06070029 f
Y OF CUPERTINO � rl „BUILDING DIVISION PERMIT ...CTRACT('iR INFORMATION 'f�
INOADDRESS: DEBBIE KWAN PERMIT N006070029
351 SANTA PAULA AITR'S NAME: PERMITI55UEDATE
DEBBIE KWAN 07/07/2006
NE:
SANITARY NO. CONTROL NO.
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMBMECH
a 0 0 0
i00 LICENSED CONTRACTOR'S DECLARATION Job Description
%�C I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
G with Section 71)(f)(3)of Division 3 ofJU Busieas and Professions Code.and my license
infpnforce..it at. y33 PANEL UPGRADE INSTALL EXHAUST FANS AND RECESSED
License Cissa Ib
DamContractor
oad a LIGHTS
C ❑ 7 7 CContractor
ARCHITE(TSDECI-ARATION EMINENT ELECTRICAL PAID FOR BL 7/7/06
f rc< 1 understand my Plans dull M used as public records
5yU
r u Licensed Professional
10
OWNER-BUILDER DECLARATION
g I hereby alum that I am exempt from the Contawors License Law for tW
0 o fallowing mason.(Section 1031.5.Business and Prefecsioos Code:My city or..any
ma a p
<m which mquiermit to consumer,alter,impmw,denrokee,or repair any swwure
u-< prior to its issuance,also requires the applicant for such permit to file a signed statement
that he is licensed punuanuo the provision of the Contractors license Law(Chaplet 9 Sq. Ft. Floor Area Valuation
ii=@ (commcncingwithScction7000)ofDivWon3orth.BusitrssandP fmiomCodc)m $4000
i Nat be u exempt themfmm and the basis for the alleged exemption-Any violation of
Section 7031.5 by any applicant for a permit subjects the applican to a Civil ficmisy,of APN Number - Occupancy Type
not mom Nan Eve hundred dollars(5500).
I,ss own.of the pmpeny,m my=Playcn with wags ss Noir wlc comp=Oon,
will da the work.and thesuuwure Issas Warded oraffemd foraale(Ses.7044,Business - Required Inspections
and Profession Code:The Cormsee o's License Law docs not apply m e an comer of q P
property who builds or improves themon.and who doessuch work him miforthrough his
own employ.,provided thntsuch improvements art not intended cantered for We.If,
however,the Wilding ar improvement is sold within one year ofcompledon,rise owmr-
builder will have the bon em of proving that W did not Wild or improve for purpose of
sak).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
commer the project(Sec.7044,Business and Professions Code:)The Commcmr's Li- // )
ewe taw does oat appy to an owner of properly umbo Wilds os improve thereon,and
who contractsfor such projeeu with a conuuror(sl licensed pursuant an Jere CContractorsL
Covi Lh
Law.
�1
ver exempt under S B P C for
Ownmoon `7CJ-
er Date
W ftK MPENSATION DECUBATION40 O
1 hereby affirm under Penalty of perjury one of the following declaration: /^
❑1 hove and will maintain a CeniEate of Covent to self-insum for Workerr Camper- \!\V!!
ration,ss provided for by Sasso.37W of the labor Code.for the Nor...of the
work for which this pe Tri,is used.
❑1 have and will maintain Workers Compensation Insurance.as required by Section
37W of the Labor Cade,for the penfommmec of the work for which Nu permit is issued '
My Workeh Compewtion Wumna ani.and Polity number are:
Cartier. All01 Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need am W campioned trusts permit is fmonc hundred dollars(5100)
or Icss.)
1 certify that in Ne Performance of the work for which this Permit is issued.T shall not
employ any fiction in any manner an as to become mbjmi m the Warkeri Compcnation
Laws of Caiimmia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cci incase of Exemption.you should
Inatome subject to the W.,lem'r Compensation provisions of Ne law Cada you mus,
O forthwith comply with such provisions m this permit shall W deemed revoked.
z Vy CONSTRUCTION LENDING AGENCY
(-r 1hemby.M.that them iia emormcdon lendingagenry for the perfwmmceof
(Y the work for which this permit is issued(Sec.3097,Civ.C.)
0 Lcndcr's Name
Z lenders Address
U Q 1 ttnify than 1 have mad this application and sum that the above information is
UL Hcorrect.l agree to comply with all city and county ordinances and sure laws miming to
OU building r0roomti0n,and hereby autnoriae represnutiveso(this city memer upon the
.iFk
W ahove-memianroms.cst(and cef Non which s.
H LL (We)agree to saw;,indemnify and keep hamiless the City of CuNmino!goit'
fq in consequence
of tu,cosuind eafionscemay in any way vcrnm vgainslsaid City
V z A APPLICANT
Y02e ITANDng fNis permit.
'-' APPLICANT UN DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCyR
\ fi/fi/o(o Re-roofs
SignaS rApplsan✓Cormicmf Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the,applicantor forum Wilding mcupantstom m handle Weardons mamrial
as deBocal by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Code.Section 155334)?
0Y. @No All roofs shall be inspected prior to any roofing material being installed.
�
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant infurore refused
gby me B tax equipment w dMana which P g
Dour kvardon air cantaminanu u Jefiwd by rise Bay Arca Air Quality Management all new materials for inspection.
DW cit /
DYcs ��Nu '
I have mal the has N—materiab requirements under Chapmr,6.95 fifth.Califor-
niallcalNASafmyCode, mtiw 25505,25533 and 15514.1 understand that if use,Wilding
dors no,lummull havei manl that it u my ro mihiiity m notify the=up=t or the
mhibrornt w en yon a issuance ntleeni(iamoucafimay.A Signature of Applicant Date
Owner in auction ed Ag D�. All roof coverings to be Class "B" or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35704061 . 00
DATE ISSUED. . . . . . . : 07/07/2006
RECEIPT # . . . . . . . . . : 35142
REFERENCE ID # . . . : 06070029
SITE ADDRESS . . . . . : 22351 SANTA PAULA AV
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DEBBIE KWAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ALEX SIUMING TONG
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : DEBBIE KWAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
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FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----- --- -- - ------------ ---------- ---------- ---------- ---------- ----------
BELEC200 METERS 1 . 00 29 . 43 0 . 00 29 . 43 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- --- - ------ ---------- ----------
TOTAL PERMIT 207.. 66 0 . 00 207 . 66 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 207 . 66 VISA
TOTAL RECEIPT 207 . 66
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL
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.-. .. . ..,. __- . . . ..--- .._. . ..... �..._,,. .G .,, .. .. .
Communiry Development
10300 Torre Avenue
Cupeftioo CA 95014
Telephone(409)777-3228
ocrlyr Fax(408)777-3333
CUPEkTINO
Building Department
JOS ADDRESS:,--2,.I vW M IIN��ulel AVO PERMIT# 01^nw2ct
OWNER'S NAME: D2 PHONE# ; -
GENERAL CONTRACTOR:Qyy)' FAX# (d5Q— 2-40—QJQ5
�CJ am not using any subcontractors: �( �/�(�
i °
e Date
Please check applicable subcontractors and Tcormpetee following information:
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 Rock
Tile
/? /er
Owner/Co or Signature Date
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CITY OF CUPERTINO
Civ Or PERMIT APPLICATION FORM
CUPEkTINO ,,
N# 351 ��—T v�� Date: 7/ 0 (�
Building Address: Mailing Address (if different from building address):
smear/ ON74 ?401.4 kvc
Owner's Name: Kw Phone#: (,:IL-e) 7�-r-9678
Contractor:Evuneut eelth c License#: 8 3 6 133
Contact: 4(&X ZoNy Phone:(, 6rnj.2q-t" Cupertino Business License#:
ax: c 6J&,tJ-qo-0/ -
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description-
Residential L7 Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Proj ect: 4�na ov Occupancy Group:
Type of Construction: Pa,v,P 4y►t47-4Ce , Please check this bog if the project is a
.ex44t a...0 44 reafr•+( / j second-story addition: ❑
ro'ect Size: Standard Ef Laze ❑ Major ❑
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> 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
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CITY OF CUPERTINO
cirvoF PERMIT APPLICATION FORM
CUPEkTINO
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
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
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 Stomp/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 c 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 Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Mise 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
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(� CITY OF CUPERTINO
°ry°F PERMIT APPLICATION FORM
CUPEkTINO
LQuantity 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 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 Mechanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee s foot PLUMBING
PLLONGRNGC PlanningLR Comme/Multi-Fam PLANNING
PLLONGRNGR Plannin Lon Ran a Residential PLANNING
ZADDCHG Address Change BUILDING
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