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05100224 (2) CITY OF CUPE 1 0 BUILDING DIVISION PERMITCO' TR QR INFORMATION �11111O BUILDING ADDRESS; HE GONGXIN PERMIT NO.05100224 11480 CHARSAN LA RS NAME PERMIT ISSUE DATE HE GONGXIN 10/27/200S PHONE: SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 00 LICENSED CONTRACTOR S DECLARATION Jo as I locreby grim that I am licamuml under provisions of Chapter 9(commencing luo s, FINALED z hu,Section 70011)ofDivision 3 ofthc Business mid Prolicamons Code.and my license is in full(..a and cffhcL REPLACE WINDOWS 7213 Licc=Cl=.Uc.# Dow comamber ARCHITECT'S DECLARATION NO ti 2005 9, 1 understand my plans shall W used as Public minted LL t; Licensed Poticasional OWNER-BUILDER DECLARATION to oat I am exempt rourn doc Cormacturs Licerric Law far the I hereby�fflrm SUILL"AN;L7 no following Madam.(Section Ito LS,Business and Professions Code:Any city Or county which requires.Permit to construct,eller,woes.,demolish,or repair any structure S10000 prior x)its issuance,also resiums she applicant for such Permit to rile a signed statement Sq.Ft. Floor Area Valuation that he is licensed purniml to ft provisions of the Connector's Licesse,Law Chapter 9 (cornmencing with Section 7000)of Division 3 of use:Business and Professions Code)or 'on that his Ina exempt basilicas,and drbabasisfar tho alleged exemption.My violmi of U U Session 7031.5 by my.,pit.,for. .I,subjects list,applicant civil penalty of Occupancy Type not mom than five hundred ftlant(S500). [3 1,..of the pri or my employees with vnigcs as their ashe cionpimissido., will din in.work...it hommethre Is no,inusidled orliffmond rot sualk,(See Initial.Businest and Profession"Cade Inic Cononsver's Lioends Law it=not apply to so owner of Required Inspections property.1W Imilchicarimproves thiman,and who doossuals wark hurnsoffor through his Own employ=,pmvided that such improvements ids not immoralist oroffered for able.If. however,the building or improvement is mid within one year of completion,the nowner- build.,will have the Iturdis.Of proving that the did.1 Wild in improve for psurpose,of sale.). I "asowner of On,property.im cadibsiv,ly camounirts with lictrissid couraticion,to ustruct the pmjea(Sec.70",Business and Professions Code:)Ile Commuctur's U. come Law does not apply to an owner of propicrly who Wilds or impmout themon,and, who contracts for such projects with a commurims)ficensad purmant to this,Contractor's Lice.Law. E]IturniuminintindbaSea -.118tFiCionthismation Do, /Ot"'9A, WORKER'S COMPENSATION DECLARATION , I hereby affirm War penalty of Perjury mus Of ft following dsidiumb.. r-1 I have and will maintain accridicamorcomandurachf-imbom forWormesCompen- armon,as provided for by Section 37M.1 Or Labor Code,for thice performs of does work for which this permlt is issued. C]I have and will rismend.Worker's Compensation Issuranim,at resound by Section 37W or the Labor Colo,for the priformarec offt wtal,for which this perm,is issued My Workers Coaripemossion lumbrance carrier and Policy number am: Cartier: Policy No.: CERTIFICATE OF EXEMPTION MOM WORKERS' COMPENSATION INSURANCE (Dismission aced Out Wcwplcwd ifft Permit a forums humool Out(SI W) or kart) I 0colly that in the porfornminco of the work for which this Permit is ismod,I shall not orb.ployany picianninany mannerwastacomictubjectuothe Workers'Compensation Laws imcidiftmia.Did Applicant NOTICE TO APPLICANT.If,after making this Cenificaus of Exemption,you should become subject to the Workers Compensation Provismns of the Labor Coda you bout Z forthwith comply with such provisions or this permit shall Its deemed revoker. Z`0 CONMUCTION LENDING AGENCY I thereby affirmi that ft.4.construction lemb.ij.pinc,for the perforarceof Ne work fur which dus perant is issued(Se'.5097,Civ.C.) LLI Lender's Name z Urxhri Address J 0 1 unify that I h.wo resit t1m,application and some count the above informustim is LL F COmcL I&grim to empty with all city and county ordionsinscs and stato[..a rolating to 0O Wilding construction.and hereby audionto reprommudveus or this city to enter upon the above-nummod imermty,for m,pi Innipmes. /? 93. (We)egme to save.indemnify it keep harmless ft City of C.Ini..as.ins, ,) limbiliums.judlproms,toss and..pcomes which may in my way teen itipunst said City U Z in conscriumee of the granting of this rmit. APPLICANT UNDERS`fANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: tz� Date 2 —0 4-- SOURCE REGULATIONS. e0l"9107- Re-roofs 7 4_�_ Signaturc imApplicarisCommetor DOW HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will ft applicant or future Wilding ocesurpart mom orhandit hiscardous material 4 defined by ft Cupertino Municipal Onto.Chapter 9.12.and the Health and Safety ik,Section 25532(a)7., 1 0yes All roofs shall be inspected prior to any roofing material being installed. Will the applicant Or room Wilding em,upunt om c4unponand or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit ha,,inimus air coularminams as defined by the Bay Are.Air Quality Management all new materials for inspection. District? 0 Yea )DlN. I have mail ft haambousinsterhill milaircirmusunder Cholver6.95 offs Calif.r. not Health&SdiciyCoak,Socuoras 355115.25557 aodn514.I usuicraturoxi untsifft Wilding does;no,stimmly have.unismt ft,it is my responsibility 0 moul,the occupant of the mquirements which must he met prior W issuance of a Ocrulleaus o(Occupancy. Signature of Applicant Date I�/>S21,21 All roof coverings to be Class"B"or better Owner or...horned hmi.d agent Date CITY OF CUPERTINO *` ".moi § '�` C ' � �' BUILDING DIVIs1ory PER T C®NTRACT�iR INFOR BION BUILDING ADDRESS: HE GONGXIN PERMIT NO. 0510022.4 480 CHARSAN TA VS NAMEEGONGXIN PERMIT ISSUE DATE HE 1ARCHITECTIENGINEER: E: SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 i 00, LICENSED CONTRACTOR'S DECLARATION lob Description %w I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing <dd with Scaion]IXMl)of Division 3 of Ne Business and Professions Code.and my licensee in full fame bacterium REPLACE WINDOWS l E2_ License Class Lie,tt vt-w Date Comrazwr. 'N�4LE® ARCHITECTS DECLARATION f rc< 1 understood my plans shall Inc used az public mmrds cede o f, Licensed Professional 5 OWNER-BUILDER DECLARATION m ,I 2005 1 hereby from that 1 aexempt from the ComrectaI License,Law for the NOVY no fallowing mason.(Section]031.5,Business and Profc'ore Cale:Any city or county <m ff which requites a permit m cnnswn,alder,improve.demolish.an repair any structure ININ _ $10000 prior in its issuance.also squires the mNieent for such permit to rile aligned statement -�< that he is licensed pursuant o the provisions of the Contractor'&Licenu Law(Chapter 9 Sq.Ft. Floor Area atlbn yFa (commencing with Section 70M)of Division 3 of Ne Business and Professions Code)or i Our he u exempt tiemrman and Ne basis for the alwgcd cam pfon.Any violation of Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of r0 Occupancy Type not more than five hundred dollars(5500). ❑I.as owner of the property,or my employes with wages m their sale compensation, will do Ne work and the swante a not imeaded or aRered for ander(See.]044,Bounces Required Inspections and Pmrenians Code:The Canuaewes License Iew does not apply w m owner or q p property who builds or improves thereon,and who does suchwork himselfor through his Own empioyces,p.filed Nat such improvements are nminterr cd orofired for sale.If. how vee the building or improvement is sold within mm year.(cmancuon,the owner- builder will haw the burden of playing Our he did not Wild or improve for purpose of sale.). L as owner of the property,am exclusively contracting with licensed conoaewrs to c nmmnt Ne project(Sec.]044,Business and Professor.Code:)The Contractors Li- cerise law docs not apply b an owner of pr.p<rtywho Wilds or Improves daemon.and whe contracts for such projects with a contractor(s)licensed pursuant in the Coaoecwrs .License Law. 10"'Y"'Wormes am axcmpt under Sec ,B&PC far this reason er l=„-�`a'�.— Dam /J •z _ WORKER'S COMPENSATION DECLARATION 1 hereby aRrm under penalty of perjury,one of the following declarations: ham and will maintain a Curufcore of Comedo self-insure far W.ran'sCrmpen- n,as provided fo by Smdce 3]00 of the Ube,Code,far the performance of the far which Nis permit is issuetl. have and will maintain Worker's Compensation Insurance,as required by Section of the labor Code,for the performance of the work far which this permit is issued. Compensation msvmnce,caner and Policy number am: Cartier. Policy No,: CERTIFICATE OF EKEMPITON FROM WORKERS' COMPENSATION INSURANCE This section need nm W completed if tW Permit is farone hundred dmlan(SIM) - on I—) I modify thin in the perforrower of the work for which this permit is issued.P shall not employ any parson in any manner an as am bjeet to the Workcri Compensation Applicant Laws of Caifomia.Dam NOTICE TO APPLICANT:IL after making this ovisio s o of Exemption,you ashould most become h comp y it Wader's Compensation or thin previsions of this Lead Code you most .J z, forthwith comply with such provisions or this permit shall W deemed mwked. ZO CONSTRUCTION LENDING AGENCY [-. I hereby differ that them is a construction lending agency for the performance of GG 7 Ne work(tar which this permit is issued(Sec.309),Civ.C.) ls]Q Lender's Name D z Under's Address U Q 1 cenify that I haw mad Nis application and male that the above information e d, l-^ c.n<eL 1 agree to comply with all city and county limitations and sure laws relating to DU building construction.and hereby anthomn reprasenutives of Nis city w enter upon we r U.1above-mcntimbed property fur inspection purposes. (,y (We,)agree to save,indemnify and keep harmless Ne,City of Cupertino against ,,0 liabilities,judgments.costs and expenses which may in any way accrue against said City UZ in consequence,or the granting of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. G�--�—�>--a_ !uL9 7/4T Re-roofs G7 Signature of Applicanueonvaaar Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant of future building occupant store or handle Emardous material Aft& 'n.'by Tc Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ade.Section 8532(a)9 All roofs shall be inspected prior to any roofing material being installed. QYes WN. Will the applicamor future building occupant use equipment ordevices which If roof is installed without first obtaining an inspection,I agree to remove emit ha[ardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. Owner? Oyer VN. I have mad the bavardous materials requidemsms under Chapterb.95.f thc Califer ria Health&Safmy Code,Sections 25505.25533 and 255)4.1 understand that If the building does not currently haw a term,Nat It is my responsibility an noufy on,occupant of the mgnimments which most m mel pd.,to tuddlee.(a Cemfrde or a.trpmpy. _ Signature of Applicant Dale –�� ✓�'�7G” All roof coverings to be Class"B" or better Owner or authorized agent Date' CITY OF CUPERTI CUCITY TYOF O P IT APPLICATIONIORM N# � / /v — Date: /0/2 �/2oD Building Address: , Mailing Address (if different from building address): /4130 G/q,,cah Lata e Owner's Name: Phone #: Contractor: License#: �jGuh� bti.`la�v Contact: Phone: Cupertino Business License#: Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential ❑ Commercial ❑ Sq.Ft. Floor Area: q.Ft.: Cost of Project: w Occupancy� Coup i0. UOO. r LL Type of Construction: Please check this box if the project is a V C second-story addition: ❑ 40F ro'ect Size: Standard ❑ Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERl Boiler<= 100,000 Btu MECHANTICAL 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/ uasi 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 1 of 3 II �Ob ChL{NSAn �he� /�-• 6v/' �hb � •�///ULCN��V r 'L ® SGc97� o� GVOY`p �W�h alo"v �o�.,r f� lav, �owo%n w>hdov l l I , �iYsf /—Lrip r (Not cXah`.e o V✓1 .�7xey� 23 " X ➢9 " Sl;d"d doer wj F`xeoP y K tabs V Nock W4 �xc�P - • �3 x � �A�^�!r F 71 ,rx S9 ,- Beef r- - I 71 ~)e Gi ora 4 2 I C I � I - - - - - - — � /�P3Pis �cEYv �A6A�° h�A,► ' ® OCT ry 2995 4i4by � Bvltor., 3 po. �S oV,. , �✓, 3 X S'9 ® � nGtic�i✓ �h-wpP 7/ X46 71 "X46 V 46 xS$ „ l� f3ecq \� wig geoQ 3S"x w,o 1�"" 34ry � W16 S9 'x s$ 1b'1 �eo1 /3eo� W r✓�S 4 sof "x 43 5 ' X43 { Cin{-fivna�� 'S xQ7 9S"x4 �