04070145 (2) CITY OF CUPERTINO
BUILDING DIVISION PERNS CONTRACTOR INFORMN
BUILDING ADDRESS: KUO HWA CHEN /T. C. WHANG 111I1N°04070145
74
ER'S NAME: PERMIT ISSUE DATE
W N
KUO HWA CHEW T. C
ONE:
SANITARY NO. CONTROL NO.
ARCHITECTYENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ye;�ig 111
0
_oo LICENSED CONTRACTOR'S DECLARATION Ib DCSCr
Y C 1 hereby affirm that I am limsed mOI
nunder provisions°f Chapter 9(com
encing p
U
with Section?")of Division 3 of the Business and Professions Code.and my license is TANIFINIU III III
n�d immImmaondeffam. REMODEL KITCHEN/BATHROOMS
>�j_ License Clea U1.as 90Z - - d3S
zt4-� Date Centimeter
a sARCHITECTS DECLARATION
1 understand my plans a ans shall he used is public records
®3� IA
3 G Licensed Professional
OWNER-BUILDER DECLARATION
.�<f I hereby affirm mot I am exempt from me Contractor's Licensee Law for me
00 following moon.(Saturn 7031.5,Business and Professionsco
Code:Any city nr unty
X m Pi which requites a permit to mower,alma improve,dcmdL h,or repair any summon 9000
prior W its issuance.also requires the applicant for such permit to rile a signed smmment
t < that he is licensed funereal to dre,prowisiore,of kc Centimeter's Licaftean Law(chapter 9 Sq. Ft. Floor Area Valuation
a $ (commencing with Section 7000)of Division 3 of NC Business and Profcssians Code)or
y — Nat he is exempt uhertfrom and the Buis for the alleged exemption.Any violation of
Secuon 7031.5 by any applinnt for a permit subjects the applicant m a civil peredy of 3 501llffi�erO0 Occupancy Type
not more them five hundred dollars($500).
01,uownmoflMpmpmy,mmyemploycnwithwaguumeirrolecompenorlon, ,,ssa��s...ggq p
will domcwons Con1c;and to Con isnotimcnded man Law red
not
apply
70,W.Business Required Ins LE®
and Pm who bs Code:The Conuilmon,Ldwho Law dues not apply ll an owner is q p
propertywhobuildsvided met umereaeandwho don smhwork moff atthrough his
haver cmployms,provided mase such impmsemenu are ne year of
mpeered for ole. r-
builder,the building or improvement soldwithinono year of completion,theeoncr-
builder will have dm When of proving this M did not build or improve for puryase of
salon SEP3e 2014
❑1,as owner of the property,am exclusively contracting with licensed romractors m
consumer me pmjcn(Sec.70Cd.Business and Profusions CadeO The Conuacter s Li-
ccueLaw donrsnot chapply rjeanownerofpropertywhoWildsorarmtouCommeand BUILD tl
who. aces for such projects withmconvanor(s)linnsed pursuant to the Conaanoss `®y tpCf� I@9yyp`Jtlryg
see law.
Clamemmpt dersee. .B&PCT renis rtuon
oar /r 1st Js&'
W KER'SCOMPENSATIONDECLARA
1 hereby affirm under Penalty of perjury one of the following declarations:
❑Iharm and willmunuia aCemrinm of Consentmself-insumforWartersCompen-
ano.n,ss provided for by Secuon 37W of dm labor Code.fee the performance of me
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,u required by Section
37W of the labor Cade,for the performance of Ibe work far which this permit is issued.
My Workefs Compensation Insurance carrier and Policy number sre;
Comer: Policy No.: .
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need net W eomple.d if me permit is return
hundred dollars(5100)
or less)
1 eenify m me performance o!the work for which this permit is issued,l mall not
cmployany ymanner sea as o ec mesubjecuo the Workers Compensation
Laws of ca D 1+�-Yuri.
Ap canes ✓ `��fY/�
WN qE TO A" 1CAN:It.after makmg this Certificate of Exemption.you should
p e subject w the Worker's Comp reemo r provisions or me Labor Code,you must
.JO forthwith conn,Ywire such provisions or this perm it than l be memed revoked.
Z" CONSTRUCTION LENDING AGENCY
[-.� IWmby affirm met mart is a construction lending agency for dtc perfrmtarom of
".�> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Under'a Name
6s Landeri Address
V1 anify that I have read may application and state mel the shave Informed.is
{2..E' comcm I agree to comply with all city and county ordinances and sate laws relining m
�U building conswmion,and hereby aumoriae repremmisuives of this city aro came upon the
r� move-mentioned property for iurreelmn purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
F' ,I Iiebiliucajudgencncs.cases and expcuu which may in any way accme agama aid City
U Z Aconsequence
PLIC NT°of ft UNDERSTA°g of DS Ars Permit.
ND WILL COMPLY WITH ALL NON-POINT Issued by: D
�K?/
SOURC R11ATIONS VT' rC
— i*
Re-roofs
Sign of APplic °mmum ate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future Wilding occupant store or handle ha ardous material
as ticfined by me Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Ca1c.5ccy25532(a)?
m `J All roofs shall be inspected prior to any roofing material being installed.
❑Y
Will eW applicant or future building oceup rat use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conmenimma in defined by the Bay Area Air Quality Management all new materials for inspection.
DisuicR
❑Yrs �Nu
1 have mad me havamens mamrimarequiremenes under Chapter 6.95of the Califor-
maHealm&Safely Code,Sections 25W5,25533 md25534.l undersand mat lithe Wilding
door not currently hen+:a mnam,that it is my responsibility W early the Oacupam of the
requircmcm hie usrl t rwismanaafaccmOCamrif0m yr. Signature of Applicant Date
or mou,ca agtn All roof coverings to be Class "Bt'or better
CITY OF CUPERTINO*
CUPEt�F PERMIT APPLICATION FORM o `f �S
APN # Date:
Building Address Mailing Address (' d' erent o bu' ding address):
2 06 LI, Q 119Z)V, Gt f
Owner's Name Plione #:
c _ w!
Contractor: 2V v License#:
O l �'e k
Contact:, Phone: 6531Cupertino Business License#:
G✓�a� Fax:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description: Pe� u � nocrr gQ K' chi -
Residential ® F �� ,d t��Co /mmerci lam❑l 7N d
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: fS� Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
Project 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> IM 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
2- q /
lof3
*CITY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEVINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCONSIE New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCONIW 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 rinklerBackflo PLUMBING
/ BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER WaterHeater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 clip MECHANICAL
BREMAHUiAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BRENU T A P Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
a BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Ap Hance ELECTRICAL
2 of 3
p- *ITY OF CUPERTINO * .
CUP kTTYOF O PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmd] 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 Insection 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 Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Change BMDING
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A ROVED
s N+ I ACCORDA E WITH CITY 0
PERTI DIN ES
drrJllS .dr{
This �► pf Wens specifications MUST be
1 kept on the jo all times and it is unlawful
C�Q1J I>LA�xj to make angel or alterations on same
A houI en permission from the Building
• Deo ent, City of Cupertino,
' eQ The stamping of this plan and specifications
her ,
r,Pkpjoot 5 r, s4( SHALL. NOT be held to permit or to be an
ti/ AP001„►! arroval of tha wn'-fi... p ;ny provisions of
uaiance or State L,w.
Tk
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