08020077 (2) CITY OF CUPERTINO ��L,� �2T�** ��y}�L,���� * �« z
BUILDING DIVISION PERNUT S^V�NTRA, T,pR NFU,A tA�l�gtt l.� �
y : Wit,
BUILDING A40FESS: PERMIT NO.
104UC JUDY AVE TBD - TO BE DETERMINED 08020077
R'S NAME: PERMIT E DATE
STEPHISSUE
CHEW - 02/13/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHIfEC IENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
30o LICENSED CONTRACTOR'S DECLARATION IbDeSCrhon
rd 1 thereby NODescription
affirm
al 1 am licensed under provisions of Chapter 9(commencing
wRh Section 7")ofDivhion 3 crave Buaineu mad Professmas Coda.and my accuc is 125 TO 200 AMP UPGRADE
?n in full fade socialites.
C s 2 License Class Lk.g
Dau Contractor
ARCHITECTS DECLARATION
1 uWenund my plans shall the used is public records
kt�
bud Licensed Professional
y OWNER BUILDER DECLARATION
CmatION
at o E 1 hereby a1Bnn Nat I I.S.attempt from 1Pr Conlriat Cc License law for the
i o o following moon.(Salon 7W 1. Business and ve.dmioos Cede:Any city or county
3$ which requires n permit no c mmi the alto.hnprove,h permit t or repsig any swerum
_ZS^
prior miu issuance.atm requires du applicant(or inch permit to Bk aaitnod statement
¢¢x�
that ho is licensed pursuant to the purrism.of the Conuacmrs Lice.Law(Chapter 9 Sq.Ft,Floor Area � Valuation
yF$ (commencing with Section 7000)of Division 3 of the But.and Prefectures Code)or 3[](]Q
Q that he Is asempt thereho oand the basis for the alleged exemption.Any NolNon of
Section 7051.5 by any applicant fora permit subjects the applicant to a civil penalty of pp Number Occupancy Type
rot mom than five hundred dollar(S500). 3 75 10 0 0 2.tl bl Num
❑1.as owuer of Ne property a may wplaym with wagex as thele sete composed..
will do the woh,and thesuumum is not intended aro@red formle(Sec.70th,EuaiM••
and Poor..Ins Cade:The Co^mcmB Liaise Law dam at apply m an owner of _ Required Inspections
propeny who Wildsorlmproves Nerean,and who daeauchwark himtenor thmngh his ,
ownemployces,provided that such improvements are amt intended oro@red for We.if.
however.lie Wilding ar improvement is said within ane you of mmplction,the owner.
Wilder MB have the burden of proving this M did not Wild or improve for purpose of
mat).
y].a mater of the property am exclusively contracting with actuated conuanon to
canswc,the project(Sec.70".Business and Professions Code:)The Contractors Lb
cave law dose not apply m an owner of property who Wilds or improm Neaten,and
war convects for such projects with aemmosemr(s)licensed Furman,in Lot ContracmYs
Liaise law.
❑I oro Meerep,under SSes,�.e�, / n' ,B h PC for Ws noon
4oror I/t�fGsi`^cil f ALN Date j1 lI w,
WORKER'SC PPNSATION DECLARATION l'^
1 hereby aftlrm under penalty of perjury cue of eche following dalatWoos:
C]I ltsve and will maintain a Certificate creatural m self-houre forWorkers Camper
anon,as provided for by Section 5700 of the Labor Code,for the Performance of the
wok far which this permit is issued.
❑1 have and will maintain Wort Compewation btsunna,as acquired by Schon
3700 of du Labor Cade,far am pertomanca of the wart for which Nit permit uluuce.
My Worker's Compensation law.carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need am t he cam placed Ir the Permit Is fa one hundred dollars($100)
or lea)
I certify that In ter Performance of Ne woh far which this permit is Issued,I shall not
employ any person in any manaesseu before subject to the Workeri Compensation
Uvea of.?kif its„Dam.
Applicant,` r
NOTICE TO APPLICAtT:If,after meting this Certificate of Exemption,you should
become subject in the Workers Compensation provisions of the La Wr Code,you mum
z forthwith comply with such provism.or this permit shall be domed revoked.
'Zy CONSTRUCTION LENDING AGENCY
[ti I hereby affirm dam dem k acouuunlnn lendingagency far thermformmc
ata -
Ci Nc work(or which dds permit It issued(Sec.3M,Civ.C.)
4 Q Undoes Name
=z Lead e.Address
U O 1 anify,that 1 here mad this application aod tum Lost Ott serve information Is .
U,^ cr n I atter in comply with all city and county aNinanva and was laws)Wing in
�0 LS J' Wilding construction.and hereby mNorim repreunudvrs of this city to color upon Ne
Li] serve-mentioacd property far itupecdon purposes.
G (We)agra to save,indemnify and kap hmmlem the City of Cupeni^o against
W Iiabilitiex.judgmenti cow and oviparous which may in any way accrue sgaitultaid City
z in consequence of the Smart of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date,2
SOURCE REGULATIONS.
(�^ C 's'�r I n, - �/
Slgnetum ofA anUC^o nectar Dau Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam or fours building mcupant mom or handle humdow material
defined byte Cupenino M niciryl Code.Chapter 9.12.and Ne Health and Safety
Seedan n532(,)+ All roofs shall be inspected nor to an roofing material bei) Installed.
❑Yos No P P Y g g
Will ftapplicant err far”Intildrall9ccapant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Im arck m air mournamm u defi by Nr Bay Area Air Guilty Management all new materials for inspection.
District?
❑m
I have mal the Imumuts materials requiremcnu uok,CNpur6.95ofNe Califor•
nu Heal"SafctyCodc,Satiate 25505.25533 ant!25534.1 understood dam fide Wilding
does act currently 1mve•moans.IN,It u my mmonubility in ratify Lot oauPm,of de
mrtmcnts which mum beret poor in issuance of a Certificate of11. S ignature of Applicant Date
y , OR
Gwtt" ar.mNa (eG`^ lD r� All roof coverings to be Class"B"or better
,
Re #I• a$v ( oma7I
CITY OF CUPERTINO ,ORopC)ol�
• CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN# 37S I�®a Y O� Date:
Building Address:
(M-Dg J f�✓e , Cu �,t-��.,o �Sro N
Mailing Address (if different from building address):
Owner's Name: Phon #_ 56c1, D'7(f-2-
Contractor: Phone: 4t5- 21 _ 7533
Dca;ae-n 14a tvrs Fax:
Contractor License#: 3 191 S.3
• Cupertino Business License#:
Contact: Phone: 5-10 _ 06- —7 719,
Sohn Tsa Fax:
Residential LA Comfdercial
Job Description:
?+ 3 _
i 2S -to
Building Permit Info: _
Bldg R Elect Plumb 5a Mech ❑
Type of Construction (Usage Class): Occupanncy Type:
1 FR, 11FR E] 11, 111, V-lHR El 11, 111, 1V V-N 1
Valuation: Square Footage:
• Project Size: Standard ® Large ❑ Major ❑
CITY OF CUPERTINO
CUPEkTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID "' Fee Description Fee Permit Type
Group 1GENRES or
r.
1GEN1QQK
113TEMPPER Temporary Buil mg Permit (good for B
30 days)
1BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
cl 100,000 Btu/b. Z9.3kw
1BBOILER2 Installation/relocatioh of ea " V "
e •; .. ; . boiler/compressor over 3 horsepower
,.
to & incl 15 horsepower, or ea
absorption ss over 10000 Btu/ti
1BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to &incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
&incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M,
boiler/compressor over 30 hosepower 'T ' h ry '
to &incl 50 horsepower, or for ea '
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
113130II�,ER5 . hLgtsllatjon/rcloc4tio o�feApol � ZVI M ay;1
b'" refiigeration.compressor over 50...
horsepower, or ea absorption sys over
1,750,000 Btu/Ii
113APPLOTH Foi ea�appli,4nce or'piecd of equip: .>.'� + +::r
regulated`by, this Code but not classed'
in other appliance categories, or for
which`no other fee is listed in this '
code.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour) •
1PLMBINSP Other Plumbing & Gas Inspections P
(per hour
1MEETINGIHR Application Meeting B
CITY OF CUPERTINO
CUPEftLTINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWL/Duplex New B
1ACOUSRESAD SFDWL/Duplex-Addition/Alteration B
1ACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
1 FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
IFIREPLMAS Fireplace Masonry B
1FIREPLFAB Fireplace Pre-Fabricated/Metal B
1FLAGPOL>20 Flag pole (over 20 8 in height) B
1MODUSTRU Modular Structures B
FOUNDATIONS
1FOUNDREP Foundation Repair B
1PILECAST Pile Foundation Cast in place concrete B
1PILEDRIV Pile Foundation Driven (steel, pre- B
stressed concrete
3 of 5
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/SfFee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
RETAINING
WALL(CONCRETE
OR MASONRY
1RETSTN Standard (up to 50 ft) B
1RETSP310 Special Design, 3-10' high (up to 50 `) B
1RETSMO Special Design, over 10' high (up to B
50'
1RETCRB< Gravity/Crib Wall, 0-10'high (up to B
50 ft
1RETCRB> Gravity/Crib Wall over 10' high (up to B
50 ft
SIDING
1 SIDESTBK Siding, Stone &Brick Veneer B •
(interior/exterior
1 SIDEOTHER Siding all other B
SKYLIGHTS
1 SKYL<10 SF Skylight less than 10 sf B
1SKYL>1OSF Skylight greater than 10 sf or B
structural
1STAIRS Stairs-first flight/ea addt'l B
STORAGE RACKS
1 SRACKS<=8 Storage Racks 0-8' high (up to 100 sf) B
1 SRACKS>8 Storage Racks over 8' high (up to 100 B
st
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
4of5
CITY OF CUPERTINO
WIF
• CUPEI�TINO GENERAL BUILDING APPLICATION
FEESCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows
1WINMEWSTR New Window-structural shear B
wall/masonry includes plan ck fee
IEPERMITFEE Electrical Permit Fee E
( 1MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
lTRAVDOC Travel &Documentation B
1BUSLIC Business License B
5of5
• CITY OF. CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37510002 . 00
DATE ISSUED. . . . . . . : 02/13/2008
RECEIPT #. . . . . . . . . : BS000003927
REFERENCE ID # . . . : 08020077
SITE ADDRESS . . . . . : 10408 JUDY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : STEPHEN CHEW
ADDRESS . . . . . . . . . . : 10408 JUDY AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : WENDY N CHEW
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD. .- TO BE DETERMINED
ADDRESS . . . . . . . . . . : _
CITY/STATE/ZIP . . . .
• TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 3, 000. 00 0.50 0. 00 0 .50 0. 00
1ELECINSP HOUR 1 . 00 122 . 38 0. 00 122 .38 0. 00
IEPERMITFE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00
ITRAVDOC FLAT RATE 1. 00 40.79 0. 00 40.79 0.00
---------- ---------- ---------
TOTAL PERMIT 204 .46 0. 00 204 .46 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 204 . 46 VISA
---------------
TOTAL RECEIPT 204 .46
•
Community Development
10300 Torre Avenue
9 Cupertino CA 95014
Telephone(408)777-3228
lotCITY OF Fax(408) 777-3333
UPERTINO
Building Department
JOB ADDRESS: PERMIT #
l04fo Ave C -�iwfl CSA R5o1 � OkO A 00 -7-7
OWNER'S NANEL PHONE # 4-IS
GENERAL CONTRACTOR: cG i s 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
/Contractor Signature Date