04080042 (4) CITY OF CUPER14Np t°�•, .,r. zc n �x teats ;` P
BUILDING DIVISION PI',RM C�NTiUQTnRINFORMA''N" '
BUILDING ADDRESS: PERMIT NO.
JERMY TUCKER AND JOYCE C G 04080042
OWNER'S NAME: PERMIT ISSUE DATE
ONE
SANITARY O. C NTROL NO.
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 0 0
trop LICENSED CONTRACTOR'SDECLARATION Job Description
i.F 1 hereby air,m Nal l am licensed under provisions of Chapter 9(commencing as is s�
siw with Scents7000)Of Division)ofthe Business and Professimo Code,and my license ix INI C/AN Itla—
infwlrorceandeffecL KITCHEN REMODEL (CABINET / I UN�TERaT� S,
j,w�A? Lieenm Class Lie.x
,1=w Date camraelm ANTI KNOCK/ELECT. OUTLETS)
Y ARCHITECTS DECLARATION ^
Y5d< Iunderstand my plans shall Ui unit as public records �i�� _ J yjn��
]yU L
'' t-' Licensed ProltssionA
y0 OWNER-BUILDER DECLARATION Illsss��m
<S 1 hereby Orion on 1 1. exempt from the Contractor's License Law for the �� q N
p o following reason.(Section]Inl.i Business and improve.
de inns Code:Any city a county (xj�y�yg
xm or which its requires a pemdo u,ennecum.coma,in,prove,demon n,nr repair any tatement
,IILL
r pdormiuiuuancc.alturequirexnc�applicantforiuchpermilmFIC asigneJxulemenl Ft. Floor Area Val t
< that he is licensed pursuant to the provisions of the Contractor's License Low(Chapter 9 Sq. t�D9000
�Haa (commencing with Seeical B)af Division 3ofthe Businwand ProfesxionsCMgtar
that he is exempt therefrom and the basis Tor die alleged cacmptinn.Any vialauon OI
Section 7031.5 by any applicant for a permil subjecu the applicant to a civil initially of APN Number Occupancy Type ..
not more than rive hundred dollars(ssoD).
❑ I,as owner Of property,or my employers with wages as their campencome, 3263704q . 00
f
will do Bit work.and doestmcture is not included or offered forsale(See.1644,Business Required Inspections
and Profenimu Code:The Confiscates License Law docs not apply to an owner of q p
property who builds or improves thereon,and who does such work himselrar through his
Own employeet.provided Wal such improvements arc notimmnded reoffered imitate.If.
4 however.the building or improvement is told within one year of completion.the owner
builder will have the burden of proving Nat he did not build or improve for purpose of
salcJ.
❑1,as owner of Ne propcny.am cachatively contracting with licensed cnnmaaom to
construct the project(Sea 7W.Business and professions Cade:)The Contractor's Li.
centers Law does not apply to an owner of propeny who builds or improves Neuron,and
who contracts for such pct with a eonvactor(s)licensed pursuam m But Contractor's
Li c se Law.
1
an emmpl under See. .B A,P C for this reason
wsncr v / 4L✓ Due,
WORKER'S COMPENSATION CLAR ON
Ilembyafrirmunder pen ally.,perj.r onea�7e(aLlowingd=iwations:
1 have and will maintain a Certificate of Cament to self insum fur Warkees Compcm
as provided far by Section Too of Ne labor Code,far On performance of Nc
ore for which Of,permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Scaian
)]110 of We Lobar Code.for We performance of the work for which Nis permit is issued.
My Worker's Compensation Insurance canner antl Policy mor her aa:
Cartier: Policy NO.: -
CERTIFICATE OF EX EM"ION FROM WORKERS'
COMPENSATION INSURANCE
n1u,section need nut be eampined if Ne pcomil is(mane humlmd dollars($10(1)
less.)
1 certify that in the perfmm ucc of Nc work for which this pumit is issued,1 shall not
employanypersor� ymannersu ,lo Ccrnre sub cel la lM1C Workeri Compensation
Lawsca Celir c_�`
Applicant �¢ .
ICE
TOA ANT: f,atm g n r ani roam of Esabor o d you should
e subject oNt Worker oCDmpcnr Of$ provisions of the coed Crede,. mon
.J O (o with comply with such provisions or Nis permit W deemed mwkcd.
Z"0' CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the perfurmenm of
ry' Iz ffic work for which this permit is issued(Sec.3097,Civ.C.) y
W Q Lingers Name -
}z k iters Addle35
U C) 1 ceniry that 1 hast read Nis application and sure Nat the above information is
iy F^ correct,I agree to comply with all city and county ordinances and sine laws palating m
0U building canswaion,and betcby aithorite representatives of this city to enter upon the
above ms,judg judgments,
c sat rend car coon pumanv
Er-r (We)agree w save,indemnify and keep harmless the City of Cupertino against
N liabilities, of W,coarsing of Oil
may in any way accrue against said City
(JZ in consequence of Nc griming of Ni}larmil.
.- APPLICANT UNDERSTANDS ND WILL OMPLY WITH ALL NON-POINT Issued by: Date
SOURCERE LATIONS.
C'9 r e fl o a Re-roofs
Sig'nawrc o pp t.m(Con ac m DIM
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
the applicant tar forum building occupant slot,or handle hrrardaos material
u def by Nc Cupertino Municipal Codc,Chapter 9.13.and the Heaton and Saray
Code.Section 25532N)' All roofs shall be inspected prior to any roofing material being installed.
17 Yea
Will the appliam ort/ut\ure,building oecupanl use equipment or devices which If a roof is installed without First obtaining an inspection, I agree to remove
mit hazudous air ccnmminants as dcrincd by the Bay Arca Air Quality Management all now materials f0[InSpCCt100.
Istria?
0 Ycs pTsvo
I have mad the havudnus materials equircmcnu under Chapter 6.95 of the Cali for
nit Hwlth d,Sarclyc Wc,Sccdims 5Sf15 355))and 35534.1 undctsund thairdr Wilding
dace not curb n 1,hate a renanl Nal' my¢,,nsibility m notify tM occupant of Nc
regaimmentxwhichmaxlbeme n�samanc Of aCe'tidcateofOccupancy. Signature of Applicant Date
owocrr t ariacdagcnt Dam All roof coverings to be Class•'B" or better
CITY OF CUPERTINO
Im 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub : Blk: Lot :
APN . . . . . . . . : 32637044 . 00
DATE ISSUED. . . . . . . : 08/06/2004
RECEIPT 4 . . . . . . . . . : 26566
REFERENCE ID # . . . : 04080042
SITE ADDRESS . . . . . : 10364 CRESTON DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JERMY TUCKER AND JOYCE CHANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1014
RECEIVED FROM . . . . : JEREMY TUCKER
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : JERMY TUCKER AND JOYCE CHANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1014
TELEPHONE . . . . . . . . :
AVE ID-- ----UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-
-- --------- ------- - -- ---- - - ---- ---- -- - --- -------- - - --- - --
BPERMFEE VALUATION 15 , 000 . 00 223 . 56 0 . 00 223 . 56 0 . 00
BPLANCHK PERMIT FEE 223 . 56 298 . 34 0 . 00 298 . 34 0 . 00
BENERGY PERMIT FEE 223 . 56 107 . 31 0 . 00 107 . 31 0 . 00
BPTRAP NO OF TRAPS 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BSEISMICRE VALUATION 15, 000 . 00 1 . 50 0 . 00 1 . 50 0 . 00
BPVENT UNITS 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BREMRELOCA NO UNITS 1 . 00 137 . 87 0 . 00 137 . 87 0 . 00
- ------- - - --------- - - - -------- - ---------
TOTAL PERMIT 797 . 37 0 . 00 797 . 37 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- ---------------- - ----------- ------ -- - - - -
OTHER 797 . 37 VISA
TOTAL RECEIPT 797 . 37
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•CITY OF CUPERTINO,
CATV 4 OF PERMIT APPLICATION FORM b(�_ 6 o 0 F T '
CUPEkTINO
N # 3 2 G 3 D (! CI Date: F161 o 4-
Building Address: Mailing Address (if different from building address):
10 3 6 1+ C P%STd'n1 D R
Owner's Name: Phone#:
X32 - 6744'
Contractor: _ License #:
Contact: Phone: Cupertino Business License#:
Fax:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description: Rc-moN Kk-rtHcKJ. N6w CA6+Voij IJeW CO:'JT'FK 'Cd PS , ADP Awn KNO(
�(
Residential ® r� tsx.-,=up somF EftC?',(KtnL oor�,rS Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
No CNK� G-
Cost of Project: Occupanc roup
t 5 c90o . L 0
Type of Construction: X Pleas check this box if th roject is a
/ _ secon -story additio
roject Size: Standard ❑ 'Large ❑ Major ❑
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 Elce 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
� aGs^66
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