03060072 (2) CITY OF CUPERTINO �' '- _ +"
Bummrvc DrvlsloN PERMIT 'ICON.,""k-T R INFORMATI(•H
BUILDING ADDRESS: TRACY TRAN PERMIT N0.03060072
OWNER'S NAME: PERMIT"09A'J102003
• TRACY TRAN
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT`ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION
�ZW 1 ion? affirm that I am fttheBu under provisions of Chapter 9(commencing Job Description
W withSeorceAn g)exDivision 3af NeBusiness and Professions Cade,and myliwna is
y in full forte end c(fmt p� pA �m
®
pLl? License Class Lice DECK & PRE-FAB GAZEBO
f'a Dau ContrscmIFI�tll�Gr ■
22 ARCHITECTS DECLARATION
W U I undcruand my Nati shell be used u public rccmds
o f Li«nud Profesamn.) SEP O.22003
S OWNER-BUILDER DECLARATION
I i hcrchy affirm that 1 Am seem,.fru.the Contractors Uconse I.A.for thd
O0 following reason.(SccdonIIB1.5,Business and ProfcuionoCm4:Any city orcounty BUILDING
5 m� which requires a permit to construct,alter,improve,demolish,or repair any someone
_Zo' prior m its issuance,also requires the applicam rorsuch permit to rile a signed summcnt
s< that heulicensed pseement0NCPmvrdmuOfurn Comraclor'slJanseLaw(Chapser9 Sq. Ft. Floor Area aa �4 Ion
YFG (commencing with Section 7000)of Division of the Business and Profeaainns Code)or V�V
y
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7071.5 by arty applicant for A Permit subjccu the applicant to a civil penalty of 3 ABN NQBa Wr 0 0 Occupancy Type
out.me Nan five hundred dollars(g500). P Y YP
0 1,ex moor of the propeny,or my employees with wage u their sole compensation,
a will d°the work and the swcwm is not intended proffered for ole(SecBusiness,Business
end Professions Cmc:The Conmcmrs License Law does not Apply to an owner of 102 — PIERS d Inspections
property who buildvu s orimpmNereon,and who doessuch wort himselfor through his
Own employees.provided that such improvements and not intended or offered foraale.If. 103 — UFER
however.the building or improvement iasald within one year of completion,the owner.
Wilde"will neve the burden of proving that he did net build Or improve for purpose of 104 REBAR
alt')' 105 - ANCHOR BOLTS
❑1.u owner of the poOe.70..Business exclusively comsacdns with Imemedonmect ors b
enmwnth oes not pplytula own ,ntsmywhoans Codr The Conu,con, U. 106 — SEWER & WATER
cerise law Boas not apply a an owner or t mpeny who cadre or tmprovns theteoa,and. 202 — UNDERFLOOR PLUMBING
who contracts for such projects with a contranor(s)licensed pursuem N the Contractor's
L .Law. 203 - UNDERFLOOR MECHANICAL
I ameaemptundm Sca ,B&PCfor Numason 204 - UNDERFLOOR FRAME
° fir an, 205 - UNDERFLOOR INSULATION
WORT P S 1 II RAT
I hemb affirm ander It r 301 - ROUGH PLUMBING
y pend y o rjury oro of Ne follow g dedantians: _
❑I have and will maintain,Cenlfiale ofContent o,elf-houre forWorterf Compcn- 302 — TUB & OR SHOWER
sation.As ymvided for by Section 3700 of the Labor Code,for the performance of be 303 — ROUGH MECHANICAL
work for which this permit is iseueQ 304 - ROUGH ELECTRICAL
❑1 have and will maintain Workor's Compensation lasu.nct,u required by Section
37M of the Labor Code,for the performance of the wart for which this Permit is issued. 305 — FRAME
My Workers Campettsadon I..carries and Policy number Are: 306 — HOLDOWNS
cam`r: PolicyNo.: 307 - INSULATION
CERTIFICATE OF E%EMPPION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
(This section need not e completed it permit is for one hundred dollau(SIOD) 309 - EXTERIOR LATH
IemsaJ 310 - INTERIOR LATH
e certify,Nat I.the n"fimmance
rmoar the work for which this permit rk issued,l snail not
e.ployany persoa in mannered aawbecome subject the wo¢ers'•Compensation 311 — SCRATCH COAT
Lawsof California.Data
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT.If.after making his Certificate of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject to the Workers Compensation provisions of the Labor Code,you must
]Z roothovidt comply with such poroisimm or this permit shall Is,doomed revolcOd. 502 - FINAL PLUMBING ENERGY
?O CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby alumNm thera is A eonstruminn lending agency for the pcolurmance of 504 - FINAL BUILDING ENERGY
x >
doe work rurwhich this Permit isissued(Scc.J09'r,Civ.CJ
Lenders Name 505 - FINAL ELECTRICAL
y Q
� Z sneetaAeerea 506 - GAS TEST
J O 1 coolly that I have read this Application and sum that the Above information is 507 - FINAL PLUMBING
y. (•-' Correa 1 agree to comply with all city and county ordinances and soon,laws relating to
U building construction,Andhereby Wdodmrtprounooti.ofNucity toCole,uponNc — FINAL MECHANICAL
Canovomentioned property for inspection purposes.
(We)agree to save,indc.ni fir and troop harmless the City of Cupertino against O "FIIiabilidu,judgmcnu,costsande.,.whichmayinAaYwayacwcagainstsaidCity WNWGOZ in consequence of the granting of this PermitAPPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 5RKS Dat
SOIRteERE6 ATIONS.
Re-roofs l
tgwwre of Ap,fr.. amractor Du
HAZAR ATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant sore or handle havidous material
As defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
We.Section 25532ta)?
❑Yea XNu All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future building occupant vac a If a roof is installed without first obtainingan inspection,I agree to remove
PP 6 P equipment or devices which P
coil hazardous air contaminants AS defined by the Bay Area Air Quality Management all new materials for Inspection.
Distric,
❑Yes No
I have read the Lamm nus materials mqmde
uirecnu unr Chapter 6.95 of the Calirar
nia Hmlth&Safety Code,Sections 25505.25533 and 25534.1 underst000d Naz if the building
Jou rot li ncntly nate A tenant Not it u my responsibility tify Ne occupant or the
myui -ch,vojch,.ustbemetpriortoissuance Ora CcniBcate aapancy. ignature of Applicant Date
owner m,umoriana sent 11D,c All roof coverings to be Class"B" or better
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OWNER-BUILDER VERIFICATI011
• 1. (Check one) I or my immediate family(parent, spouse or child) will perform:
A. All the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C 7.behiredJQAQ;-
1 below
UN 1 0 2003-
2.
003
2. A state licensed contractor
A. _ All of the woVeork
B. _ A portion of (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder InformYe:
(reverse side). /� \ /
Property Owner's Signa � Z A CAA1 r 1 � l Dad: 14
�j0 7
Job Addrs10-]-'2- To h Yn } V2 Permit# ✓� �/
'" 1 a y o
• Any changes to the inforiationprovrded on this form shall be submitted to the City of Cupertino Build
Department.
- Y OF CUPERTINO • o 04U--il Z
CITY OF PERMIT APPLICATION FORM
CUPEf�TINO
APN# !L7 Date: /
Building Address:
10-7
Owner's Name: Phone #:
408 - SU _ art 12
Contractor: License #:
Contact: Cupertino Business License#:
T✓A fA V1/
Buil Permit Info:
JSIdg Elect ❑ Plumb ❑ Mech ❑
bDe 'ption: _ FAV
Residential D tbK &A-�a n Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction:
f-
uanti Fee ID Fee Descri tion Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BB0ILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTTO 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
- 2 -2 �
1of3 � � 2 , ��
SR ATY OF CUPERTINO •
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Descri tion Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pb1g Fixture PLUMBING
BPGAS Gas Piping S stem 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 eOfFixtures 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
13PWHEATER 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 A liance Install MECHANICAL
BREMBUSWAY Remodel Buswa s ELECTRICAL
BREMFIXT L;,I,+;--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 A aratus ELECTRICAL
BREMNRAPP Rem Non-Res A liance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
2 of 3
Saw. CITY OF CUPERTINIR
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
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
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 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 Electical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE I Plumbing Permit Issuance PLUMBING
PPL BG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
CITY OF CUPERTINO �" '-
BUILDING DIVISION PERMIT CUNTI2ACKTUR�INFURMA'�ION : .
BUILDING ADDRESS: TRACY TR.ANV 111ITN0.03060072
EWS NAME: PERMIT 769'/'l 0 2 0 0 3
NE: SANITARY NO, CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
RLDG ELECT PLUMB MECH
0 0 0 0
uoo LICENSEDCONTAd under SDECLARATION
fChap
4 1 hereby affmn w,I ren licensed under provisions of Chapter 9(commencing Job Description
with Sauon 7=)of that
3 athe Butlroas and Plefessiom Code.and my license u
n n. in full fora and effect. ww�
; _ L enmeu Lic.g DECK & PRE—FAB GAZEBO INALE®
Dam Commuter
ARCHITECTS DECLARATION
W1 mumsund my plans shall W used u public records SEP 0'2 2003
ke.
G G Licensed Professional
5 OWNER-BUILDER DECLARATION B � ��-°°°
<F 1 hereby a(Sm Ne,I am eumpt from Ne Cmaracrar'a License Law for the �'BaaBrl'��
p O following reason.(Section 7031.5.Business and Profesduns Code:Any city or county
e B� which requires a permit to construct,alcor,improve,demolish,or repair any structure
a y prior m its isuan e.alm recut.the applicant far such permit to file.signed summon,
< ,hathe is licensed pursuanuodle provisions of Ne ConmmorsLi.com law(Chapter9 Sq.Ft.Floor Area C3Y@;"lOn
tcFO (commencing with Serlion T001))of Division Sof Ne Businessand Professimu Cme)or Y
i that he is eaempt therefrom sold the Was for the adcged caempdon.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 AP141Qi5Wr 0 0 Occupancy T
not more than five hundred dollars($5M). P Y YPe
1,u caner of Ne propmy,a cosi employm with cages u Heir talc compewtion,
willdo thework,and the structure,isnot intended oroRerel hustle(See,7044,Beat.
and Professor.Code:The Conuaaors License Law does not apply m an owner or - d Inspections
property who builds or impmaoa;theaon,andwho daaauch work himselfor,lwugh his 102 - PIERS
own employees,provided thatsuch improvements are not intended proffered forssle.If. 103 — UFER
however,the building or improvement is said within one year of completion,the owner.
builder will have the burden of proving that he did not build or improve for purpose of 104 REBAR
"l`')' 105 - ANCHOR BOLTS
❑1.ss weer of the See.7 ,Business siv nil contracting with licensed ntra'aoors,o
amm La the project(see. nBaa,wnrofand Professions code:)The Contractor's Li. 106 - SEWER & WATER
ave hwdoes nuchapply mjcm owner of PmpenY who buddsoeimproves Comoa,and 202 - UNDERFLOOR PLUMBING
who contracts for such projects with a eonV9emr(s)liaysd Oursuant m lite Convenor.
C nse1.w. 203 - UNDERFLOOR MECHANICAL
lam uempty der See ,B d:PC fee Nisomon 204 - UNDERFLOOR FRAME
WORC RA
'te 205 - UNDERFLOOR INSULATION
I hemby affim,on& penslty of Buryoneefamfollw Ideclaradons: 301 - ROUGH PLUMBING
I have and will maintain a Cer4cm,ofComent,.telf-insure fm Worker's Compton- 302 — TUB & OR SHOWER
station,as provided to,by Se tiara 3700 of the Labor code,for d o perfmomme of no 303 - ROUGH MECHANICAL
work for which this permit is issued. 304 - ROUGH ELECTRICAL
0 I have and will maintain Worker's Compensation Insurance,u required by Section
37W of the labor Code,for the perfomrance of the wont for which this pemth is issued. 305 - FRAME
My Workers Compensation lot..currier and Policy number sur: 306 — HOLDOWNS
Ca.rier. PoliNo,
307 - INSULATION
CERTIFlCATE OF FXEMPONty FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
moots)
rlht,satiro need not a completed it the Permit it for oro huweddollars(SIW) 309 - EXTERIOR LATH
310 - INTERIOR LATH
I pploy the,er on in my mavac of dm work for which this permit rl issued,l shall nm
omployany cahruon in mannermssmbccome subject to the Wprteri Cempensadon 311 - SCRATCH COAT
Lawscant pmia.Dam 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT,If.after making this Ccniricale of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become Subject to the Worker's Compensation provisions of the Labor Code,you must
�z forthwith comply with such prodalonsorthis Permit shall ondeemed revoked. 502 - FINAL PLUMBING ENERGY
?
CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirmthat thea it.construction lending agency In,the perfutrance of 504 - FINAL BUILDING ENERGY
z> theurwhichthisp mitublood(S .J097,Civ.C.)
1<ndresNam. 505 - FINAL ELECTRICAL
i 0 pdera
Z) z Lpaertnddre: 506 - GAS TEST
p 01 anify Nso I here rod this applicadan and sum that the obo a infomadun is 507 - FINAL PLUMBING
L,r_ mrmc,.1-gra to ComPly withall tit,and cWmy ONirtanaaand Nm bow refining to
pU Wildingconswction,andhembysuthodaemprescnutimofthucitytoenteruponthe - FINAL MECHANICAL
a abovcmentioned property far inspection purposes.
(We)agree m saw,indemnify and keep hsomless the City of Cupcni.against 0 F I
.�.rA liabilities,jodgmcnu,cp.uandcapcnsu which mayin anywayaccrne ag.mulaaid City I NG
JZ in consequence of the granting of Nis permit.
r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 5 C WORKS Dat
s0 �OfApplimm
ignuD InRe-roofs
TERIALS DISCLOSURE Type of Roof
Will dm applicant a future building occupant store or handle harsrdous material
u Sector,
ec or the 32(.)?ro MuniciMl Code.CTapter 9.13,and Nc Health and Sa(ey
. El ea3553z(a)'! All roofs shall be inspected prior to an roofing material being El Yea �No P P Y g g installed.
Will the applicant or future Wilding occupant uscegmpcom,ordcviccs which If a roof is installed without first obtaining an inspection,I agree to remove
it heranious air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
istrla3
❑Yes No
I have nom the burs nusmamrials requimmenu under Chapmr 6.95 of the Califor.
nice He-]"Safety Codd Sections 25505.25533 and 35534.1 undcrsutW dm if the building
dors not currently haw a a:nam,that i,u my responsibility lily the acupant of the
requi uwh' muatbeme(poortoismuccof-Ccrdfcam Rcupancy. ignafUfeOfApphcan[ Date
Owner or authorized egmo pa AI I roof coverings to be Class "13 or better