08010139 CITY OF CUPERTINO F, '� � >t>
BUILDING DIVISION PERMIT CUk ' "apt',' �Ik I'111t�aW"
BUIL 1 GA KESS: PERMMNO.
��14�a VAI AVE CHIA-LUN FERNG 08010139
ER'S NPERMIT ISSUE DATE
CHI
AME:A— UN FERNG 21410 VAI AVE 01/24/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O
�o$ LICENSED CONTRACTOR'S DECLARATION Job Description
1 Mmby&M m that 1 am lh nsed under pmv. m of Chapter 9(commencing
with8cdon7M)of Diviuon3afthe Businwutd PmrcWuns Code,andmylicenseis RE-INSTL 'ELECTRCL METER
n ver in full fame and efIWL
Ctg3 Llmeac Class Lt..g
qqq Dau Contractor
q ARCHITECTS DECLARATION
2 I uMcrsund my plans Shall M used So public rem ds
to6
k w Licensed Professional
SO OWNER-BUILDER DECLARATION
I Mreby affirm that I am exempt room the Contractors Lleerm Law for the
p O following mason.(Secdun 703 1.5.Business and Profession Code:Any city or county
which requires a Permit to construct,alun Impmw,demolish,Or repair any structure
prior to its issuance,also requires iW applicant for such pcmiuo file a signed suumcm
< that he.licensed pwwmL m the provisions of the Commctor's License Law(Chapter 9 Sq.Ft.FIOor Area 150 Valuation
$ (commencing with Secdon 7000)of Division 3 of No Business and Professions Code)or
.. Net he s exempt therefrom and the basis for the alleged eaemydon.Any violation of
Session 70313 by any appllesnt far a permit subjecu the applicant he a civll penalty of A,7�7 Number Occupancy
Sm mart Nan fiw hundred dollen(S300). 36205026 .'l7'V' p y Type
❑1,as owner of die propmty,or my wploycu with wages as their Sale corepewdon,
will do the work,and the ereclure Is notinundedar offered formic(See.70414.Business
and professions;Cade:The COnlnmar's Wceme Law don sot apply as an owner of Required Inspections
property who builds or improves thm:on.a cad who doe such work hisesel f ar through his
awecmplayna,proWded dist Such impmvemenu are notinundW moffemd fmsele If.
however,the Wilding or impmwment I,Sold within am year of completion,the Owner-
builder will haw the Wrden of proving that M did not build or improve for purpose of
Saw.).
❑1,as owner of the property am eaclwively cartooning with licensed camncmn to
construct the project(Sec.7044.Busineu and Professions Cade:)The ConVecurs U.
,MUS Law docs not apply to an owner of property who Wilds ver Improves thereon,and,
who camocu for such pmjeeu with a canuscmKD licensed puresenb to the Contractor's
License law.
❑l am axemptund/er See ,B&PC fm this mason
DainL� 0.0 OMPE RATION RADow LA
I hereby alErm under thereby of perjurya f doe fallowing declarNOm:
❑Ihaw and will munuinaCenifieamofC:naentloself-insumforwarkees Compen- -.
sulan,az provided for by Section 3700 of the Labor Code,for the performanm of US „,•.
wart for which this permit is issued.
❑I haw and will mainlaln Workers Compete awn Inwarrec,as required by Section
3700 or ds labor Code,for the performance of the work("which this permit is Issued.
My Workers Compensation Immense carrier and Policy number art:
Carrier. Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
masmetton need notbccomplewd If1W permit Iaforan:humboddollala($bi)
or less)
1 certify that in the performance of Ne work for which this permit is issued,I shall not
employ any person in any manner as as on becomfS djemm de wnume COmpuouton
Laws of Cslifomia.Date •Y
Applicant
NOTICE TO APPLICANT.IL after making Lhif Certifies Facmpdon,you should
became subject m the WOrkera Compemadon Penrodam the labor Code,you must
QZ foMwithcamply with such movisinm or Nis pcwilahall edeemedrtmium.
'Z'y CONSTRUCTION LENDING AGENCY
E••r Iherehy+lfiw that ft.sScomtruNnn lending agency far the pmfurmasreeur
�i> the work for which this Permit is issued(STI.3097,Cih,C.)
Va Q Lender's Name
Larder's Address
Addr
z
U Q I anify,this 1 Mw mad this application and amu that the abaw Ufmmadun IS
IL mora I agree to comply with all city and county Ondwances and SUM laws miming to
-� building conswetion,and hereby auhadae represenudws ofthis city m mus"pon ft
W aMw-mendoned property for inspection purposes
(We)agree l:saw,taciturnity and keep harmless;we City of Cuperdne against
„y y otenides,judgmens,sass and Cape which may in any way accrue agaiml said City
(„)4 in consegmnce of the gat {ng of N' Pe iL
•7 APPLICANT E ANDB NO ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE CUL
Re-roofs
Signs morA nV nr
Dele
HAZALS DISCLOSU Type of Roof
Will the applicant or upantumc area die hmudous maurul
defined by the Cupertinohapmr 9.13,and eke Hnith and Safetyle,[:cyan zss3z(+)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the a plic or future building no
use equipment m devices which If a roof is installed without first obtaining an inspection,.I agree to remove
emit haSardous at Iran.as defined by the Bay Area Air Quality Management all new materials for inspection.
District? /
❑Yat ]fu
I hew mol the hmaNuTus mueriasmquiremens under Charmer 6.95 of the Collins.
nuHealth&Safety Code,&cdam 25505,25533 end 25534.1 undesund that irthe Wilding
does not cmmndy haw a unSnt,that it s my responsibility In noury dte occupant of the
requirements which an=IS,met prior mimaance or.Comefic+morOceupancy. Signature of Applicant Date
Owner or suth.d.dageal Dam All roof coverings to be Class"B"or better
® CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
. Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36205026 . 00
DATE ISSUED. . . .'. . . : 01/24/2008
RECEIPT # . . . . . . . . . : BS000003766
REFERENCE ID # . . . : 08010139
SITE ADDRESS . . . . . : 21410 VAI AVE
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER CHIA-LUN FERNG
ADDRESS . . . . . . . . . . : 21410 VAI AVE
CITY/STATE/ZIP CUPERTINO CA, 95014-4935
RECEIVED FROM . . . . : CHIA FERNG
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY CHIA-LUN FERNG
ADDRESS 21410 VAI AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4935
® TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------ --------- ---------- ---------- ----------- ---------
IBSEISMICR VALUATION , 150. 00 0.50 0. 00 0 .50 0. 00
1EPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
1TRAVDOC FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00
----- ------ ----- ------
TOTAL PERMIT8208 0. 00 82 . 08 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- -------------- -------------------
CREDIT CARD 82 . 08 VISA
---------------
TOTAL RECEIPT 82 . 08 -
Deo/ o �9
CITY OF CUPERTINO
® T
CUPE INO
R. GENERAL BUILDING
PERMIT APPLICATION FORM
APN# o� — o y Date:
Building Address:
Mailing Address (if different from building address):
Owner's Name//: // Phone
elL� — Z44 P y!
Contractor: vPhone:
Fax:
Contractor License#:
® Cupertino Business License #:
Contact: Phone:
C�/7/'Q — Luer fPVv 0
Fax:
Residential Commercial
Job Description:
71
Building Permit Info:
Bldg ❑ Elect 0 Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1 FR, 11FR ❑ 11, 111, V-1HR [�] 11, 111, lV V-N ❑
Valuation: 40 Square Footage:
® Project Size: Standard ❑ Large ❑ Major ❑
CITY OF CUPERTINO •
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BTEMPPER Temporary Building Permit(good for B
30 days)
1BBOILERI For the installation or relocation of ea M
boiler/compressor to &including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h 29.3kw
1BBOILER2 Installation /relocation of ea M
boiler/compressor over 3 horsepower
to &incl 15 horsepower, or ea
absorption ss over 100,000 Btu/h
1BBOILER3 Install ation/relocation of ea M
boiler/compressor over 15 horsepower
to &incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
&incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
lELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing& Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B
CITY OF CUPERTINO
® aFC17 GENERAL BUILDING APPLICATION
CUPEIi,TINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
1ACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
1CHIMNEYR Chimney Repair B
FENCES -
1FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole(over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PMECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
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CITY OF CUPERTINO
CUPEI�TINO GENERAL BUILDING APPLICATION •
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
IRETSP310 Special Design, 3-10' high (up to 50 ') B
IRETSP10 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1 SIDEST/BK Siding, Stone &Brick Veneer B
(interior/exterior
1SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
ISKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
I SRACKS<=8 Storage Racks 0-8' high (up to 100 sf B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco a lication
F==
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CITY OF CUPERTINO
ITY OF
® CUPEkTiNo GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass. B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
1ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
/ 1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
/ 1TRAVDOC Travel &Documentation B
1BUSLIC Business License B
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