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03120117 CITY OF CUPERTINO 'r'*yyT��+f�,� `-nom'y` '`" BUILDING DIVISION PEAR b V�l\� VT�A��1+'!l'©1,4Ma � arxva.;t"' 'rte .`�', a` BUILDING ADDRESS: _ SZU TSUNG CHENG/ LI LING J 4 RNO03120117 BR'S NAME: PERMIT ISSUE DATE PHONE: SANITARY NO. CONTROL NO. ARCHITEC178NGINEER: BUILDING PERMIT INFO BLDO ELECT PLUMB. MECH 300 LICENSED CONTRACTOR'S DECLARATION O O O O Job Description Ib' I hereby affirm that I am licensed under previsions of Chapter 9(commencing n� with Scaton7000)of Divisma3oftc indictment Porfimov Code.sadmy limmucis Li fail form s erre"' WINDOW REPLACEMENT 5= Dam ciao Conr Date Contractor ,e hall DECLARATION un y I derhand my plains.shall be used An public rtaNs Licensed Professional S OWNER-BUILDER DECLARATION 1 hereby A Tum that I em exempt from she Contractor's License Law for IM y00 fallowing lesson.(Sued..TIBIA.Businua and Pmfcstluru Code:Any city Ar county $ which requires a Permit to coatrwL&net.imprnw.demolish.m repair any someone Ind.,I,,its issuance,also mpora thcapplicanl formch pcmiuo File a signedsukment £ C thatAd1,liecnsWpunanttotheprovisionsoftheContmeturiLicenselaw(Chapter9 Sq.Ft. Floor Area Valuation y g (commencing with Section 7000)of Division 3 Alibi,Business and Professions Code)at a that he is exempt dcrtfmm and die Atria fol the alleged esempdm Any violation of 86000 Section 7031.5 by any applicant for•permit.0jecu Ne applies.,m,civil penalty of APN Number - Occupancy Type net7nore dun five hundred dollars(SSW). ❑huowner of the properly.or my employeuwlN waguuNeir wk core nut'an, will do the work..nd the summon is not intended or offend tarsal.(Sec. -Required Inspections and Proressiou Cade:The Comractoh Liaram Law Goat not apply bp p/openy who builds or lmprows monon,and who dao such work Mmol( rouSh hu ownemployeaa,provided tho,such impmwmenn henot iolesWed or olfe o .If. -`'- however,Ne building or Improvement Is midwiNlnoayevofam11.6 r- J J} builder will haw the burden of proving Ne,he did not build or Impmw puryom of t ole.). ❑1,at owner Of IM property,am exclusively connecting wIN Ikon conatmcl the prefect(See.7044,Business and Professions Code:)The Conuse ave law does not Apply m an owner of Property who bunds or improve Merton.and who contracts fm such projects with a con,nctor(s)licensed pusausnl As the Carinate. l,icdnm law. ' Diem exempt der Sm. ,B k P C for this(won Oat's— _a WO KERS P NDECI.A\\OR�AON I hereby aBism uMer pent o dalaratansc - El I have and will melnmin aCenlOcamor COmmnt m ulf-Insum forWory ea Compen. talion, wprovided for by I. 3700 of to labor Code,for Ne perfotmaucc or IM ork for,which this permit I.is issued. ❑1 haw end will maintain Workees Compensation Insurance,As required by Section 37W of shd Labor Cod.,for Ne pcdormanca of Na work for which this permit Is issued. My Workees Compensates Ihnunna artier sad Policy number art: Coder. Policy Na.: CERTIFICATE OF EKEMPnON FROM WORKERS COMPENSATION INSURANCE (Thissecdm nced nothccompleted if the permit Is rmoachundred dollars(SIM) _ or leas) 1 cattily thatperrmmuca of lie work for which this Permit n issued.I shNl net employ any the In any mune Ino t bee III) it dmworyen'Cpmpenudon Laws Ff C.Bro rk. etr — - A plkut E APPLICANT:I e ser m. Shu Ccnifiam of Badminton,you should e subject to th Wohu'I ompcnu n provisions or the Lahr Code,yssu mat 7.. fonbwiN comply with arch Prov sine nr h s permit shell be deemed reeked. „Z,hO 1 CONSTRUCTION LENDING AGENCY F-' I really afllrm Na,fa iso consumed..lendid,,ancrcy for the perfurmenceuf CYi •7 Ne work fur which this rami,Is issued(See.3119'1,Civ.C.) W�A Lcndefs Name z IL mder.Add.. U Q 1 certify Nat 1 haw rad this application sad sum mat the.bow Information u U, coma,I qme to comply with all city and county on inanaes and trate law relating to C) building cons,mctma,sad hereby emhmlu repAmmium,or this city to enter upon the �• W above-memioned property for inspection purposes. I..a (Wel agree to saw.indemnify and keep harmlus the City or Cupertino against it I,, Ilebilides.judgments,cons and eapeves which may in try way acme Against aid City 1' V z APPLLICeof the thit Permit. ANTUNDERSTANDSAND WILL COMPLY WITH ALL NON-POINT Issued by: Date iv SOURC GU= Re-roofs PIS' ore afApd onuwI. — Dam H ARDOU ATERIALS DISCLOSURE Type of Roof Will Ne applicant or flour b ilding occupant store or handle hanrdous material u d'I'cd by Ne Cupeni.n Municipal,Cade.Chapter 9.13,and the Health and Safety Are.se❑ayus 35533(,)+ )�No _ All roofs shall be inspected prior to any roofing material being installed. Will td applicant orfuture building occupant use equipment ordcvma which If a roof is installed without first obtaining an inspection,I agree to remove curio hazardous air contaminants As defined by the Bay Arca Air Quality Management all new materials for inspection. Disuict7 []Ya �No 1 haw mad the hatudhmsmamrlals mmimmenu under Chapter 6.95 of the Califor. ni.Healon h Safety Code,Seaton 25505,25533 and 35534.1 undcrnud Nu trial building does not curnotly haw a tenant that it is my responsibility to notify Nc oceupent of tic require nu th must be me prior t issuance of a CerdOca of Occupancy. � Signature of Applicant Date Owner ur authorized cep t I U ire All roof coverings to be Class"B"or better CITY OF CUPERTINO ' �" ^"� �` ' ' ' r '"» BUILDING DIVISION PERMIT CON ,"tCTnRANFORMATIONf!- BUILDINGAODRESS: SZU TSUNG CHENG/ LI LING JEBhtIT"D03120117 OWNER'S NAME: PERMIT ISSUE DATE E: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO SLOG ELECT PLUMB MECH 0 0 0 0 .00 LICENSED CONTRACTOR'S DECLARATION lb Description �i I hcmby affirm that I am licensed under provision o of Chapter 9(commencing � with Settle.70M)of Division 3 rifle c Business ani Professions Code.and my license is in full force and effect, tq3 Llc,mcClaa Lle.g WINDOW REPLACEMENT Dam Contractor 3 ARCHrfEC`S DECLARATION v� I understand my plan shall W used As public rccorW J 30� Licensed Pmresaional ta Oat I am exempt from DECLARATION 0 q 1 hereby.(Tian that I (. .Bump from tie Comncm(s License Law for the _ Oo following moon.(Sauon7 o sru t.ainua and vefdcooli Co de:Any city or county $ which requires a pnmit re cnnaWn,alter,improv,demolish,area siany structure - _ S° that hpoor nitscensed issuance.Also requires prevision of forsucthe Coit PermittoLicensesigned(Chapter < (commencing wit pursuant it)the of Division(the the Business License Law Code) FL.statement FIOd-r"Are10❑ $ (commencing Section and of Dlviaion3 nftWBed!exemption. pion.Any violation of t 33 that he u exempt therefrom and the buss for the alleged esemplim.Any violation of � I Section 7031.5 by any applinnt for a permit subjects the applicant to a civil penalty of AP um CuP- cy Type not mom than five hundred dollen($500). J ❑1,u owner of the property,or my employees with wages As their sole compensation, / :f will do Ne.,it.and the structure is not intended or offered for oto(Sec.7044,Business - And Pmfeumn Code:The Contractors License Law does not apply to an owner of • 0 0 Required Inspections property who Wlldsor impnws therron.and who doeuuch work himadfor Ovough his own employees,provided that such improvements Are not intended or oQered for We.If. however,the building or improvement is sold within one you of completion.the owner. builder will have dv burden of proving that he did not Wild or improve for purpose of sale.). ❑I.a owner of the property,am exclusively conditioning with licensed convectors to construct tim project(Sec.7014.Business and Pmfradans Cade:)The Convector's Li. cone law does not apply to an owner of property who Wilds or improma Nemon.and, who contracts for such projects with a contractor(s)licensed pursuant to he Contractor's Nice..law. ' I. moupt du See. .B&P C for this reason oa,4 V Dames aa_0 WO KER'S 0 P NDECLA\RATLON I hereby eflirm under pens y of Pe ore of dw fa71awio'6 dalanrion: ' cove and will ssln a C matnNRnto of Canute m ulhlusurt for WarkdsCompn- ation,uov pidc l for by Seto eon 3700 of the labor Code.for Ne Performance of Ne work for which this permit is issued. ❑1 ham and will maintain Worker's Ci mpwuon Insurance,As required by Section 37M of the Labor Code,for the performance of she work for which this Permit is issued. My Workers Compensation Inunnce rimier and Policy neither are: Cartier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need nothocmnpleted lithe Permit Is formic hundred dollen($10() or lea) I unify Ne yrt Ne performances,of Ns,work for which this Permit u issued.I shall not employ any in any mann nutobecom ubjeci to the Worteri Compensation Laws Qf Cilifor ik. atm A plicem E APPLICANT:I e tar mitkiligpis continuant,oreof of Exemption,you should eh core t to k W such Nor comes or "n Provisions of Ne Iahm Code.you muse .J Q forthwith comply with such Pen siov or s permit Natl W dumrA nuked. z' '••' CONSTRUCTION LENDING AGENCY (-t 14 I hereby alBrm that Nem its construction lending agency tot the performance of !Y.7 the work for which Nis .it la issued(Sec.3197.Ci,C.) In lendc/s Name ,=z lenders Address U Q 1 cenify that 1 have read this application and Gate that he show information is {7. corrccu-I agree to comply with dt city Audi county county ordinances and state laws testing to Wilding construction.sed hereby au lu me representatives of Nis city to enter upon dm W shove-mentioned property for inPection purposes I gy (We)agree to sew,indemnify And keep hsrmlets the City of Cupertino against 1 rA IiabiliueLjudgmenu,costo and expense which may in any way seems against aid City U 7 In consequence mf the granting of permit. b t'� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC GU ON . Re-roofs S' sere mf Appli nbanm Date H ARDOU ATERIALS DISCLOSURE Type of Roof Will Nc epplicent ar fou ilJing occupant nort or handle h47ardaa motorial As denied by the Cumnium Municipal Code.Chapter 9.12.and the Hcalth and Safety - Code.section zss32(,)+ ❑Yes VNu All roofs shall be inspected prior to any roofing material being installed. ' mWill 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 halrA dous air contaminants As defined by the Bey Arca Air Quality Management m? all new materials for inspection. ❑Yes No I haw mail the haardousmatod W requirements under Chapter6,95 of the Califor- niaHcalN&Safcty Co ,Snuom255(I5.25533ud25534,1undentud NuiflW Wilding data not currcmly haw a¢nut.Na k E my maPenibiliry M Madly the occupant of the requircm cess rtnmatWme pdmrmiauucomr.cenine. arOcnpapy. Signature of Applicant Date ownruraamamed. r Dam All roof coverings to be Class"B"or better ' 1 om WWITY OF CUPERTINO* CITY OF PERMIT APPLICATION FORM o� Z °17 CUPEII;TINO APN # Z / �� v�� Date: la-c2a -� 3 Building Address: Mailing Address (if different from building address): o eAV a CaeKt w CI1 SD4 Owner's Name: Phone#: S-Z,k TS un� (.ke - 96 Contractor: U License#: Contact: Phone: Cupertino Business License#: Fax: Buildin.g Permit Info: Bl Elect ❑ Plumb ❑ Mech ❑ J Desc ' tion: sal e pane Kkidefial ❑ 'lad double an, WW Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: / � Occupancy Gr p: Type of Construction: Please chec his 6ax—ifAldproject is a second-story ad i on: ❑ Quantity 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 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS 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 wElec 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 • -Z, S� Iof3 , 36C'-J 1 OITY OF CUPERTINO0 cITM0 PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Fami] Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTRAE 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 Cbeck Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE RepipeOfFixtures 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 HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREM3USWAY Remodel Busways ELECTRICAL BREMFIXT Ligbfing 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/A aratus ELECTRICAL 2of3 �,,��� . *ITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3 w (K) --o W)X3-�,TB'`H) CEIVED FV (Vt)X34(I-1) IF A (�) 119 b(W)X 71� �(H) "PROVEV. ' IN ACCORDANCE WITH THE Cf TY 00 1 cum 0 C ESA ORDIMANC P.ERT u �47Q�1e. C�1)XS �(H) JJ X 51 � ED � hl set of pan. n specifi tions M >< sept on till ��at ,and itis un IaH ul.to ma' , any changes ges a alteretl rnr same , out written porn ission-from ity of Cupe The stamping of this plan and specifications SHALL NOT be held to permit or to be at, approval of the violation of any prowoiono if anv City Ordinance or State law.