The URL can be used to link to this page

05120066 CITY OF CUPERTINO �._�»�' �` 7- hp BUILDING DIVISION PERMIT ONTRAC�TORJNEORMAT ON LD �s dx .ac'> E hzd, BUILDING ADDRESS: CHAN YONG PAK PERMIT NO.05120066 ' 10550 STERLING BLVD OW NER'S NAME: PERMIT ISSUE DATE CHAN YONG PAK 10550 STERLING BLVD 12/13/2005 NE: SANITARY N0, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O O O O pop - LICENSED CONTRACTORS DECLARATION lob Description U 1 hemby,affirm that I am licensed under provisions of Chapter 9(commencing p with Section 71100)of Division 3 of due Busixas amM Professions Code,and my license is ^fid mp.11faemadeffea REPLACE ELECT. PANEL (200AMP) j�j? License Class Lic.0 �Fp Date Contractor ARCHITECTS DECLARATION < I undersand my phou shall be utitl As public me amts Jsa 100 t; Licensed Pmfcssional OWNER-BUILDER DECLARATION iI I hereby affirm that I am exempt from the Contractors License Law for the o O following mason.(Section 7031.5.Business and Profradom Cade:Any city m county $ which.,aims a permit to comwct,alar.improve,ac n.lim.or moat,any strumurc $800 priorm its issuance.0somquims the applicant forsdch permiuo file a signed statement EEs< hot he is licensed pummart to the provisions of the Contractar's License Law(Chapter 9 Sq. Ft. Floor Area Valuation yFC (commencing with Section 7000)of Division 3 of the Busincase and Professions Code)or Q�.- that he is exempt therefrom and the basis for the allegect exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more man five hundred dollars(SSM). P Occupancy Type D 1,m owner of has property,in my employees with wages As their sole compensation, will do the work and the swmum is not intended proffered formie(Sec.70/4,Business and a ftywh obu Code:The Conmcmh Liana law dery not apply lf an owner is Required Inspections property w builds vi improves chicon,and who ares such work himself ed through his Manemployees,verheprovided Nar vete improvementsarenot intendedmortaredfor owner, however.me building orden of ovinent gthatssold withinore year or mproeforon.puowner. of builder will have dm burden of proving that he ata not bulla or improve for purpose of cele.). I.as awrcr of de Martin,am exclusively contracting with licensed conoacmrs e omtmet the pmjecs(See.70A4,Business and Professions Code:)The Contracmrs U. minor law dors not apply to an owner ofieroperty.who builds or improve thereon,and. who contracts for such projects with a cmuactor(s)licensed pursuant in the Contractors License law. D I am exempt under Sec. B k P C for this mason Owrcr ) Data —A CER'S COMPENSATION DCARATIO Ihere W affirm under pera ty of perjury one of the fallowing declasatimu: 1 hsm and will maintain aCerdfina of Continuo self-insure for WorkcrsCompen- 1371W on.ss provided for by Section 3700 of dm labor Code,for tha performance of the wants for which Nis permit is issued. 1 have and will maintain Workers Compensation Insurance,as requited by Section of me labor Code,for the performance of the work fmwhich this permit is issued. Wohees Compensation Insurance artier and PoI'y number am: Cartier: Policy No.: _ CERTIFICATE OF EKEMPI70N FROM WORKERS' COMPENSATION INSURANCE (This action need not becomocued if the permit is formmhundred dollars(SIM) or esti) I certify that in to performance of the work for which this permit is issued,I shall not employ any pmson in any manner o As to Income subjec to ryWorkers'Compersation Lawaof Califomi Dae Applicant NOTICE TO Ili fir:If,after mak' g this Ccnifcealc of Exemption,you should become subj m d orker's Compenseuon provisions of 0m Labor Code.you most .JO for0wiOt comply wi suehprovidom or this permil mail he deemed invoked. Z y CONSTRUCTION LENDING AGENCY (-v lthereby a d.mat them is a eonsupolinn lending agency for the perfunmrce of 6i the work for which this pantie is issued(Sec.3097,Civ.C.) l a0 lander,Name Q z Lenders Address U Q I certify mat I have mad this application and sate that the above information u t" comm I agree to comply with aB city and county ordinances and sum laws rell ing in QU building construction.and hereby audi mpcarath,cs of this city to enter ditch the � w above-mentioned property for inspection pappus. cw (We)agree to ave,indemnify and kap harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City fJ Z in consequence of the granting of this permit t� APPLICANT UNDER ANDS Apra WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULA Signfee plicanKo��`— Data Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tapplieant or Idiom building occupant store arhandle hazardous material u defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety 'Agilcale,Station 25532(.)? ❑Yes AN. All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by me Bay Area Air Quality Management all new materials for inspection. District? Dyes No 1 have mad the hdzardo.sohdcriah mquimmcnts undo Chaper6.95 ofthe Calif., nu Health Ai SaretyCOdc,Sectina25505.25533 and 25534.1 uMerstvxl hair the Wilding does Ml currently have.demon,that it R my m ndesibillly b hadry the pCcupNl of me requiremcn whim must Met zinc ismemeof.CcNdcaeof Occupancy-.B� Signature of Applicant Date Owmf adm li,rnl / D,m All roof coverings to be Class"B"or better Community Development ��-1 10300 Torre Avenue t Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building De artment JOB ADDRESS: PERMIT # O 6 / 0 5�d e 1 1).4 1 O SIL OWNER'S NAME: m PHONE #4o — 7J, GENERAL CONTRACT FAX # I am not using any subcontract s: o 1� Si ature Date Please check applicable subcontractors and complete the 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 Owner/Contractor Signature Date OWNER-BUILDER VERIFICATION 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 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 9 Certificate of Insurance covering workers compensation must be on file at the City of Cupertino Building Department office. Person/Frrm Address/City Phone Number Type of work to be performed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signature: Date: Job Address: D �S D �l 1/ Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. City of Cupertino Building Department CITY OF 10300 Torre Avenu C U PEkT I NO Phone: (408)777-3228 Dear Property Owner- An wnerAn 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-boulder 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 yourself 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 plant o 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 ra contributions. There may be financial risks for you ff you do not carry out these obligations, and these risks are U' especially serious with respect to workers' compensation insurance- For nsuranceFor more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish the US.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 pdnted an Recycled Paper CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEIZTINO APN # Date: \3'7S'- - 03 - Building Address: Mailing Address (if different from building address): 0 V of Q V b o a 5 r Ca x3'd Owner's Name: v Phone #: C k Cc -ve o Q Contractor: License#: 0 W . 2 Contact: Phone: Cupertino Business License#: O w �e 1Fax7 4/_ Building Permit Info: AR 11; 'Jew_ ®Q _ d2 O.e� Twp, Bldg ❑ Elect VKL Plumb ❑ Mech ❑ / Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Project: Occupancy Groin . 0 - Type of Construction: ✓ Please check this box if the project is a second-story addition: ❑ Project Size: Standazd � 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> IM to 1-.75M Btu MECHANICAL BBOILER5 Boiler> 1.75MBtu 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 Flee Svcs 600V<= 200A ELECTRICAL / BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING I Of3 � ZV �� 2 Cbl CITY OF CUPERTINO CITY-OF PERMIT APPLICATION FORM CUPEkTINO 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 Interce for 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 do 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 BRENLkH LAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation ofFumace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREDHNHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL 13RENINRAPP 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 AML I BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 « CITY OF CUPERTINO CUP TTOF O PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 Vmporag 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 PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 0 3of3