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03120008FRTI QF CUPERI'INO y BUILDING DIVISION PERMIT � CONTRACTnR INFORMATION FC2ITY DING ADDRESS: - PERMIT N0 0 3 12 0 0 0 8 56 ROSROARDEN IA -R'S NAME: PERMIT ISSUE DATE NG WING HUI 003 NE: SANITARY NO. CONTROL NO. ARCHITEC (ENGINEER: BUILDING PERMR INFO BLDGELECT PLUMB MECII O tZ l� Q LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing P with Section 70(18) of Division J.(the Basins, and Professions Code. And my liana is in fanmrc�arf� j u ,-d 8QI �q� Liccnu CJ Lich Da�2<?/Oi cams PANEL UPGRADE/OUTLETS ® IN KITCHEN F'N^Lw I ARCHITECT'S DECLARATION Ito a I understand my plans shall used publicc records JAN 13 2004. Licensed Professional OWNER -BUILDER DECLARATION I hereby .('Sero on 11. crump, from the Contractor's License Law for the fallowing renua Permian IIo Business and sea Code: Any tiny or county yea BUILDING s r ve de repair structure which requires a permit re construct, alter, improve, h permit t fi prior In its censecc,also nt 1. the the inion or for suchpermilmflmssigned statement pursuant bubc theumnsetaw(Chapter Sq. Fl. Floor Area ValUa[$4500' ofDivisonr (commeccrnud he Business Code) Division 3 of nbe Business cxcmnd Professions lation of (commencingwithsciefore Nat be H cacmpl therefrom and she bazu for the alleged caemptiun. Any violation of and she Section 7031.5 by any applicant for a permit subjects the applicant to s civil penally of APN Number Occupancy Type P Y YP not mom Nan five hundred dollars ($500). 36617041.00 ❑ I, As owner of the property, or my employees with wages As they sole compensation. will do Ne work, and the swmuat is not intended or offered (or sale (Sea. 70,14, Business Required Inspections and Pmfetal", Code: The Conuacmr's License Law does not apply 1. an owner of Property who builds or improves themon, and who does such work himself or through his own employ=. provided not such improvements an not intended or offered for sale. If, however, the building or improvement is said within am year of completion, the owner builder will have the burden of proving that he did not build or improve for purpose of sale.). 1, as owner of the progeny, am exclusively contracting wit licensed contract.. t. construct the project (Sec. 7004, Business and Professions Cade:) The Cunmcsor's Li. _ cense law does not apply to an owner of progeny who builds or improves thereon, and who contracts for such projects with a conoscmr(s) licensed pursuant to the Contractor's License law. ❑ 1 son cacmpl under Site B h P C for this rcazon Dale WORKER'S COMPENSATION DECLARATION I hemby affirm under penalty of perjury, am: of the following declaration: I have and will maintain a Cerdfcate of Consent to sel6insure for Worker's Compcm satiom, a provided for by Section 3700 of the labor CMA, for the perfomom. of the work for which Nis panni, is armed. ❑ 1 have and will maintain Workers Compensation Insurance, As required by Section 3700 of the labor Code, for the perfornance of Ne work for which this Penn it is issued. My Workers Compensation Insurance exam and Policy number am: Cam k' �'—XA—aS Polic u �o� 2 ,/ CERTIFICATE OF EXEM17.11.N MWORKERS' / COMPENSATION INSURANCE _ o7hissection need not be completed if the permil is for one hundrad dollars(5100) " or less.) 1 unify Nat in the perfammnee of the work for which this permit u issued. I shall not employ any pe..n in any meaner an As At become subjui In the WorkrrS eompensatl.n Laws of California. Date Applicant NOTICE TO APPLICANT: IL after making this Cenifcale of Exemption, you should become subject to the Workers Cempcssaion provisions of the LaMar Code, you must fi nawith capply with such pmvisimss of this permit shelf W crcmctl mvukcd. CONSTRUCTION LENDING AGENCY I heathy affirm that them is a construction lending agency for the performance of the work fur which this permit is issued (Sec. 30,07, Civ. C.) , Under', Name Lender's Address 1 ccnify Net 1 have read this application cad state that the above information is correct. I abate to comply with all city and county eminences and moa lows relating to building construction, and hereby solitaire representatives or this city to enter upon the above-mentioned progeny for inspection purposes. (We) Agree I. save, indemnify end keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way sonic against said City ss in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT I// Issued by: Date SOURCE GULATIONS. 2 Re -roofs Type of Roof Ore a(ApplicanVCo ,meter Data HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hanNuus material defined by the Cupertino Municipal Code. Chapmr 9.12, and the Health and Safety .semmnzss3z(a)? Dyes KN. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which - iI havamoas air contaminants ac denned by the Bay Ama Air Quality Management all new materials for inspection. soviet? 0Yes XNo 1havematy theha.s cJ..25malemquimments4.lun mw6.93ofthe Wilding 25533 and23534.1 building ria Healthur Safctyhaw a mount. excthe Jrca not cancn,ly have a tenant thnl h is my rrsgmaihility, m sanely the ¢cupant of the It i M angry the m mite cots which malbemn donnrssuancc of a Ccnlncam of occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better 10 A,roe , B,ddA , Da,m y CITY OF .CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM p 3 /aeo68' 1 of N# O !V Date: La�r?zv--5 Building Addr s /3r6 Se yards,, Ali Owner's Na&ePhone #: UDR) -3t6-01#0 Contractor: M 1 KH-eck-rk C t AJ License #: Contact: - moi' lCee (a-wa-n Cupertino Business License#: Building Permit Info: /� B] ❑ Elects ❑ Plumb ❑ M h ❑ Job Description: Residential ElU If e Sq.Ft. Floor Area: $/Sq.F .: Cost of Project: rii� Occupancy Group: Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . 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 BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax - Resi/Mobile BUILDING BELECI000 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 BMITIGATC Comm. HousingMit. Fee BUILDING 1 of CITY OF CUPERTINO CUP TYOF PERMIT APPLICATION FORM W �_/ 2 of 3 Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTUR.E Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPMTERCEP 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 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 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BR.EMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > 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 W �_/ 2 of 3 CITY OF CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Grou BREMPOWER Power Devi ce/A aratus ELECTRICAL BRERECEPT M Rc tl Switch & Outlets ELEC TRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 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 Insection 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 t