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05060195 (2) CITY OF CUPERTINO :r� BUILDING DIVISION PERMIT CLINTRACTOR INFORMATION BUILDING ADDRESS: WEST COAST DEVELOPMENT ""'NOD 5O 6 O 195 10451 GLENCOE DR OWNER'S NAME: PERMIT ISSUE DATE SHUI LIU 6455 ALMADEN EXPWY 06/29/2005 ONE: SANITARY NO. CONTROL NO. (408) 323-1549 7�- CHIEC,ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ' (� � •(�lo NSD 0 LICENSED CONTRACTOR'S DECLARATION r I Mreby&Man Nat I am licensed under provisions or Chapter 9(commencingIOb DCSCfIpt1O0I th Sation7")of Division3ofthc Busimcssnd Profession Codc.ndmylicenseis U bI�\: ��L .umrceanaeRea UPGRADE ELECT. PANEL (2OOAMP) ense clow LiaNm Coattail.,—FARCHITECTS DECLARATION a5 C< 1 understand my plans shall he used u public records ;ON Licensed Propositional Fri, II l I �I I) la II 1`as OWNER-BUILDER DECLARATIONI II ) \VP��D L— I Wrch lLde atm Sal I am exempt from Ne Convmrs License Law(or the `Il �l p o following reason.(Section 713 I.S.Business and Pmfessisu Calc:My city or county � � II I r K m which require a permit in consumer.alar,improve,demolish,or repair any ssr icsurc $1000 Loi prior m its issuance,also requires the applicant fa,such Permit to rile a signed monomer $'zc that kislicensed pursuantmthcpmvisi.uofthnConrmceriLt... aw(Chaper9 Sq.Ft. Floor Area Valuation .� (commencing with Section 7000)of Division 3 of Ne lbsinessand Professions Code)., a.9$ Chet he is exempt therefrom and the basis for Ne alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of er Occupancy Type not marc Nan Eve hundred dollars(5500). ❑I,uowner of the pma+ty,or my employes with wage utheir sole compenssdn, will do the work.and d,eswcture is Out ntended or a(fced for side(Sec.7W,Business Required Inspections and Pmfu'ou Code:The Comea tors License Law does not apply m an owner of - q P property who buildsat improves thereon,and who doessuch work himself or through his Own employes,provided Nat such impmsemcnu ase not intended oroRered forsale.If. however.Ne Wilding or improvement is sold within am year of completion.the owner. builder will have the burden of proving that he did not Wild or improve for pugote of sale.). I,as owner of the mr,any,am uduswely considering widt licensed m...m consumer the pmject(Sec.7064,Business and professions Cade:)The Condition's Li. cense Law duo not apply to.n owner of property who Wilds or improve thereon,and who contracts for such projects with a contractor(s)licensed pursuanuo dm Contractors License Law. ❑I oat exempt�arae,See. �— B&P C far this rcazon Owner. Er e � Data t- WORKER'S COAXPENSATPON DECLARATION I hereby affirm under petWty of perjury one of de fallowing dalaretiou: I have and will maintain a Certifiaa of Consent in self-insum for WorkersCom,en- 703710) ion,u provided for by Section 3700 of Ne Labor Code,for the performance of the rk for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,u required by Section of the Labor Code,for the performance of Ne work for which this Permit is issued. y W.,on's Compensation Insurance carie,end Policy nmber am: rtier: Policy No.: CERTIFICATE OF MEMPTION FROM WORKERS' COMPENSATION INSURANCE (Ihu section recd not W completed if site Permit is raone hundred dollars(SIM) or ti ss) 1 certify thst in the informancc of the work for which this permit is issued.I shell not employ any person in any mnnersp u o become suhiw to the Workers CompCnsadon Laws of California.Da __ L: tai' UJ AapIieam tedg-� - s` Ae aP NOTICE TD APPLICANT.If,after making this Certificate of Exclsiption,you should become subject t.the Worker's Compensation provisions of the Labor Code,you must .JO forthwith comply with such provisions or this Permit shall W deemed revoked. '„Zj" CONSTRUCTION LENDING AGENCY ��+ Ihereb afLrm that Mete is a construction lending ac F Y g grey for the performance of Luthe work for which Nu permit u issued(Sao 309'i,Civ.C.) Q finders Name � Z landeri Address U Q 1 ttnify Net I have read Nis application and suss that the Move information is D, F COMCl,1 agree m comply with all city and county ordinances and sou laws relating in OU building construction,and hereby authmim reptesentstieS of this city m enter uponft , Fu .hove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless Ne City of Cupertino against fa'A Liabilities,judgmcau,costs a ad exPeucs which may in any way came against said City U Z in consequence of the gtanti ng of thiagrimil. ^ APPLICANT U ERSTANDS A(NO WILL COMPLY WITH ALL NON-POINT Issued by: Da[gj_,1�-S SOURCER TIONS. Re-roofs P r Signature afApplianUCanuacmr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant of future Wilding occupant nom Of handle hevandri material as defined by the Contains,Municipal Code.Chapter 9.13.and the Health and Safety ale.Schen 255 W? - All roofs shall be inspected prior to an roofing material being r-1 Ye, / .. P P Y g g installed. If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or(uwrc building by the Bt use equipment or devices which _ it havardnus air contaminants az defined by the Bay Arca Air Quality Managcmcnt all new materials for inspection. isvict? ❑Yes <No 1 have mad the Wardnxmaerials requinemcnu under Chsper6.95 of thc C.Iifor- niaHalth&Safely Code.Satioe 25305.25533 am125534.1undetnnd des ifde Wilding does not cuncn0 have a tens at it u my rcspouibility m notify de occupant or de roquircom - mouse pfaratitsana.r.ceriBeamafaaPncy. Signature of Applicant Date Owner. agent Bate All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEI�TINO Building Department JOB ADDRESS: PERMIT # 1aL15 \ G 1 0 CC 0,5-4 alms OWNER'S NAME: 5 rn PHONE # "1 10-ZL44 1 GENERAL CONTRACTOR: We-5V Coag FAX # I am not using any subcontractors: __ _ Signature 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 Owner/Contractor Signature Date CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO APN #�ZC -3 ', Date: Building Address: Mailing Address (if different from building address): IOLISI Cc �@nCo� �v • Owner's Name: Phone#: L, ; - LI yS3 — q � 3 7 Co ractr: License #: X322 EST CncS-1S� ��e�. Cntact: Phone: 1 V-,Ll L4 Cupertino Business License#: .e� 1 Wa'V S Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential• Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: , p a Occupancy Group: Type of Construction: Please check this box if the project is a AML second-story addition: ❑ Pro'ect Size: Standard ❑ Large ❑ Major ❑ - Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER] 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 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 3 �/ l�/ 1 of 3 CITY OF CUPERTINO cl OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP 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 AiiiL-- BPTRAP Kitchen Trap PLUMBING IF BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFLYT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 a CITY OF CUPERTINO CITY ' YOF. PERMIT APPLICATION.FORM CUPE TINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl 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 Inspection 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 PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING c • 3of3