees wit wage as imrsele compensation.
will do the work and Ne structure is natinumund or offered fonale(Sec.7044,Business
and Propositions Cade:The contractors License law time,not apply w an owner of Required Inspections
propeny who builds orW mws therenn,and whodoessuch work himaellor through his
own employ=.Provided that such imprnwmxms art not Intended muttered brash.It.
howewr.the Wilding or improrcment is said within am year of completion,the owner.
builder will haw Ne burden of proving Nat W did not Wild or imprew for puryase of
Wo.).
1,as owner or Ne property,am exclusively connoting with licensed contractors to
cmusuct Ne prefect(See.7044.Business and Professions Code:)The Conr¢mr's Li.
cerise law dors nm apply m an owner of propeny who Wilds or improves themmn,and,
who contracts for such projects with a conmmer(s)Barred pursuant in dm Contractor''
License Law.
0 1 am exempt under Sec. B h P C for Nis reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hemhy affirmunder Porosity of perjury ore of the following declantimes:
I haw and will maintain aCertillmta of Consent m sel4inuue(or Workers Compcn-
setion,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this Permit is issued.
C3I haw and will maintain Worker's Compensation Insurance,as required by Section
3700 of the LeWr Code.fm the performance of the work for which this permit is issued.
My Wmlkes/Co pensa.a.lwmnce ortimand Polleymrecras: r
Cartier:JT'09v Polley No.:/7U�xsr/-63 >
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This action mad nm W completed if 1W Lemur Is forone hundred dollars(SIM)
or less)
I coolly Nat in Ne performance of the work for which Nis Permit is Issued.I shall not
employenyr y manner suss w become subject to lho Workers'Cmnpensadon
Lawsof Califomn etc
Appli n
NOT APPLICANT:IL altar making this Cisions tc of Uc r on,you should
Woo mbjmty it Wahpin Campmosstionprovisions of de laWrCmkc,you mmt
,J Z forthwith comply with such provision or Nu permit shall Ec dmmcd mwked. ,
z8 CONSTRUCTION LENDING AGENCY
F"n4m I hemhyaRrm that Nem iaarnnsuuction lainingagcnry(nrsW pcolvaroncemf '
tita work(or which Nie permit Is issued(Sec.3097,Ci¢G
0 Lender'.Name
0.
5 z undo/s Adultness
V Q` I unify that 1 haw mad imn this apdim and slain Nat 0m show information is
!I.V correct.I agree to comply with all city and county urdinsnms and sou laws elating to
0 building construction.and hereby auNoria,rtpmsenutivm ofthis city to enter upon Nc
LU
above-mentimned property for inspection Purpose&
G (We)agree to saw.indemnify and keep hunless the City of Cupertino against
cn lubililes.judgreems,cmuendexpo which
way anmagalnst said City /
V z in consequence of ,Staining or Mi it
^ APPLI ERSTANDS WIL WITH ALL NON-POINT Issued by: Date
S C GULATIONS.
Re-roofs
rgnxturc of pplicmrVC.Mmcmr Doc
HAZARDOUS MATERIALS DIS SURE Type of Roof
JI circ applicmr art lawn building accuPent Hort or herdic bvrdous material
m defined by tita Cupertino Manic' 1 Cabe.Chapter 9.12,and the Health ane Safety
Coca. Cl Y.zss3z(a)? All roofs shall be inspected prior to any roofing material being installed.
Cl Y. Na
Will the applicant or future bui meupant x equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hauMom air contaminants Oncd by the BayraArea Air Quality Management all new materials for inspection.
Distria?
❑Yes Nu
I he. odousmatcriab u' mon ndcr hapier6.95olNcCalifor-
niaHcal get ,SeNam 35505, 3 and 534 ndcamndthmifthe Wilding
J ecu yhaw atanen4 Nmhon esrtywnotil'y Nm
ccupmrn(thc
which mwim prior rlasc cmrdresworacapancy. Signature of Applicant Date
Owner or auN ed agent Q,ta All roof coverings to be Class"B"or better