08050176 (2) -
BUILDPNG DIVISION PERA UT CON'ItiRACTQR IN 'ORMATIOI�T ,
BURRING ADDRESS: PERMIT NO.
1.0409 BRET AVE OCCIDENTAL EXPRESS 08050176
OWNER'S NAME: PERMIT ISSUE DAIS
'I..IIFNGYU GE 1019 HOWARD ST 05/22/2008
NE: SANITARY NO. CONTROL NO.
(510) 676-7718
ARCHTIECT/ENGINEER: BURRING PERMrT INFO
BLDG ELECT PLUMB MECH
uGc LICENSED CONrItACTIOR'S DECLARATION - Ib Description
I hereby affirm that I am OesCil licensed under provisions of Cramer 9(commencing p
with Secuon7OOMof Oividan3ofox Buun=wdProfessions Com.andmyliceueis UPGRADE MAIN SVC PNL FRM 40AMP TO 110AMP
in full farte and cR
"`
jai License Class Ifo
q Dao: t�lD Contracwr
7W ARCHRECI'S DECLARATI
1 urs
ndcuml my plans shall be used a plo natures;uhlcores;rds
CyV
l.icemed professional -
OWNER-BUILDER DEthe Com ON
oto ,
KOC I hemhy,aRrm that 1 1. exempt from the Coroners :Any c Law for the
KOC following moon.(Section 71D 1.5,Business and tie.do mli Cade:Any city or county
$ whichitsissrecall.n permit re construe ohne,improv,m Permit to
«e a sir any m==, ,
i that wins tensed ,elm scquir a IM applicant f«cmh acus.Io fileese Laws stammrnt
< mal mencin uN rursuant 7 the Provisions of use C.mrxwsalicenxlaw patina,ode)or Sq.Ft. Floor Area Valuation
y�$ 'at he a exam
ith Section7000)nd the
Division n 3 of ore ageBusiness.nd Professon.Any vi Chic)or _ $1200
mat a 7 31.5 b thcaefrom and the buts for be allcts the exemption.to Any it penes of
Section done five
any applicant for a permit subjects the applicant a civil penalty of Number Occupancy Type
rot mom dun fico huntlmd dollars(55(10} 37510077�j
I,umxner of nie pwpmy,«my employm wiN xgassthem sele compcnssnon,
will do use work and the structure is not Intended or offered for sam(Stec.70N,Business
and Professions Cade:The Communes License Law does rot appy w an owner or Required Inspections
propwywha Wilds«improwslhercon.and who doessech w«khimaelfor through his
owe employes,Provided that such iorm.enu art not intended«offered f«sale.R.
however,the building or improvement is said within one you of complouon.the awrer-
huilder ,will have the burden of proving that M did net build or improve for purpnx of
rural.
❑1,u owner of the property.w exclusively commuting with Raved contracmn to
construct the project(Sec.70 kt.Business and Pefaanou Cade:)The Cumaarors U.
,cause Law does not apply w an owner of Property who builds or improves Ihemon,and.
who contracts for s mh projects with a eontrserer(s)licensed pursuant w the Commencer
L.iama law.
lumcxcmptundeasee ,BAPCf«dtiamuon
Dam
WORKER'S COMPENSATION DECLAR mON
I hereby affirm under perWty of perjury ane of use following detlanu«tc
❑Ihsw and wOl mainuinaCenifiwm of Cottsentmxlf-inartf«Workd.Compen-
safion,u provided f«by Steuon 37W a do labor Code,for the Performance of de
wart for which this permit is issued.
&have and will maintain Warme.Comp rcuu n Insurance,u retrained by Section
of the Labor Cadc,for me perform..(use wort for which this permit is issued.
My Wortds Compensation Inst..caries and Policy number
O 11 `�
Cartier. � CA i-s-Y-tea MON PRO
CERT CA�EXEMPTION FAOM WORKERS'
OMP pAT1Epl$ OI{Ip(SURAjIIS
uscatirarcdmothec. tad' l ormchmtmedmBars(SIOB)
or mss)
I ceNh that in the performance of the work f«which this permil is issued,l shall not
employ any Person in any mannerx as in become subject to the Worlinae Compensation
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:If,arm,making this Certificate of Exemption.you abould
become Subject m the Workers Compensation provisions of me Labor Code,you most
wJ 0 forthwith comply with such provisions or mu Permit shall o deemed meshed.
`-' CONSTRUCTION LENDING AGENCY
[-i N+ 1 hereby or.that mart is a conmecam.matting spray for me pM«ma a of
a
the work for which this permit is issued(Sec.3097,Co.C.)
Wh Q
Lender's Name
z Lender.Add.
V O 1 anify that 1 have read this arplicuimt and sum mad the show informants is
ti.
connect.I spa w comply with all city and county ondinan rs and some 4ws rtlNn,as l
building consllmcden,and hereby athod>e mprwenuuves of this city in cmer upon me
Gahow-menuonnd progeny for inspection purposes
(Wo)agree x ace,indemnify and knee hamdess the City or Ceramics against
incoiticaumeofthe cougrueM eapcasesmit. may in any way ar'�ne againsl.tiO City
()z APPLICAner DERSTANDSunfing;of thisD WILL
^ APPLICA DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:%12f, Date
SOUR E G NTjO S,_ ��z/u��
_^�7l �'- Re-roofs
St ofAppli HAZARDOUS MATERIALS DISCLOSURE D>m Type of Roof
Will me arldr—t«future building occupant start ethanol.matron.mawrud
ns donned by the Cupertino Municipal Code.Chapter 9.13,and me Halm and Safety
40 Cam.Section z5532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes jRNo
Will me applicant or futum building oacuum use cquirsomm«mvisos which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha>ardens air eonuminanu as mOncd by me Bay Ama Air Quality Management all new materials for inspection.
Disrict7
❑Yes 19 No
In ew rend the haraNmsmamrialamquimmm�ta unmr ,Chapmr6.95 of me Califon
nia HalmhSafetyCodt Sceuonu255U5.25533"25534.1undcutaadmaiftM building
d«a mol cm ndy haw a mn 4 mal It's my x mibllity w mdfy me«supwi of me
mquimmcats which mum he metpnorta issuance oft Ccniream or Ocwpamy. Signature of Applicant Date
owner aamoti>mdsent Dam All roof coverings to be Class'%¢ or better
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37510027 . 00
DATE ISSUED. . . . . . . : 05/22/2008
RECEIPT # . . . . . . . . . : BS000004872
REFERENCE ID # . . . : 08050176
SITE ADDRESS . . . . . : 10409 BRET AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ZHENGYU GE
ADDRESS . . . . . . . . . . : 10409 BRET AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : JOHN TSANG
CONTRACTOR . . . . . . . : HENRY KARNALOWICZ LIC # 29877
COMPANY . . . . . . . . . . : OCCIDENTAL EXPRESS
ADDRESS . . . . . . . : . . : 1019 HOWARD ST
CITY/STATE/ZIP . . . : SAN FRANCISCO, CA 94103
TELEPHONE . . . . . . . . : (510) 676-7718
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- --- ---- ---------- -------- ------- ---------- ----------
1BSEISMICR VALUATION 1, 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 .79 0 . 00
ITRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
---- ---------- ---------- ----------
TOTAL PERMIT 82 . 08 0 . 00 82 . 08 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 82 . 08 MC
---------------
TOTAL RECEIPT 82 . 08
•
D�o5ol7 (p
CITY OF CUPERTINO
COF
• CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
-7610 09-7 , 6 o s 22 ,ten
Building Address: ff
ICrO� 6 r,4 kJ 2 CCA I r'
Mailing Address (if different from building address):
O D C:,( G("J ve
Owner's Name: Phone#:
zk,pm � — 3 S' 3179-
Contractor: J Phone:
oC l�deH I l v Ce Fax: 1
Contractor License#: e� k c1 I S-.3
Cupertino Business License#: ? cl g
• Contact: o� TSS,KcJ Phone: Cr?(._ -771
Fax:
Residential 19Commercial
Job Description: ( (p•qy �e "S2 Y J iCQ I�q vtC'. ( �i �Q oy �� 110 C,
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No
Building Permit Info:
Bldg ❑ Elect ® Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
11 111/V—&HR ❑ 11, 111 B T -8 cQ 1
Val ation: Square Footage:
O. oc7
Project Size: Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
• to the application or if applicable, include in plan set & the sheet index.
Points Achieved: Zf
For help, contact Build it Green at www.builditgreen.org
CITY OF CUPERTINO
CITY CUPEr�TiNO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1 GENCOM
1 BTEMPPER 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)
1 BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3 Installation/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
1 BBOILER4 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
1 BBOILER5 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.
1 ELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
IPLMBINSP Other Plumbing & Gas Inspections P
(per hour)
1MEETINGIHR Application Meeting B
CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPERTINO
S 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
IACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
1CHIMNEYR Chimney Repair B
FENCES
1 FENCE>6FT Non-masonry, over 6 ft in height B
1 FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1 FLAGPOL>20 Flag pole (over 20 ft in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1 PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete)
3 of 5
Se CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPEVINO
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
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1 RETSP 10 Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'hih 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)
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>10SF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 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 application
4of5
.:CCD..
CITY OF CUPERTINO
CUCITY
TYOF O GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass B
door (ca 8 windows)
1 WINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
r 1 EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1 PLMBLNCK 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
• � rv2 UO or
5 of 5
Community Development
10300 Torre Avenue
Ao�
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
SCUPERTINO
Building Department
JO/B ADDRESS: PERMIT # �� U
( b ✓ oe J tD
O R'S NAME: W PHONE # o , - (2 2g"
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signa 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
Owne or Signature Datel G