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02110150Oz z0 a> ao oz UC V. OF tea 0. U 2 CITY OF CUPERTINOrsa..:94vat�sdas .. BUILDING DIVISION PER T �CONTRAGT0R INFORMATION ' BUIL DR PERMIT N(02110150 OwZll'fANC:HSIANG HSIEH & JANE L S U APPLICATI1^1sYbT6J2002 PHONE: - SANITARY NO. CONTROL NO. BUILDING PERM IT INFO ARCHITECUENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION mlamftheBdinder Chapter 9 Iion7 REMODEL KITCHEiI� RescYtp9KiIHROOMS ).fDivMon Division I of the Businds and Pmfcssi0na Code, and my license is ssendPme.1ifsOvia.ndmlict..is with Section ]def effect. I. mu Loma and arras. License Class Lie. N RE P I PE FI N�►LE® Date GonuacwL an ARCDECLARATION ARCHITECT'S used I undersand my plane shellall u mm d public eos ,IAN 3 1 2003 Licensed Professional DECLARATION 1 hereby 1 em .Bumps Oat I am exempt from Ne Conws Law for the BUILDING reasm .affirm(Scc .. following moon. (Such 703 s In Business and Professions C"de: Any oily or county Co : Any c which requires t construct. t. 41M alar. improve, or repair any ewnum permit re cores $25000 n h porguh, prior m its issuance, also requires the applicant for Coit permit m 01e na signed aoamcnl the, that he is licensed pursuant mthe provisions of the Cantncmr; Licerue law (Chepar9 Sq. Ft. Floor Area Valuation (commencing with Section 7")or Division 3 of the B amass and Professions Coca)ar 35932033.00 Nat he Is exempt therefrom and the basis for she alleged exemption. Any violation of Section]031.5 by any applicant for a permit subjects the applicant a civil penalty of not more than five hundred dollars (S500). ppN Number Occas T' : ane Occupancy Type: 101 — FOUNDATION ❑ I, u owner of the property, or employes with wags their compensation,sies is will Pr the won, and the the Contra not intended offend w do s not a(Sec. tooa4. Rosiness r ea and Profession Code: The Contractor's License Law not apply m an owner of 103 - UFER Required Inspections property who builds t such and who does such won himmlfor through his own idimprove h improvements are not intended croffeopted 104 — REBAR ver, theu,ping or Improvement n diecforsale.lr, vementpm old wi gots however, the building prim of is Ott heiid of yld or improve for theowarf Wilder will have the burden of proving that he did net build or improve for purpose of 105 — ANCHOR BOLTS "is) 91 as owner of the property, em exclusively contracting with licensed conuuma m 106 — SEWER & WATER couwm the project (Sec. 7044, Busineu and Professions Code:) The Consractor'a Li. 202 — UNDERFLOOR PLUMBING cease Law does not apply to an owner of property who Wilds or impmwa thereon, and 203 — UNDERFLOOR MECHANICAL who contracts for such projects with a contractogs) licensed pursuant m the Conlreemes LieenaaLaw. 204 — UNDERFLOOR FRAME ❑ImeexeJ"derSec. BA,PCfor thi 205 — UNDERFLOOR INSULATION Owm Pt2 2 .301 ROUGH PLUMBING WORRER'SCOMPE SATIOjuryo DN ECURA 30'Z _ TUB & OR SHOWER Ihereby elan under penalty of perjury one ofthefollowing 303 — .ROUGH MECHANICAL Wmkxr'declarations. maintain 37M of thematicCode. fart for Workeh Compeo- ❑ Ihive and will for moon, u provided far by Section 3700 of the IoW, Cade, for the performance of the 304 — ROUGH ELECTRICAL wort for which thin permit's issued. 305 — FRAME ❑ 1 hate and will maintain workers Compensation Insurance, as required by Section 306 — HOEDOWNS 3700 of the UWr Coca, the performance of the work for which this permit is issued. My Worker; Campewtian Insunoannumber ce carrier d Policy art: 307 — INSULATION Carrion: PolicyNo.: 308 — SHEETROCK CERTIFICCATE OFOMPE SAEXEMPTION TION INSURANCE 309 — EXTERIOR LATH Cods sec0on neadn01,be completed ifthe permit is feronc hundred call. 310 — INTERIOR LATH orient) 311 — SCRATCH COAT 1 Id Yf thn in 0 performance of the wort for which this permit i iamo, l shag not employ any permn manner as becapm uE'ect the Warken'Compensesion 313 — ROOF NAIL laws of Gallleml App, 501 — FINAL ELECTRICAL ENERGY : ,a1 making thieCcAthn.0crEscallption,youshould 502 — FINAL PLUMBING ENERGY become subject m the Worker's Compensation provisions of the L mar Crdc, you must forthwith comply with such provisions or this permit shall be deemed revoked. 503 — FINAL MECHANICAL ENERGY 504 - FINAL BUILDING ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm Nat Vert is a construction leadingagency for the performance of 505 — FINAL ELECTRICAL the .,tfor which this permit is i1wd(Sce, 3097, Civ. C.) Lenders Name 506 — 507 — GAS TEST FINAL PLUMBING Lmder;Address 1 certify that o trove read this application and sate that the eWve inromtviun is 508 — FINAL MECHANICAL correct. lagree 0 comply with all city and county ordinances and aaalawsrelating to building construction, and hereby auNonaa repruenativca of this city 10 cnmrupnn the 5 FINAL GRADE ehov-mentioned pmpeny for inspection purposes 10 FIN I G (Wju agree m ave, indemnify and kap harmless the City Cupertino against ru in fOccowingexpeucswhtchmayinanywaysameagaiusaidCny A consequence or the of this permit. 5 N LI WORKS UNDERSTANDS APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. b �e-roofsIf Type of Roof at dVCon r r c HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle haurdous mamnal ax defined by the Cupertino Municipal Code, Chapter 9. 12, and the Health and Safety ,. tion25532(e)? 11L//ttt Code, OYu fmrvo All roofs shall be inspected prior to any roofing material being installed. Will If a roof is installed without first obtaining aR,inspection, I agree to remove the applicanwr furore WilOingmcupant oxequipmemordevices which Out havardom air contaminants as, defined by the Bay Area Air Quality Management all new materials for inspection. nein? ❑Yes No I have coed the huand us materialx requirements under Chapmr6.95oftheCalifor- niaHcalthdrSafetyCode.Satiou25505.25533md25534.1undmsandduuifthe Wilding does not currently hoc a tenant, than it is my respoutbility m tmdry the occupam of the requirements which muss he met poor ue issuance or a 'ficaaof Occupancy. Signature Of Applicant Date L All roof coverings to be Class "B" or better r euthonaed agars, D, • I 1 0 C� � ►' a , CA--q-rr � �....: qe �el?t qn the yap at "a% and it is nn l wi�f tot anyg1$p&da or alterations o damp tylt� etfeaf Cu elrtnon from mssio Cit the k!?!t4!AH �.p.:, _ -Y P Tjle stpmpplpC of this n and specifications StI;�F,. NOl be held toplapermit or to be an ,ppwval of the violation of any provisions ,f any City Ordinance or State Law. CSM I 2 6 2002 �n MITTAL SUB#1 _..._.�..._. �6froo:-30, OCQ V O Uri 71T. . 1 f CUPERTINO CITY OF CUPERTI PIT APPLICATIONORM AXIN ff O q y, 'J' / Date: % / (/, I �/ Building Address: y3 ,,,.,p Other Appliances MECHANICAL Owner's Name: _ Sl h I �AW Phone.#: O Contractor: BCONSTAX License #: BUILDING Contact: BCONSTA)MQ Phone #: BUILDING Applicant/Contractor: BCONSTAXH Fax #: BUILDING uilZlingrmit Info: Bldg Ele6t PI b Me BUILDING scriptio� Residential: BELEC1000 Elec 600V <= 1000A ELECTRICAL Sq.Ft. Floor Area: v I $/Sq. t.: ELECTRICAL Architect/Engineer: BELEC200 Valuation: ELECTRICAL Type of Construction: BENERGY Occupancy G oup: UL_ 1 of Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTA)MQ 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 BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi -Family Res MECHANICAL BNEWMULTI New Multi -family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING 1 of Fj 0 CM or CUPERTINO PECITY OF CUPERTIlV RMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BNUMULTI New Multi -family Res PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING 13PCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING MIXTURE Pb1g 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 rinklerBackfio PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING I BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIItHAN 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 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 Heatin' MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL 2of3 f 6 CITY OF CUPEkTINO 0 CITY OF CUPERTIf PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSF&2FAM Single & 2 Family BUILDING BSFNA Single Family New Add 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 Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane 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 > 1.75 M Btu MECHANICAL 3 of 3 CITY OF CUPEWrINO BUILDING DIVISION PERMIT ONTRACTOR INFORMATION:: ItU1414QMDRSL) Pi, PERMI'TN(02110150 nfyHMtaHSIANG HSIEH & JANE L S U APPLICATIJNJSY1762002 TONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 )p a r LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing CS 1 REMODEL KITCHEl � �AnI'HROOMS zdWith Scaion]IXNBnfDivision3ofNCBusiness and ProfessiormCode. and mylicense is am infull infullnce REPIPE �s'��® 34 Classecftcm. Class hic.N .w Dale Contractor r� ARCHITECTS DECLARATION xQ I understand my plans shall he used as public records JAN 24 2003 Licensed Pmmasional n� OWNER-BUILDER DECLARATION C I hereby affirm that 1 am exempt from the Cmmompas license Law for the 1 O (< following reason. (Section 7031.5. Business and Professions Code: Any city or county ILDING $ which requires a permit ser construct. alter, improve, demolish, or repair any structure $25000 ee poor it) its issuance.also reyvires the applicant lirtsuch permit o file a signed statement that he is licensed personal n the pnrvisionsof the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation -S (CommencingwiInSection7lXXqofDivision3oftheBusinessandPrnfcasinnsCode)or 35932033.00 Z — that he is exempt nherefrrm and be, basis for the alleged exemption. Any violation of APN Number Occupancy T e p y yp Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollar, ($500). 101 — FOUNDATION 1, as owner of the property, or my cmployecs with wages as their side compensation, will do the work, and the structure is not intended or offered for sale (Ses.7W. Business and Professions Cost The Contractor's License Law does Out apply man owner of ±82 P INS 103 - UFER Required Inspections property who builds or improves thereon, and who docssuch work himself or through his own employees. provided nhatsuch improvements sre not intended or affect for sale. If, 104 — REBAR however, Nc building or improvement is sold within one year of completion. Ne owner, 1O5 — ANCHOR BOLTS builder will have the burden of proving that he did not Wild or improve for purpose of sale.). 106 — SEWER & WATER 0(1, as owner of the propcny, am exclusively contracting with licensed contractors to 202 — UNDERFLOOR PLUMBING coruwm the Protect (See. ]OCC, Business and Professions Craig) The Comment's Li- censeLawdocsnolapplymanownerofpropertywhoMandsorimprosesthcreon,and, 203 — UNDERFLOOR MECHANICAL who contracts for such projects with a cnnlrannr(s) licensed pursuant m the Contractors License Law. 204 — UNDERFLOOR FRAME I am exerlp(Jynder Sec. B&PCf0 to re on 205 — UNDERFLOOR INSULATION per, J Ne- l7 N 2— 301 — ROUGH PLUMBING WORKER'S COMPE SATIO— DSA 302 — TUB & OR SHOWER I hereby affirm under penalty of perjury one of the following declarations: 303 — ROUGH MECHANICAL I have and will maintain a Certificate ofConsenuo self-insure for Worker's Cumpen- -.'it as provided for by Section 3]Iq of the Ichor Code, for Nc Performance of the 304 — ROUGH ELECTRICAL work for which this Permit is issued. 3 05 — FRAME ❑ 1 have and will maintain Workers Compensation Insurance, ss required by Section 306 — HOEDOWNS 3](X1 of Ne Labor Curie, for the performance of the work for which this permil is issued. My Workers Cnmpernation Insurance carrier and Policy number am: 307 — INSULATION Carrier: Policy N., 308 — SHEETROCK CERTIPICATE OF EXEMPTION FROM COMPENSATION INSURANCE 309 309 - EXTERIOR LATH Tlnisseenmi need not M completed ifthc permit is for one hundred dollars($ Dan 310 — INTERIOR LATH n"eon' 311 — SCRATCH COAT I unify that in the performance of the work for which this permit is issued, l shell not 313 — ROOF NAIL employ any person manners out Mco rte ub ecunthe Workers Compensnion Law, G�TirI'llmni 501 — FINAL ELECTRICAL ENERGY hoyf � y/ VI 502 — FINAL PLUMBING ENERGY NO n APPLIIAW. Itaifter makingConi acme of Exemption, you should become subject o the Workers Compensation previsions of the LeMrt end',you must forthwith 503 — FINAL MECHANICAL ENERGY 0 comply with such provisions or this Permit shall M: deemed revoked. 504 —FINAL BUILDING ENERGY .N.,CONSTRUCTION LENDING AGENCY I hereby air,. Nat there is a conswnion lending agency lir the Performance of 505 FINAL ELECTRICAL the work for wh;rnthis permit isissued (Sec.3B98Cie. C.) Under'a Name _, 506 GAS TEST Q Lcnder'sAddress z 507 — FINAL PLUMBING C) 1 cenify that I have rens this application and sure that the above information is 508 — FINAL MECHANICAL buildinglagree comply and county building Nc hereby ivesofand smlemwtrupinthe 5 FINAL GRADE U .andhemaucity onstrunauthentic epresntainances of this city no enter upon power.nunives ationection,and aMvo for inspection an 10 FIN I G 06 (We) agree to saw, keep hs. (We) abrec to save, indemnify and keep harmless the City of Cupertino against Zincoisequenc Z of the costs and expenses which may in any way eacroc against said City mcsmscs.jur consequence granting Of this whi. 5 N I WORK.$' '+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. 70-9e— — _roofs at 1an AZARDOUSMATERIALS DISCLOSURE Type of Roof Will the applicant or future building tecupant.nlom or handle hasarduus material defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Ic, Oros 255321a)? 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 nr future building occupant use equipment or devices which emit hazardous air contaminants as difind by the Bay Arca Air Quality Management all new materials for inspection. District! 0Ycs Nn HE maJ Nc havaNpusmatcrials requirtments under Chapter A95 ul Nc Califoo- iia Dcalth6 Safety Glc, S -tiom25505, 25533 and 25534.1 understand thn if tM building dues not currently haw a tenant, that in is my responsibility as notify the occupant of the requirements which must be met prior to issuance ext a ni fiesta of O:cupam:y. Signature of Applicant Date —, L 44Ar All roof coverings to be Class "B" or better authmirtN agin