05030106 (4) CITY OF CUPEWrINO
BUILDING DIVISION PERNXTORINFORM* r�ON
BUILDING ADDRESS: ROBIN SUNG PERMIT ND05030106
NER'S NAME: PERMIT ISSUE DATE
JI
PHONE: SANITARY NO. CONTROL NO.
(408) 257-1827
ARCHITI
2 7-
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u00 LICENSED CONTRACTOR'S DECLARATION
MwF I hereby affirm that 1 am limuscd under provisions of Chapter 9(commencing Job Description
u�' with Section7")nf Division Sof to Business and'Professinns ode,and my licenm ix
'�« in nx arta caret. JJ UOUp DRYWALL ON GARAGE/REPLACE` WINDOWS (2)
j�= License - 1� �Lie.p
Date Contra r START JOB WITHOUT PERMIT/BPERMFEE FEES DOUBLED
ARCHITECTS DECLARATION
I undersand my plans shall w used az public remain
DyU
3O Licensed Professional
OWNER-BUILDER DECLARATION
ay I herehy affirm the I am exempt from the Comoser ar's License Law for the
00 following M.M.(Section 703 1.5,Business and Professors Code:Any city or many
v$ which requires a Permit In construct,alter.improve,dcmofish,or repair any structure
prior in is issuance.also requires the applicant for inch Permit o file a signed sammcnt
ti'< that he is licensed puuant m the Previsions of Ina Contractor's L icensc law(Chapter 9 Sq.Ft.Floor Area Valua"2 0 0
mnrsa (commencing wit Section 70[0)of Division 3 of the Business and Professions Code)or
c .. Out he is exempt therefrom and the basis for to alleged exemption.Any violation of
Sermon T031.5 bynny applicant forapennit subjecu @c applicanno a civil pe..Ity.f APN Number Occupancy Type
not mom than five hundred della.(1500).
❑1,as owner of the property.or my employees with wages as their sale compensation, 36226038 . 00
will do the work.and to structure is maintained or offered for sale(Sm.7014.Business Required Inspections
and Pmfossiom Code:The Contractors License Law dues not apply to an owner of q p
property who builds or improve thereon.and whodoes such work himself or through his
own employes,provided Out such improvements tie not intended m offered for sale.n-
huilder thebuilding orimprovement iisold within one year of completion,thepose of
builder will bare the burden,(proving that he did not wild or improve for purpose of
sure I.
1.as,weer of the See 7W.
,am exclusively ad contracting wit licensed contractors m
canswct the es not (Sec.o an owner
of and Prony who
Code:)The Coovactor's and cense Law coca not applytoan owner of property who vesica or improve tenon,and /
whocontractsLacu for such projects with a conuacmr(s)licensed pursuant to the Contractors
Lirenx law.
I am ezwpt under Sea .B h P C for tis�nnreason \�
r Dale V
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of paps,one of 0e following declarasione /
❑1 ham and will maintain a Certificate of Consent to self-insum for Workers Compote
ration,as provided for by Secu,e 3700 of the Labor Code,for the petfmmmtcx of the
work for which tis pcnnit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
37M of the labor Code,for the performance,(the work for which the permit is broad,
My Wofkers Cmmpens imm Mm.nm anicr and Policy number arc:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(This section need not W evandcued if th<permit is foronc hundred Milan(51010
Mur Ims.)
1 certify Our in the performance of the work for which tis permit ls issued,I shall not
employ any person in any manner sn as In wcome subjen to me Workers Compensation
Laws of Cnlifomia.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificate of Exemption,you should
become Subject to the Worker's CO FOrmodim provisions of me labor Cede,you must
.,2 foMwit comply with nuc h provisions or mu Permit shall be deemed revoked.
zCONSTRUCTION LENDING AGENCY
4 I hereby affirm that them is a construction lending agency for the performance of
at> the work far which mu permit is island(Sec.3097.Civ.C.)
W�Q Under',Name
Lender's Address
U 0 1 coolly that 1 haat mad this application and sum that the above information a
ly F torte".1 agree to comply with all city and county ordinances and puce laws relating to
O U building construction,and hereby summon mprescntativu of this city in enter upon me
C[l above-mentioned property for inspection purposes.
(We)agree to saws,indemnify and keep harmless the City of Cupertino agaiet
IF—t ra/1 liabililiesjudgmenu.costa and expenses which may in any way accrue against said City
U in consequence of the granting of this permit.
^� APPLICANT UNDE STAN ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCL!AFZj�L I; �
Re-roofs
Signamie of Applicant(Connonor Date
HAZARD MATERIALS DISCLOSURE Type of Roof
Will to applicants(mute building occupant nme or handle hmarEous material
az defined by the Cupenino Municipal Code,Chapter 9.1;and me Health and Safety
'okra Section 25532(a)? AAA,,, All roofs shall be inspected prior to any roofing material being installed.
p Yes ay N,
Will the x,dwitot or fumre wilding..pan,sac equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
.mit basilica.,air contamimmis as defined by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yes ANu
1 have mad the n',ardous materials mquimmenu under Chapter G95 of the Carter.
M.He.]"SifmyCode.Semiosis25515.25533 and 25534.1 undersand that it do Wilding
does not currently haw a tenant not it h my reapmsihility to notify me,ocuPant,l the
m wmmmc hmastla: ecpdormhouarmeofa Rotate ar Occup w_ Signature of Applicant Dale
C 0' D
wnereraammria<aasent Date Al:roof coverings to be Class "B" or better
•e� i .a1 aFG - t' r�¢r?+v, k.-'a.
Na",
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• CC, . REEl�TIA PROTEC' r �C®YEwRS,YIEE}Tri
an Of a 1-- �aL.: � i.rm � n� � �r� �'r "*S'"
CUPEkTINO rMEv .-,.STs_. � +-waw h o- r v.
Assessor's Parcel-- 'N��umber^: gg��
Name of owner. v!!1 �) `/
Project address. 75 .1� �L`�Cft-f-1, C .. (f �CS� /1
Contact person. ��//? U`//� Phone.
Fax.
Net square footage of lot.
Existin Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL: -
• Are there at least two 10 foot by 20 foot clear spaces inside the garage? `✓ N
Is privacy protection planting required for the project? Y N
On what floor(s) is work being done?
Brief description of work. 0 Z)/?
�rtjiltdi'G
Code editions: 2001 CBC (Y -N)2001 CFC (Y -N)2001 CMC (Y- N)
2001 CPC (Y - N)2001 NEC (Y - N)
Effective 11/1/02
COM
LMAR
CEIVED
7 2005
Plan Review Process Work Book Page-8-Revised 4/28/04
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(�Q- kITY OF CUPERTINOP
CITY of
PERMIT APPLICATION FORM
® CUPERTINO 6Z
0
APN # 2 Date: 3 _o J
Building Address: ,.,,Lt.. Mailing Address (if different from building address):
Owner's Name:, Pho e#:
Jin Oo6 .130-6540
Contractor: License #: 1
o i
Contact: // Phone: — ,,7 Cupertino Business License#:
O4 7 (SZ//I Fax:
Building Permit Info:
Bldg Q Elect ❑ Plumb ❑ Mech ❑
Job Description:Sp ,nq dj vide/ 0h yv-4 Wap// �— 3X3 �a �Jl+ W/`/i
Residential ® ✓ / Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: j-1--pO Occupancy Group:
r
,MLTYpe of Construction: V/VPlease 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 IM Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Conun/ uasi 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
BELE 200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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