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05080144 CITY OF CUPERTINO +x^777771 , BUILDING DIVISION PERMIT CONTRCTOR INk'ORMATIO,N:e.;: I _+-,z°a rid F,._.x �.0 BUILDING ADDRESS: PERMIT Nil 5080144 78 WESTIYNN WAY 14 Ull OWNER'S NAME: FERNTT ISSUE DATE ILBOK LEE 08/17/2005 ONE: SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUM O 300 LICENSED CONTRACTOR'S DECLARATION fI 1 herebyaMm Net 1 em licensed under provishes of Clupmr 9(mmmeming IOb Description m� with Section 7")or Division of the Business esti PMIMALens Code,end my Himmel In lull"A's.I cl (p 1 TERMITE /DRYROT REPAIR Clara Lir.« Da Contractor /CI (STAIR LANDING/REPLACE LIKE TO LIKE) 3 ARCHITECTS DECLAA "Q All CIV-C-TXlg) CONTRACTOR: EDWARD CAREY CONSTRUCTION daraund ml he used As public me D O lLdli�f6J [�.A A 5 esti Cla4ndlruianel g OWNER-BUILDER DECLARATION 2 i I hereby Afrm that I am exempt frim the Comrumr`s License Lew for the 0 o following mann.(Section 7031.5,Business and Professions Code:My city or county 3$ which requires A permit it enmtmct.slier,improve.demnlim.or mp,ir my muctum 'y^ prior to its issuance,Alan requires the applicant for such permit mole aAll statement �< that he is licensed puissant ILL the previsions of the Common's Limns,Law(Chapter 9 Sq.Ft. Floor Area Valuatio n (commencing with Sol 70M)of Division 3 of the Business sold Prefesdou Co ll or y C.J(]0 0 Nat he u mmpt dmmfram and 0m buss for ties alleged exemptlm.My violadm of Section 7031.5 by any applicant for a Permit subjects the Applicant in a civil penalty of APN Number Oeeue not mom at" w hundred doltare5500 ( ). TTA P ❑I,uownmofthepmpeny,amyemploycuwiNwMuNeirmle=peme0m. Jul will do Ne work and thestructure is not Merit dmoffeed fall(Sm.7044,Business / and Professions Code:The Cenummr's License law does not apply in an owner of Required Inspections proenywho dsorimprrowathemnn,andwho hwoek himselfm WlMie 7Ownemployces,provded hat such lmprowmeu awrout lnuMedmoffiesed forsal f / �1C7l/I however.the building or imprevemant is sold within one year of completion,the owner. builder will have the buNen of proving Wt he did mi Wild or improve for purpose of }1 saes.). ❑1,as owner of dao property,am exclusively contracting with licensed mnbmmes m v construct the project(Sec.7064.Business and Plefessiou Code:)The Council Li. cave law does not apply in an owner of property who Wilde or improves daemon.and, who contracts per such poi with a conuumr(s)liamed pernmm in that Comeau - Littnm Law. ❑I am exempt under See. .B&Pcimthiamamn _... Owner - Dau WORKER'S COMPENSATION DECLARATION "" °' -. ''0 "' '•""' -'- I hereby affirm under penalty of perjury ore of Ne following decuntions: I haw and will maintain a CeNOuta of Consent to self-insure,for Workerm Worker's Copcn- - alien,u provided far by Section 37M of the Labor Code,for the performance of the work for which Nrmit is peis issued. And will maintain Workers Compensation Insurance,u required by Section 700 of dao labor Code.for the performance of the work for which dais permit Is issmd. My Worker,Compenudon lasuranu caMa nd py0icy n rmar are: Carrier.•.f•�'r C2MP. fPEltAey No.: CE FICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE CNB scrum mcd not x completed iftle permit Is fmom hundred dollars(Sim) or lea.) I molly Not in the pcd1 mmm of the work for which this Permit is issued.I boll mi employ any person in my summer an As in become subject to the Workers'CompemNm Laws of California.Dam Applicant NOTICE TO APPLICANT:If.after making this Comfleate of Exemption.you should become subject he the Workers Compensation pm'idoes of then labor Code,you most .J O foMwiN comply with such provisional or this pemiL dull be rimmed newkcd. z'"•� CONSTRUCTION LENDING AGENCY [-rte IWmby M.that Nem 1,A mnsmsNm lending Agency for the serformantt of ai r7 dao work for which this permit Is luted(Sec.3097.Clv.G ' QLender's Name z Lenders Mdreas U Q I cel that I have read this application and sum that the Above infamnim is Ug !'! COpecL l Agree to comply with all city and county ordinances And sues laws relating to Q SU^ Wilding construction•and morbyanNodm representatives of this city to enter upon Ne W +hove-mlemmed property,fm inspection purposes (We)agree in eve,Indemnify and All harmless the City of Cupertino against ,..i y liabilities,judgments.cues and expenses which may In my way accrue Against and City in C.)Z APPL CqA neo of QERSfANDS nuffiel of AtND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC E ONS. illa'l� Re-roofs Signal=o ApplicuVConr or Due HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Or future building mcupanumre,or handle hevudous material u MOmd by de Cupertino Municipal Code.Chapter 9.13,and the Health and Surety [2 Y., oris,section 15532(e)7 All roofs shall be inspected prior to any roofing material being installed. �o Will the Applicant or future Wilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It haumous air contaminants u turned by dao Bay Area Air Quality Management all new materials for inspection. liict7 [:]Y. I have mad the huam am. dais requirements under Chapter 6.95 of Ne Califor. 7decs Hodth&Satcty Code,Scam 25505,25533 and 35534.1 undcnund Nu ifthe Wilding mi curmily haw:a roue 041 it u my ecspondhility,re notify tin occupant of the rdmCaB•yhwhminbemetNnortoissuanceot,QeNTxaupffk Signature of Applicant Date owner m..iUnmd.sent Data All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 C F Fax(408)777-3333 UPEkTINO Building Department JOB A D ESS1 � :. y PERMIT# W`>�TL-Y 0 0 A O 6 114 OWNER'S NAME: PHONE #jotO a'L y- e� GENERAL CONTRACTOR citi'Zc FAX# (p - 1P f- 'fid CD bx) I am not using any subcontractors: CLA-4� Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fentzng 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 1 CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM APN# Date: 3s z a� 5 Building Address: ailing Address (if different from building address l J ST L-v N t4 A- u 1� Auc r-!c7 Owner's Name: J _ Phone#: G I Cl (OSP 1' a- < Mi7S LLRjiZ Contractor: License#: eP 2 CA-i gn�SilZJcic>>`! �l� (oI C tact: Phone:(per-8V9 HJIZ Cupertino Business License#: Fax: (osD-all q- mid 1 Building Permit Info: T>2-1,Zt)r q-e -9,4 t(L 00 a&--' fWu-YL Byc - TZe?L A-Le- L.1 9.E IV Bldg IS( Elect ❑ Plumb ❑ Mech ❑ Job Description: —1Ea v-, / D-17 4 R,-7- 2 F?a-I ?— Residential Residential Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: ?0,?FR-aX .-4JrL�tb — Type of Construction: %LH yar ,?_c'PA t rZ Please check this box if the project is a second-story addition: El ro'ect Size: StandardLar e ❑ Ma'or ❑ 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> 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 Investigation fee BUILDING I of 2,7 �� CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM Quantity 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 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 Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER InstaWAlter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 clip MECHANICAL BREMAIRHAN 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 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 AL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEIZaF PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group 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--' —.—Plumbic NrmifIssue --PLUMBING - -- PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING NG of 3