04050176 ;2(0, 638
ITY OF CUPERTINO "�} aneaw�. a�xs5m'73t.�.�* win�i ' n�ksm�sa"',d��*'%♦.5?
BUILDING DIVISION P�s'ItM V� 1�4T�R°�D,' A`1Ygyy,' f,A a�"
LDING ADDRESS: CHIO LEONG HOI & JING KO PERMIT NOO 4050176
SHELLY DER'S NAME: PERMITISSUEDATE
CHIO LEONG HOI & JING KONE: SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
woo LICENSED CONTRACTOR'S DECLARATION Job Description
O O O
I M1aroby.(Boon Nat 1 am liwved under previsions of Chapmr 9(commencing p
with Section lakOofDivision3of the cosines and Pmfcssiona Cnde,endmyliccnu is FINALED
toren tame am erre.' BATHROOM REMODEL
n z License Class Lk.4
Dale Contractor
ARCHITECTS DECLARATION
o S LeenudProfcssunderstand et y plans shell M used as public records
JUN z6 900b
OWNER-BUILDER DECLARATION
I hereby./Erre he.I am exempt from dm Contractor's License law or the
i o O following reason.(Section 7031.5,Business and Professions Code:Any City or county
which requires a Permit In construct,alter,improve,demolish,or repair any muctuu
prior to its issuance.aim requires the applicant for such Permit to file a signed statement
a:onthat he is licensedPursuant nthe provisions ofdo,Contractors LicenuLaw(Chapter 9 Sq. Ft. Floor Area Valuation
�3$ (commencing with Section 7")of Division 3 of the Business and Profusions Code)or
3 that he is exempt Nerefmm and be basis for One alleged comp ton.Any violation of
Section 7031.5 by my applicator for.Permit subjects the apPlleanl 10 a Civil penalty ofp y Type
not more Nan five hundred dollars(M). 07 OCCU anC e
'C3 I,As owner orrice properly,Of my employcea with wages As their sole compensation,
will do the work,and Ne structure isnot inonded or offered for sale(Sec.7044,Business
and Professions Cede:The Conuactors Licenu Law does not apply to in owner of Required Inspections
preperty who builds firaprovea lherton.and who dooauch work Mercator through his
awn employee,provided roomer)improvements me notintended oreffered forme.If.
' however,Ne building or improvement is sold within one year ofcomplcrion.NeOwner.
builder will have Ne burden of proving that he did not Wild or improve for purpose or
Ads.).
❑I,as Owner of the property,Am esclusively convecting with licensed common O
comnm l the project(Sec.1044,Business and Professions Cade:)The Conv¢tor's Li.
cense Law does not apply to an owner of property who builds or improves Neuron,and
h 'mets(or.uch projects withacom nor(s)Iiunudpurauanl to the Contractors
n e law.Fp
n
I ren uem ,under Sec. pB&P C for do.reason
w f v/• Data
WO
RKER'S 4PENSATION DECLAR/IT5N
I hereby e(Brm under penally of perjury orc mf the following declmalioes: -
1 have orad will meinuin a CeniOcme of Conunr m ulhiesurt for Wo luee.Compen-
ulion,As provided for by Section 3100 of the Labor Code,for the Performance of Ne
work for which this permit is issued.
❑1 have and will muntsin Worker's Compensation Insurance,As inquired by Section
37M alum Labor Code,for the Performance of the work for which this permit is issued.
My Wmka's Compensadon Insurance carrier and Policy number art:
-Artier. Policy No.:
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section Freed not be completed If the permit is for one hundred dollars(5100)
err 1.)
r i certify Nal in the performance of Ne work far which this permit is issued,l shall not
employ any pcwnin manncrsnaz obcmmc bbcl tel Workcrs'fampcnsarlon
laws o!CAlifoml
APPO d0 n
NOT OAPPLICA afer�n is Ccnificao Of Exemption,you should
becoan uhjecl to the 'or is Compcnsmion provisions of the Lahnr Code,you must
.JO for ith comply with such provisions or Nis permit shall he doomed revoked.
Zy CONSTRUCTION LENDING AGENCY
[ti I hereby affirm that heu is a construction lending gency lot the performance of
r1 7 the work for which his permit is issued(Sec.3097,Civ.C.)
fA 0 Lender's Name
z Lenders Address
U Q I sonify that 1 have uad this application and more that the above information is
G. Hcorrect.1 agree to comply with all city and county moboadell and slam laws relining ro
pU building consuuctim.And hereby allthorim represenodves of this city an enter upon the
[Ll ahowtmcnuouraff menta.coot for inspection which An
G (We)agree to more,indemnify and keep harmlea the City of Cupcnino Against
h Iiabilitiu,judgmcno,costs And expenses which may in any way Accrue egeinn saidCity
U in conuqueneeoltheg of Nis Permit
^m APPLICANT UNDER A 5 AND L COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULATIO _ v 4
Re-roofs
Si(m a ofAppliaHAZARDct US MATERIALS DISCLOSURE Data
Type of Roof
wll the Siplient w rntum building occupantnom arhondle havudoes material
az defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Seray
cadc,Sadon]3532(a)? All roofs shall be inspected prior to an roofing material beim
❑Yes Na p p y g g installed.
Will
the apNieam or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
sort ha>ardnus.irconominanu defined by the Bay Arca Air Quality Management all new materials for lnS ection.
District? p
❑Yes No
1 have read thc hvardous materials mquimmcnls under CAaper6.95 of the Califor-
nia Health&Safety Cade,Sections 75505,8533 and25534.I undersand thatif the building
I.not curendy have a mineral,th t Is my responsibility to redly the occvPWI of th
requirements hien must be met, raisswnce o! enlBcaa et ca syr W Signature of Applicant Date
Owner crauthorizcd agent Datc 11 All roof coverings to be Class "$"Or better
OVER-BUILDER VERIFICATI&
1. (Check one) I or my immediate family (parent,spouse or child) will perform
• A. All the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
vc uavaaaecu
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perj that the above is true and correct. I have read and understand the
Owner-Builder Information (r se side)
Property Owner's Signa tur at
Job Ad a 102.38 StiU II IJV Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
City of Cupertino Building Departmeje
CITY OF 10300 Torre Aven
C U P[p'('I A O Phone: (408)777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being,performed by someone other than yourself,you
may protect vourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers compensation insurance,disability insurance costs, and unemployment compensatio*
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your ;
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the.property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
, Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department, •
City of Cupertino
Printed on Recycled Paper
MAY
C%I F CUPERTINO
to4m2_1 it
1
D
APPROVEd
nr§Is
At and s iations Qd 1
gn ifre ob at all Ymas and is k a 31
P�^ atl ir9 aaka airy cbenges on allendt 9
.» � emiissimC n
i44w * City of cuperfim
t�kte
060*Al and sp ufcalfo To
�1N4u�! POT N#Mld tB penofr or'to be. : m
of airy provrsn nn
rCily vtlinannP W6m
too
Qv fa,.nL,L 1 q
t
0
TY OF CUPERTINO
CUP TY OF O PERMIT APPLICATION FORM ��(` ° ��' � 7�
APN# Date: 7/
3S r.S 7
Building Address: Mailing Address (if di erent building address):
zo I � a
Owner's Name: Phone #:
Gd,� ler , +n8- 353- 4fls
Contractor: License#:
GA W-11
Contact: Phone: Cupertino Business License#: `
Fax:
Building Permit Info:
81dEleA� Plumb Mech ❑
Job Description:
Residentia. erci
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: �� Occupancy Group.
Type of Construction: Please check this b x if the project is a
second-stot ❑
Project Size: Standard ❑ Laze ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERl 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 hid/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 of3 ZS-6 G'<ZD
If OTY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
disk
WQ—uantity 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 rinkler/Backflo 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 cfin 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 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
19 1 milk, BREMRELOCA Relocation of Hood MECHANICAL
mw BREMREPALT Repair/Alter Heating MECHANICAL
2of3
*CITY OF CUPERTINO*
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Sips 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 Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Change BUILDING
3 of 3
CITY OF CUPERTINO
BUILDING DIVISION PERMIT ;\.J,. +�VA14F�A4AY.1�111\
BUILDING ADDRESS: CHIO LEONG HOI & JING KO PERMIT N004050I76
20638 SHELLY D
OWNER'S NAME: PERMIT ISSUE DATE
CHIO LEONG HOI & JING KO
E: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: n BUILDING PERMIT INFO
sf1�F E s PLUMB MECH
a G p LICENSED CONTRACTOR'S DECLARATION
MMaa 1 hereby affirm that 1 um licensed under provisions of Chapter 9(commencing Job Description
with Section 7")ofDivision 3ofdoeBusinessndPOdleMioasCade,aadmylicense is JUN V 2004
a❑ imfall rnrenand Offset BATHROOM REMODEL
jIAZ License Class Lara
c Ilflq---O Dem ContmcWr
ARCH TECTS W U ON
1 understand my plans ocelli he used asEpublic CLAR..,us BUILDING
to Licensed Professional
S OWNER-BUILDER DECLARATION
.'�<i I hemhy affirm that I am exempt from the Conuacmr's License Law for the
❑O following massa(Section 7031.5,Business and Profession Calc:Any city or county
JIB! which requhes a Permit to cnnstrucs alter.improv,demolish.or repair any structure
_Zte prior roam issuance.aim requites the applicant for such Permit to file a signed statement
�to thathe isliennsed pursuantmthepmvisions ofthe ContrntorSLiecrse law(Cheptcr9 Sq.Ft.Floor Area Valuation
$ (commencingwith Secdon7000)nf Division3 ofthe Businessand Professions Code)or
.� that he is exempt therfrom and the basis for the alleged exemption.Any vlalatlon of
Section 7031.5 by ray applicant for a permit subjects the applicant m a civil penalty of
not mom than rive hundred dollen($500). eT Occupancy Type
❑Lasownerofthe pestrolor is omployem wlshwegeaas is(Sec.7W,B sins,
will dothework.andthe he Contitnot intended moResdos formic a(Sec.7094,Business
and profession Code:The ves tsumre Uceme Law docs not apply to an owner of Required Inspections
propertywhobuildsvied that
ach improvements
and who denouchwork himselforNmugh his
ownemployees,ping or Natsuchimpro id wit atenet ear ofdaroffered for owner.
however,the building or improvement is hold within one year of completion the awne>
builder will have the burden of proving Net he did not Wild or improve for purpose of
otos).
❑I,as Manor of the property,am exclusively contracting with licensed contractors to
construct the projem(Sec.7044,Business and Professions Cade:)The Conrracmr'a Li.
cease taw does not apply to n owner of property who Wilds or improws thereon.rad,
I, ones for such projects wish scam cm r(s)licensed pursuant m ven
the Conor's
onY
YJW.
w lam exempt under Sao. B&P C for this mason
Game Date �y
WORKER'S CBMPENSATION DECLARATIgN
I hereby affl m under penalty of perjury one of the following dalanations:
aw and will maintain a Certificate of Consent to self-insure for WmicorsCompn-
on.as provided for by Section 3700 of the Labor Code.for the perfarmnre of the
work for which this Permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
37W of thc la Wr Code,for Ne performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number err:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissccuon need maloccamplemdBthe permit is fir- ehondred dollars(SIM)
less.)
I certify that in she performance of the work for which this permit is issued,I shall not
employ any Person in mnern as obaome bcclmt Worker'Fo. tamtion
Laws of Caliromie.G
gpnl' �
NOT APPUC k ,a ter n is Certificate of Exemption,you should
boom object m the WM eh Compcmatian provisions or the tabor Codc,you must
Q 0 fo th comply with such Provisions or this permit shall be deemed revoked.
z"' CONSTRUCTION LENDING AGENCY
[r E2 Ithmbyafrrm Nn Nem is a construction lending agency for she Performance of
Cli> the work for which Nis permit is issued(Sec.3097,Civ.C.)
QLender's Name
]z Under's Addmaa
U Q I certify that 1 have read this application and sum that the show information is
1,L corem.I agree to comply with all city and cOnty ordinances and state laws relating m
Q C) building construction,and hereby endocrine reprosenutives of this city to enter upon the
U above-mentioned property for imphcOon Purposes.
(We)agree m saw,indemnify and kap harmless doe City of Cupcnst against
s„sh
liabilities,judgments. and expenses andwhich keepmayinnywayacof Cupeme matssid City
(„)z mconsequenec orshegA�fft'IDN
APPLICANT UNDER COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUTATIO
Re-roofs
7W,011
i(oat of ApplicnUContram r Date-
/�a HAZARD e b MATERIALS DISCLOSURE Type of Roof
/ WIIIIM applicant or forum building occupant store or handle he'rmdcusmamriel
as&find by the Cupertino Muni ipal Code.Chapter 9.12,end doe Health and Safety
Code,section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
[3y. Nu
will the applicant or future uilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hazardous air comeminanta defined by the Bay Ara Air Quality Management all new materials for inspection.
'Mot?
F1 Yes Nu
It aw mad the hmardnusmatorials mquiremcnm under Chapter 6.95 orthc Califon
ria Health&Safety Code,Sccuom25505,25533 and 25534.1 understand that if the building
does not currently haw a¢mansl M MY responsibility m notify doe acUPnt M
requirmerm hichmuslWmetp r ismom enificateof ry1roz Signature of Applicant Date
Owner or authorized agent Dam All roof coverings to be Class "B" or better