02080142 (2) OF
TINO
CI BUILDI c DIIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10838 BUBB RD. 02080142
G1WRsLNaMI�G CHIOU APPLICATION
SANITARY NO. CONTROL NO.
q O Z ARCHITEC PENGINEER: f BUILDING PERMIT INFO
Lk" BLDG ELECT PLUMB MECH
<t r_1 1=J LJ LJ
LICENSED CONTRACTOR'S DECLARATION
0 Z In' 1 hereby affirm that l am licensed under fCha ter 9(commencingJob Description
D M_ Provisions ve T IjT 1 NAL MODEL
MMwith Section firr7000)ofect.Division Business and Profession Code,end my license F�y
m full farce and ellen. 4 Vll tie
0 0 U Datenu Class Lic.M
Date S DECLARATION F E E3 IJ 6 2 03
3 0 fi ARCHITECT'S DECLARATION
5�`u-� g 1 understand my plans shall be useJ as public records
a¢<a
0 Licensed Professional
p
OWNER-BUILDER DECLARATION BUILDING
u� 1 hereby affirm that 1 oat exempt from the Contractor's License Law for the
I.' a following reason.(Section 7031.5.Business and Professions Code:Any city or county $5000
IFC which requires a Permit to canuun,alter,improve,demolish,or repair any structure
a3� -pdormi¢issuarce,also rcquirer the applicant for such pensntmflleasigned sutemea -- - - - - -- -- - —_-------- ----
colth4ircingwithS=ggn70Wprmisionsn3 of it
elaw(Chager9 c i„, 6$10i0�f2or'�IPai ( -;.,,, Valuation
(conigencingwiN Sectjgn 7000)of Division3ofthe Bnincsp andppppfpcions Code) Q_�SJr`Ig �. ,.,, . " , . :'ti ,. .,!i.�t i:aA n'd: •
or that he nlzhrrlpt therefrom and the hasis for the ell'eg�exembJah.Any violation '
-of Section 7031-.5 by any applicant for a iremlt subjects to applicant to a civil penalty
i of not more than five hundred doll...($500) 101ARN N00 €PATION Occupancy Type
C1 1,as owner of Ne property.or my employees with wages as their sole compensation, 102 PIERS
will do'the'work,'and the structure is not intended or offered far sale(see.7044,' 103 - UFER Required Ins ectitins't"" t
Business and'Professions Code:The Connector's License law does nm apply m an q p
comer of property Who Wilds or improves thereon,and who does such work himself 104 - REBAR
air through his awn employees.Provided Net such improvements tic not intended or _
uRerea'for sale.If,however.Ne'Wildin-or im-roveroem is sold within one - of _" -- -' ^.�
'completion.the owner-Wilder will have rise When of paving that he did not WiW or 105 - ANCHOR BOLTS „I' "'•'+
impmverorPurposeefsak.). 106 - SEWER & WATER
_ _. . _.
1;uowner of Ne pvpcny,am exdusively comrazting with licenutl conwnomm 20 --- UNDERFLOOR'��PLUMBING"'-"�. ,.
contact the project(Sm.7044,Business and Profusions Code)The Con ncnr's 2 03 - UNDERFLOOR MECHANICAL--
License Law does not apply to an owner of property who Wilds or improves theseon,
_and who contacts for.such,projects-with a contractor(s)l censed pursaant-to the ......_ 2 04-""'-'UNDERFLOOR..-.FRAM.E..__... __.-.-_
. Contraemrs License Law. ... ._ _.._._... .. _ ..__.--
connect
0lamexempt um Set: B&I'Crordiirstwron 205 - UNDERFLOOR'''INSULATION
`s_µ/mer .1 Sec) ��LG�oZ 301 - ROUGH PLUMBING
-3 X \' KER•SCOMPBl5AT101WDECLXRATION 302 - TUB & OR SHOWER
"�- Ihereby rat noxa penalty of perjpry.a.or me rnnowing deduati.m: 303 - ROUGH MECHANICAL
- i.'- 0 I have'and will onaimain'a Cenificate of Consent to self-insure for Worker's 3 04 - ROUGH ELECTRICAL
Compensation, as provided for by Section 3700 of the Labor Cade, for the
_ perromt.nce or the work for which Nis Permit is issued. 305 - FRAME
01 have and will maintain Worker's Compensation Insurance 'required by Section 3 06 - HOLDOWNS
371X1 of the Labor Cod for the plihi mance of he work far'which this Permit is
307 - INSULATION
- CERTIFlCATION OF .,a• aro, -308 - "rSHEETROCK"'
s dMy Workers Comp sato 1carrier
nm and P li y number
Garners ff t" t tt s..fP h YNo. . If s l f, r. ,. . .
EXEMPI'IONFROM,WORKERS'j a>:'* '+3.09 t ?IEXDERPOR_�i]]AtH.'
COMPENSATION INSURANCE_s' _ ._._.._._.__. .__.-,_.-___._----- -
-„. - - -- ...-3.10,___ ..I-NTERIOR--LATH-- ; - r):::ur,,; 1 —+
'' (This section need not he completed if the pert is for one hundred dollars 311 ' -ISCRATCH COAT '
ISI001 less 1
, .,313 'ROOF-•NAIL._,_
1 mfr Nai nth pert ratan of the work for whl h th s permit's r.s ed I
c n t uonl Lyaw or epn R, �°°` '_!m eO_m`stoct to the Workers 501 FINAL ELECTRILAL"'ENERGY
p= 502.. =_FINAL. PLUMB ING_..ENERGY .
Z 'NDTlr ink (CANT I mak gN ate Pi ypafnomd 503 - FINAL MECHANICAL "ENERGY '
z Z: harm n the wor smanorialn pro tt nv of the L4WrC Je,you nun
O 12 Poch reply th isionsserthisperms sludl he deem ed revoked 504 - FINAL BUILDING ENERGY „-
f„n CONSTRUC`NONLENDIIGAGENCY "-" 505 - FINAL ELECTRICAL t
1 hereby affirm that then Wit construction lending agency for the performance
'of chi work for huh N'a Perrnts�ssad(Sae 30197,civ.c) 506 - GAS TEST _
o r�
Lander',Ndreas _- .... _. . 507 FINAL; PLUMBING
Z Lend r Address. ,.tr.
,. U O .I..if,thatIhavereaddiisapplirationandtamathattheaboveinfeurr cis 5O FINAL MECHANICAL' -
'kT+ [� antro.1 agree to comply,with all city and loamy urdimnees end state laws relming 5 9 - INAL G DE
; 'O-p tabuildingconstoiction;and herebyauthorize representativesofthis citytoenter upon 5 0ANA
NAL NG
,�,r,T� 'the above-mentioned property for inspection purposes. ,
``'y (We)agrce[n save,mdcmn ly asd kmp harmless the Cly of Cupemnb ngainm 51L RKS �s^�
'Fn (A liabilities.ludgmems,costs and expenses which may to any way accrue against said V
V-► C t in consequence of the graining of this permit '
:APPLICANT UNDE TANDS AND W114.COMPLY WITH ALL NON-POINT Issuedb : Date
SOUR FREGUL- ONS. ' -2/_u y
all I
onof Applicen mrlctor + _Date D Re-roofs
ROOUS MATERIALS DISCLOSURE
Wdl de ap emu or fotute Wil bccupout store or handle hazardous Want Type of Roof
as definedby the C. isib o Mnninlsnl cone Chaprcr 9.12.anJ use xealth era safny _
Code SeW,W255321a) ! n :�"'!t
❑Ye ''" " No " ' All.roofs shall be inspected nor.to an roofin material beta installed. .
' XI r s .sl
P P Y- g g
Will the,applicant or future buildings pant use equipment or devices which' If a roof is installed without first obtaining an'inspectlOn;`I'Agree to remove
emit hawed us air contaminants as Jefned by the Bay Area Au Quality Munegminhod
All non=poilit so irca reglations. . pp ly with.
D.nn All new materials for inspection. Applicant understands andwill comp
❑Yes NO '
I have read the hazallouv materials requirements under Chapter 6.95 of the
Califomii Health&Safety Cade,Sections 25505,25533 end 25534.1 undemand that
tithe Wlldingdoes not Gurtenuy havearcnant.that it is mY responsibility to notify the - --_ _ _ _ _ --
cuPam of the requ mems which mus be met prior N issuance Of a Cenifieam of
G up O may. 26 , Signature of Applicant. _ . - . _ . .,.__. , ,- .Date
�- -
Ow or,amo aea nt All roof coverings to be Class "B" or better
.OFFICE .... . .... -._ . _. . -. ._.. ... . .. .. ....
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RFC.
AUG 6-200Z
BY:
Z ly
NEW ADD
A'F'RO VE®
IN ACCORDANCE WITH THE CITR Of
20 0 L (VATS HE,Irk CUPERTINO 0 , AND ORDI NCES
S (r iC1L& 5/{S I ✓ Sl/lii� (f '�A �ILCc (.S� )ATE
>IGNEU
chis set of ,lens a spe ..rfication 7
-1 C 0 LI NT E� he kept on the job at all Imes and it is un
C(✓ /��/ �Dt s/ti,Y r1�97E� 1 will to make any changes or alterations
/ E " se"ta Without written Permission from
`I'ns OePt•, City of Cupertino.
"--'t*gig of this Plan and specifications
u•• SA ted to permit or to be an
u,olatron of any
provision,
. .. .. . ,�•fiaace or state I-AW
j
Son CITY OF CUPERTINO 02-
CUP YOF PERMIT APPLICATION FORM
Ah
APN#' Date:
362 - o.2 osZ e/z6/ zd0�
Building Address:
108,300 v8,300 B U B g oA D
Owner's Name: Phone#:
r—
Contractor: TIM I-IU License#: 6 8 5 3 6
C. . wo C CON57KUCTIuN
Contact: Ti M �i N Phone#:
�� - 2 7= x`069
Applicant/Contractor: Fax#:
uil g Permit Info:
Bld Elect Plumb Mech
tion:
CR—esidenti-al: xn1-e,-nv,l QMo a Commercial:
Sq.Ft.Floor Area: Z $/Sq.Ft.:
Architect/Engineer: Valuation:
�SbOU
Type of Construction: r Occupancy
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances 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
BMITIGATC Comm. Housing Mit. Fee BUILDING
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BNEWMULTI New Multi-family Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
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