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06040138 CITY OF CUPERTINO BUILDING DIVISION PERMIT CON+TRAOTORANFORMATI0N r BUILDING ADDRESS: CALIFORNIA SKYLIGHTS PERMIT No.06040138 809 SEPTEMBER DR OWNER'S NAME: PERMITLSSUEDATE WU HWAI M AND BETTY M 18637 BUCKNAU RD. 04/24/2006 ONE: SANITARY NO. CONTROL NO. (408) 866-6759 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EISCT PLUMB MECH 0 0 0 0 +oro LICENSED CONTRACTOR'S DECLARATION 1 hemb form that 1 Am limned Manor mrimms of Cha 9 commencin Job Description ;� r a p Cham., ( g P .Z with SarerAnd cfio Division3of Nc Business and Pmfcssions Cook,And mylicense u a<, in fYli farce ands 00/��/ O.T T INSTALL SUNTUNNER SKYLI �_ NFRC 11607 . 81) '�Z Licenm lac Lie.# h�sJp FO Dete Con DECLARATION ee ARCHITECTS DECLARATION l w� 1 understand my plans shall W used u public Toreros 'f■/ig__® ),U A.t� Licensed Professional ��� OWNER-BUILDER DECLARATION I 1 Wreby affirm Not I am caempt from the Commences License Law for On, ar L ay 00 following mason.(Section 70 L5,Business and Pretensions Coda:Any city or county CT Q �,w which requires a permit m construct,alter,improve,demolish,or repair any structure oU $649 iy prior m its istuance.Alan requires the applicant for such permit m file aligned steteream < NatheisliconsodpursuanttothepmvisionsoftheConmount'sLice=Law(Chapter9 Sq.Ft. Floor Area Valuation e�FG (commencing with Section 7000)of Division 3 of the Business and Profeuiana Code)or that he is exempt Nereftom and Ne bun for rhe alleged exemption.Any violation of Semlon 7031.3 by any applicant far a Form,subjects me applicant m A civil penalty of Am mort than fisc hundred callus(5500). c cy Type ❑1,u awnu of she poprmy,cur mY ooployaa with wagca u Ne'v mlccompensation, will do the wart and the strtrmure is not intended or offered forsale(Sm.7(4/,Busimses Required Inspections and Prefeviona Thrac Code: e Commr ^ es ree s L' "a Law dot apply m an a war of q P property who builds m improve Norton,and who dms such wark himself or though his Own employees,provided Nat such improvements are not Maxwell coffered for sale.IL however.the building or impromment is old within arc year of completion,Ne owner. builder will have Ne burden of proving that he did nut Wild o improve for purpose of saky ❑1,as owner of the property.am exclusively contracting with licensed contractors In construct the prejem(Sec.7014.Business and Pofcssions Cade:)no Contracmrs Li- conse law don not apply to an owner of property who builda or impusws Nemo,And, who contracts fro such p np.with A conuanor(s)licensed pursuant an rhe Canuactots License Law. ❑lam¢cmpundarSee ,BAPCforlhiamAMm Owner Data WORKERS COMPENSATION DECLARATION 1 hereby An.under pommy of pojmy one of Ne fallowing docaruiou: ❑ [ham and will mainum a Certificate of Consent to auf-insure for WarkclsCompcn- utian,u provided fro by Section 3700 of do lobo Code,fur Ne perfa bo ox of the work for whim this permit is iuucd. ❑1 haw and will maintain Workefs Con emanon Iruunnce,As myuired by Section 3700 of NO labor Code,for on performance of dm work for which this permit is issued. My Workers Compensation bavmnm canner and Policy number Am: Carver.S'%ry-7t FLa^JC7 Policy Na.: ����63 �� ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This amhan need not becomplesed Base permit is ferom hundred dollars($100) a or lose) 1 certify Not in the Performance of the work for which this Permit B Wood.1 mAB not employ any per on in any mannerso As In bawne subject to Ne Workers'Compensation Laws of California.Date Applicam NOTICE TO APPLICANT:IL after making this Ccnificam of EaempOon,you should became subject to the Warke's Cam usestion previsions or Ne Labor Cade.you man .,OEforthwith comply with such pMw$iau or Nu Permit shall be dr<med rewired. zy CONSTRUCTION LENDING AGENCY l hereby alarm Nat Nem is a construction lending agency,tat Ne performance of the wish for which this Permit is issued(Sec.3097,Civ,C) F) Lenders Name - Z:)z lenders Address U C) I curtly Na I haw mad this application and state that Ne aWw information is It, F co¢m.1 agree m comply with all city and county oNinamesand note laws relating to 0U Wilding construction,and herebyauthorine represenuimsar Niacity wea(MMpnn the Wahovcmemiuncdpopcny ran iesacties which a (We)agme to saw,indemnify and keep harmla s due City or Cup:nino against tq inconseque dgm ats.of cantruand or this may in any way ecente agaiut said City U z A consequence of Ne granting of Nis permit. '—' APPLICANT UNDERSTANDS AND WIS..eOPM LY WITH ALL NON-POINT Issued by: Date G�—2- t't —V G SOURCE�` 'IATIONS, f .a� —:v 4 F�d� Y o Re-roofs Srgwurt ofA IipHA or Dete DD a MA AISDIaCLOSURE Type of Roof WIIINeApplicant or(arum buildinge.Chapter mo handle Health and C d .Sed by de Cupertino Municipal Code.Chapter 9.13.and the HcaIN Ann Safety code.Section 3ss33(a)? All roofs shall be inspected nor to an roofing material beim ❑Yea NM p p y g g installed. Will thc applicant or future Wilding occupant use equipment or dI which If a roof is installed without first obtaining an inspection,I agree to remove emit hums us air comaminansa aydcfiad by Ne Bay AMA Air Quality Management all new materials for inspection. Courts'? r/ ❑Yes ON. 1 haw man Ne huardras mamrialsrequimmenu unncr Chapter 6.95 of0e Califar. nu Health&Safety G=M,SalICns 25505.25533uM1755 .IuMcrsurq thaif Ne Wilding does not currently haw a tenant,that it is my m ility m badly the accupam of Ne requirements which most be at pier to of a Catifcam of Patsy. v Signature of Applicant Date no,or mthomed.,v s Dan, All roof coverings to be Class"B"or better CITY OF CUPERTINO em 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36212003 . 00 DATE ISSUED. . . . . . . : 04/24/2006 RECEIPT # . . . . . . . . . : 34095 REFERENCE ID # . . . : 06040138 SITE ADDRESS . . . . . : 809 SEPTEMBER DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WU HWAI M AND BETTY M ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : ELK GROVE CA, CA 95758- RECEIVED FROM . . . . : TERRY KIYAMA CONTRACTOR . . . . . . . : TERRY KIYAMA LIC # 26844 COMPANY . . . . . . . . . . : CALIFORNIA SKYLIGHTS ADDRESS . . . . . . . . . . : 18637 BUCKNAU RD. CITY/STATE/ZIP . . . : SARATOGA, CA 95070 TELEPHONE . . . . . . . . : (408) 866-6759 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------ ---- - ------------ ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BPERMFEE VALUATION 649 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BSEISMICRE VALUATION 649 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 118 . 52 0 . 00 118 . 52 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 118 . 52 VISA TOTAL RECEIPT 118 . 52 • ( - CITY OF CUPERTINO WD4013c�j CITY OF PERMIT APPLICATION FORM CUPERTINO APN# 2rnn ^ �nDate: Building Address: i- Mailing Address (if different from building address): T Owner's Name: Phone#: /amu qGg-3a4 —moo Contractor: License#: 2 —8 Contact: PCupertino Business License#: seeFax: Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: /i)5TW 4_ sutiJTv �w Ec sk y c/G H--r Nf'er /�Eo7, e 1 Residential [ - ,� Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Gro u p--5 Type of Construction Please check this box if.the project is a second-story addition: ❑ roject Size: Standard B' Large ❑ Ma'or ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> IOOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM 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 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 Elee Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of3 S ; ; CITY OF CUPERTINO CITYOF PERMIT APPLICATION FORM CUPERTINO 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 IPLUMBING 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 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 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace 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 A liance ELECTRICAL 2of3 Q`- CITY OF CUPERTINO arroe PERMIT APPLICATION FORM CUPEkTINO kQuantity Fee ID Fee Description Fee Group BREMSIGNAD Rmd] 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 Ternp 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 sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3