05110153 CITY OF CUPERTINO +
BUILDING DIVISION PERMIT _C�NTRAGTORIIYI`QRMATQN ,
BUILDING ADDRESS: GT ELECTRIC PERMITNG'O 5110153
' 21810 STEVENS CREEK BLVD
OWNER'S NAME: PERMIT ISSUE DATE
PING TAI 861 WINDSON
NE:
SANITARY NO. CONTROL NO.
(408) 362-9473
ARC HRECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I� t! 0
+op LICENSED CONTRACTOR'S DECLARATION Job Description
U C 1 bereby afrrm dant I am li¢nxd under protims of CMPxr 9(rnmmencing P
CI with Sanson TIXNn of Division 3 of NC Business and Profcuiov Cod,.and my license is
+�a in full force and effocl. REACTIVATION OF PERMIT# 04120034
32' `'CeOxdi'
Dale Contrite(Colo NO NEW PERMIT ISSUED/PAID 1/2 OF PERMIT FEES
r
ARCHITECTS DECLARATION
W U 1 undersunJ my plata shall he used as public records
sy Licensed Pro(cue..I
`0 oOWNER-BUILDER DECLARATION
j�x 1 hereby aRm that lm exempt form to Contractors Licenu Law for the
00 fallowing mason.(Section IID 1.5,Busiless and Prefeuiou Code:Any aty or county
$ which requires a permit to construct alter,improve,demolish,or repair any swewm
Z y Prior 41 Its couance,slay mquims the applKMt for Such permit us rile a signed statement
q<
dint hctsliceamdpursuuuothcprovisions ofthe Camrxwesuceom Law(Chapter 9 Sq.Ft. Floor Area Valuati$il6OO
el-$ (commencing with Sectirn 7000)of Division 3 of the Business and Professions Cods)or
5_ tat he is exempt tmeform and to basis for am alleged mampuon MY violation of
Section 7031.5 by any applicants for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
out mart Nan rive bundled dollars($500). 35716010 . 00
Dl,uawner of the psoprny,mmy wPlayw with wa&esuteuwle campenvtrn,
will do the work.and t, "Col.Is Ml intendW oeoRefed forule(SIC.70".Busiosto Required Inspections
and Pm(rssiaN Cade:The Conuxurs License Law does nut apply w e ns an owner of q P
property who Wildaorimproves thereon,and who does such workt rrselfor through his
Own employees.provided that such improvements art not intended oroRered for sale IL
however.the Wilding or improvernent is sato with.ane year of comph u m.the owner.
builder will have the torten of pmAng that Im did Out Wild or improve for purpose of A
salej.
D 1,as owner of the property am exclusively conaacting with licensed comsesms at
combum the pmiect(Sec.9044.Business and Pra(eviom Code:)The Contractees U. .(�
cense law docs not apply to an owner of properlywho builds or improve thereon.and V l�
who contracts for such Projects with a contractor(s)licensed pursuant w the contramors' C
Iscese law.
O lamue�rm'Typtuader See ,Bk PCforti.reum
1371W
ner ?I A T6r� Dae
RKER'S OMPENSATION DECLARATION (/u
1 hemby+Pore mhder pe.dty of perjury aro of to folewing dceluuio
I utve and will maintain a Catifiowar Corucm so xlf-iuule roc WmkcriCompeer-
te, r which this
foe by Section 3900 a(the l.abar Cade.fm to pcRomarha of Ih -
rk for which tis permit is iuucd.
1 have and will maintain Workers C.mpcwuo.Ivxvanse,u nquised by Section
of tc LaborCode,for to pefomance ci to work fm which the Permit u issued.Wortr/s Compens a ion huutm arti.W Policy nmber are:
rtier. Policy Na.:
CERTIFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
mossecthm need embecomplemd lithe Permit is(wane handfed do0ats($100)
less)
1 certify that in the Performance of IM work for which this permit is heated.I subsea not
cmyloy any Person in any mannerssq4 a�w be9pw the Warkeri Compcnsmion .
Laws of caI fomi Dalc ,LII �]iill me-be
AppIICNI — 1 IAO, , a i
NOTICE '0 AP Il A If.after making this Cenifiax of Exemption.you should
e
becomsobjm to tic W a Compensation pmvinimu of tic Labor Code,you most
.,O forthwith comply with each providwu or this Permit shall to domed revoked.
z ti CONSTRUCTION LENDING AGENCY
[-� 1 hereby afnm Out Cert is a construction lending agency for the performance of
Cli > to work for which tis permit is issued(Sec.3119'1,Civ.C.) '
QLanders Name
7 z Landers Address
U O 1 sctify that 1 have rad Na appliatio.and sue that tic above infamauum ts
I.. cosecs.I agree to comply with all city and county ordinarees and sale laws relating to
0 Wilding construction,and hereby aotorn mprexnutives of tis city to enter upon t.
r LU above-mentioned prope.y for inspection putposea
H (We)agree to save.indemnify and keepmthe haless City of Cupertino agaius r4j1 liabilities,fudgmc.u.casts and expenses which may in any way amuc against said City
U Z in consequence of the¬ing of this pmmit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z IP - d--
SOURCE GULATIONS. I S
si&wore _wn VCail e, "/ ,O Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
will the applicant or future building occupant sero orliandle hamdous material
u defined by Oe Cupertino Municipal Cade.Chapter 9.13,and the Halt and Safety
otic,ScO Yti 35532(.)? bywt All roofs shall be inspected prior to any roofing material being installed.
Will tic applicant or future building accupont use equipment or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove
Id,.'
mil hzrafdnu air contmia.ts u defined by the Bay Ales All Qualify Management all new materials for inspection.
tsmm9 P
Dyes
1 have mol the loccod smamnials requirementsundmrChopm6.95ofticCalifon-
Hcelth&WmyCodc.Soman 15505.25533 am12553a.I undcrsalnd tatiftc building
rims,tunmay have a leant,Sas it u my respomihaity w onufthe cupant of ticquire ts.hichmutl c L riW. afaCesar, afOcaparcy. / Signature of Applicant Date wneraraata d.;a1 D w All roof coverings to be Class"B"or better
,w . Community Development
10300 Torre Avenue
ihf.,,•6'` ' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
6�l a S eters cyecltd , rr'n a B / s 3
OWNER'S NAME: A/ 7 a- PHO # 4-0
GENERAL CONTRACTOR . p.&c•r ,, c— FAX #
I am not using any subcontractors:� �1��2�� -- VV a��
ignature Dke
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
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35716010 . 00
DATE ISSUED. . . . . . . : 11/29/2005
RECEIPT # . . . . . . . . . : 32146
REFERENCE ID # . . . : 05110153
SITE ADDRESS . . . . . : 21810 STEVENS CREEK BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PING TAI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : PINGHUEI TAI
CONTRACTOR . . . . . . . : TOM MUNSON LIC # 24731
COMPANY . . . . . . . . . . : GT ELECTRIC
ADDRESS . . . . . . . . . . : 861 WINDSON HILLS CIR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 362-9473
REE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BELEC200 METERS 1 . 00 14 . 72 0 . 00 14 . 72 0 . 00
BPERMFEE VALUATION 1, 600 . 00 46 . 53 0 . 00 46 . 53 0 . 00
EPERMITFEE FLAT RATE 1 . 00 19 . 68 0 . 00 19 . 68 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 80 . 93 0 . 00 80 . 93 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 80 . 93 834
TOTAL RECEIPT 80 . 93
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
103 UFER 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL
•
CITY OF CUPERTINO ///0 Z
CITY OF PERMIT APPLICATION FORM
CUPEPTINO
N # Date:
o . o-o 40 I/
Building Address: Mailing Address (if diffedent from building address):
a10/oSfevQds Cr /v9 . Calb%�
Owner's Name: Phone#: -to jo
f� yu
c� ,
lContrac r: License#:
C' 7 /' C,
Contact: p Phone: g0� 3b1-7427 Cupertino Business License#:
poll —}4: Fax:
Building Perrmt Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Descriptio
Residential CA-p C' ttdte- ,0417-d Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
Cost of �Proiec Occupancv GrouD:�
Type offD Constructi n: Please check this box if the project is a
L
YP� tc c .0 Y 'G G N n "e, second-stor addition: ❑
roject Size: Standard ❑ Large ❑ Major ❑
Quant ity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
B130ILERI 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 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 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA n Investigation fee BUILDING
/z � � oP3" 3
`< CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quanti Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOASfE New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical AIF-CHANTICAL
BNUCOMIvIP New Comm Plumb PLUl`4:BII\TG
BOVERTIDf Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum . PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERAIFEE 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
BPSEN VER 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 Pipe PLUMBING
BPVVHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reins ection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm AfCHANICAL
BREMA PHAN A/C Units <= 10,000 cfrn MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BRENMUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMgURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace > I OK btu MECHANICAL
BRE=AT Heater Installation MECHANICAL
BREAMMOOD Installation of Hood AMCHANICAL
BRENS41SC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMIPOLE Pole/Platform Fixture ELECTRICAL
BREAPON'VER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREM 2ELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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CITY OF CUPERT.INO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BRENIVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISNIICOM Seismic Commercial BUILDING
BSEISNIICRE Seismic Fee Res BUILDING
13SPECIAL Special lnsection BUILDING
BSWIM Swimming Pool BUILDING
BTENIP 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 1llech Permit Issuance AZECHANICAL
PPERAIITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Plannin LR Comme/ Alulti-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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