04040015 a
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON'CRe CT0R INF0'RN]`. ON h'
BUILDING ADDRESS: AAAELECTRIC INC PERMIT 100404001.5
1043
OWNER'S NAME: PERMITESSURDATE
BYUNG CHUM YANGSANITARYNO. CONTROL NO.
ONE:
( 8899 408) 557-
ARCHnECr/ENGINEER: BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
_ 0 0 0
O I hereby affirm that
am IirorocdAunder�R CONTRACTOR'S
DECLARATION
f Chapter 9(commencing P
O JobDescri tion ALR®
wife Sec0on7000)ofDrvialon Sof the Business Professions Code,and my la
tmm�aClosederr«t. REPLACE ELECT PANEL (100A) APR s - 2004
Dan Cissa Lie,g
Y Dem ARCHITECT'S DECLARATION
I understand my plans shall he used as public menrds
30�A Licensed Professional
5 OWNER-BUILDER DECLARATION
<� I hereby atRrm that 1 am exempt from Fee Communes License Law for the
p o following reason.(Section 703 1.5,Business and Prefosiom Code:Any city or county
$ which requires a permit m eonswc4 a@L improve,demolish,or epair any a unClUne
poor to its issuance.also requires the applicant for such permit to file a signed summand
tat< Fiat In is licensed pursuant othe pmvisionaofthe ComecmriLi¢nss Law(Chapter 9 Sq.Ft. Floor Area Valuation
3� (commencing with Section 7")of Division of the Business and Professions Code)or
3
that he is exempt Wemfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of 374F24]IQtditbe100 Occupancy Type
not more Nan five hundred dollars($500).
0 I.as owner of the properly,or my employees with wages u their sore compensation,
will do the work,end themuctme isnot intended or offered for sale(Sm.7014,Business Required Inspections
and Professions Code:The Conveciar'a License Law does not apply to m e owner of q P
property who builds orimprom thereon,andwho doessachwork himself orthrough his
own employees,provided that such improvements art Wuhro ided oroffued forsam.If,
however.the building or improvement is sold within mw year of completion,the owner-
builder will have the bother of proving dust he did not build or Improve far purpose of
ula.).
0 1,an owner of the pmpeny,am exclusively convecting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Cormacuri Li.
come Law dors not apply to an mosu of property,who builds or Tmprom thereon,and.
who convects for such projects with a contMpr(a)licensed pursuant in the Conmuori
License Law.
0 lam exempt undo Sa. ,e&P C for this mason
1371W
wner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury oro of the following d"Istradom:
1 have and will maintain a Certificate of Consent to self-insure for Worker'sCampen-
ion,ss provided for by Section 37M of the labor Cade,for the performance of due
rk for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as expired by Section
of the labor Cotle,for the performance of due work for which this permit is issued.
y Worker's Compensation Insurance carrier and Polity number art:
rtier. Policy Nis:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section mud not he completed time permit is forms,hundred dollars(5100)
or los.)
1 trolly Lou in Ne performance of Ne work for which this Permit u issued.I shall not
employ any Person in any mannerse as to become subject o the Workers Compensation
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:If. Act making this Cci ificam of Exemption,you should
Women subject to the Worker's Compensation provisions of due labor Code,you must
.,O Forthwith comply with such provisions or this permit shall be created invoked.
„Zy CONSTRUCTION LENDING AGENCY
f~ Ihereby affirm that Nem is a convection lending agency for the permersamen of
C ;s' the work for which this Permit is issued(Sec,31197,Civ.C.)
W 0 Lendcri Name
Loualins Address
U C) 1 certify that I have mad this application and tum that the shave information is -
w E mi1 agree to comply wit all city and county ordinances and sum laws minting to
pbuilding construction,and hereby motorize repmsenutives of this city to enter upon the
L57 above-mentioned property for inspection purposes.
f~d (We)agree to saw:,indemnify and keep harmless the City of Cupertino against
fq liabilities.judgments.costs and expenses which may in any way acerae against said City
V 7 in consequence of the granting of this Permit.
r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (7
SOURCE REGULATIONS.
Re-roofs
Signuurc ofAtildleantiCoutiactor Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cu(,.emor fumrc bullinge,Chapter
nomor handle Health amaterial
u Oehnctl l the Cupertino Municipal Code.Chepmr 9.13.and the Health end Safety
one. 0 en zss33(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu []No
Will the applicant or future building exception use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardous air contaminants in defined by the Bay Area Air Quality Management all new materials for inspection.
7i.
Oict?
0Yes UNo
I have mad the hamreous materials requirements under Climax 6.95 of dm Caliror-
Healon S,Safety Code,Sectors 25505.35533 am125534,1 underawnd Nat irms building
rs not currently have a mrant duet it is my hexa mihility m notify the oucup m of the
uimmcnu which must be met poor to issuance of a Cenificam of Occupancy. Signature Of Applicant Date
ner or authorized agent Dam All roof coverings to be Class"B"or better
J
� ` - CITY OF
CUPERTINO
CUPEf�F PERMIT APPLICATION FORM o � o o
APN# Date:
Building Address: ID
/ � / Vi M A e s(if different froin building address):
Owner's Name: y� (p /I�/'L�
r Phone#:
ContractoC/�/17��/`� License
Contact:r I S Phone: _ ft— � Cupertino Business License#:
Vv Fax: 6�
Building Permit Info: �
BldgElElectAf/ Plumb ❑ Mech ❑
Job Description:
Residential �I �� �� ` InAe ryc ❑
Sq.Ft. Floor $/Sq.Ft.:
Cost Pro' Occupancy Grou .
Type o o struction: Please check this b ct is a
second-story addition: ❑
Quanti 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 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
WBM1TIGATC
R Constax—Resi/Mobile BUILDING
0 Elec 600V ELECTRICAL
1 Elec 600A,> 1000A ELECTRICAL
0 Elec Svcs 600 =200A ELECTRICAL
Ener BUILDING
D Ener Add Multi BUILDING
A Investigation fee BUILDING
C Comm. Housing Mit. Fee BUILDING
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SR , CITY OF CUPERTINO
CUPE(�TINO PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group
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 PbIg 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 I 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 cfin MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace 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 HeatingMECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Sips,Marquee ELECTRICAL
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CITY OF CUPERTINO '
CUP TY0 PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
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 Issue PLUMBING
PPLBG
Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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