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05100176 (2) CITY OF CUPERTINOx.: .'t BUILDING DIVISION PERMIT CO .TRAG-TOT.iWORMATION. iwILDINGADDRESS: CUPERTINO PLUMBING PE'a....05100176 1017S MC LAREN PT. W NER'S NAME: PERMIT ISSUE DATE WILLIAM KAO 10297 S E ANZA BLV 30/21 /2005 qPMNE: SANITARY NO, CONTROL NO. (408) 253-0618 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Z, LICENSED CONTRACTOR'S DECLARATION O O O O u 1 hereby arfrm that I am Bmeed under provisions of Chapter 9(command, Job Description with Section 7").f Com, Lobo three and erect. C3L o COPPER REPIPE/WATER. t /�'ER SERVICE Ll uccnaecrus tic., s— Dam lO. / COnlOcmr ARC HLTF-CI•SDECLAR ION nF jw U 1 undersand my plans shall he used at public records N �•6 6 01 sa G 5 Licensed Professional OWNER-BUILDER DECLARATION LIQ[ E 0 0 1 herebyreason. .(Sce that 1 1. exempt from doe f ssinalChd License Law for the " ♦ 4 a// E00 O following reason.(Section](131.5,Business and Professional Cork:Any city or county m which requires•permit to ennswet alcor,impmw,demolish,or repair and structure 0 _ZT prformiaiensedprsu requiree movisiosof for such Contrunor's Li eas Law(ned statemem Ft: that commecingwitpSectiotwldcprovisionsofNcCommcwr'WccnscadonaCapder9 Sq.F[.Floor Area sp aluation of t: that he 4memithtS therefrom and th,basis n3 themegBusiness eand on.Any iCMc)or 3-- that he ts exempt dMmfrom and th¢basis for the alleged exemption.Any violads,n of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofccur -3 AIN r Occupancy T not more man live hundred dollars(SSW). Y YPe ❑1,as owner of the propersy,or my employees with wages as their sole compenution, will do lde work,and the structure is not intended Or offered forklift(Ste.7064.Bud. and Professions Coil The Canuxcud s Liana Law does not apply to an owner of Required Inspections property who builds or improve thereon,and who does such work himself or through his owncmploym,provided that such improvements are not intended aro@red foruk.If, however,the building ter improvement is sold within one year of completion,the owner- ' builder will haus the burden of proving that he did not build or improve for purpose of sale.). ❑1.as comer of the property,am exclusively contracting with licensed contractors to construct the Pill(Sec.70x6.Business and Profcuimm Cade:)M Contractor's U. cense Law docs not apply to an owner of popery who builds or improws demon,and who concocts for such pmjeea wild a eonvactods)licensed puauanuo the Conuacmh License law. - t]1 no exempt under See. .B k P C for this reason nor Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of pttjuty one of the following dalauticns: ❑1 haw and will maintain a Certificate of Consent to self-insure for WorYcr's Compen- $Allen,u provided for by Section 3700 of in,Labor Code.for the performance of he work for which this permit is issued. hevc and will mainland Workers Compere+don Insurance,as myuirtd by Section 37W of the Labor Code,for the Performance of lde were for which this Permit is issued. My Worker's Compensation lmumms carrier and Policy number are: �n Carder:_�^'>'Y/J//!'3 Palley No.: A��� �'D✓ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thuuction recd nmbecmnplcmd lithe permit is(mune hundred dolers($100) mr loss.) 1 amify thud in me perfs,rmance of due work for which this Permit u issued.I mall not employ any person in any manner so as in become subject to tbe Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should , become subject to the Workcr's Compensation provisions of the labor Code,you most .J•Z fordwith rnmply with such prmuiore or this Permit Mail be deemed rented. 'Z O CONSTRUCTION LENDING AGENCY (-r (hereby an—mat memo aconstrucdinn lendings,cre,lar the aforman¢of a the work for which his permit is issued(Sec.3097,Ci,C.) D]0 L.cndcr's Name z Lender'sAddress J C) I codify that 1 haw read this application and sum that thc thew information is LL E' corms I agree to comply with all city and county ordinances and sura laws relating u O V building convection,and hereby eummis reprooduddiws or this city to enter upon the W. ed pud,d �^a bdub t tighten cosy for inspection expenses which ms I,•, (We)agree to ,indemnify and keep harmless the City of Cupcnino against r'/3 liabilities, tighten 'gr regoifth emit. they in anyway accwc against said City fJ,'Z me onsegve the gr 'ng of ld'-permit. ^ APPLIC NDE ANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date D�� $OU L NS. V Re-roofs (�; S awns ofAppiicanUC Dem HAZA S MATERIALS DISCLOSURE Type Of Roof Will the applicant w forum bur ding occupant stor<orharMk hvudous mamrid as defined by the Counties,Municipal Code.Chapter 9.13,and the Health and Safety Cade,Section 35532(a)+ /'� All roofs shall be inspected prior to any roofing material being installed. ❑Ye / t , Will the pplicant or future building col sew equipment or Jcvi¢s which If a roof is installed without first obtaining an inspection,I agree to remove a emit hazardous air contaminants cfood by thus Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I hevc maJ thehnallous rials requirements under Chapter 6.95 or the Caliror ria Helm ASafctyCode ti 75305,355JJand255J4.luMcrsaMdiuiflhc Wilding does not cwrendy he ren t t rs my ma nihilitY m notify tho oaupant of the Mquimmcnrs which prir ;iss+an cenifcammr arode, Signature of Applicant Date /'• Q Owner or gem — perm All roof coverings to be Class "B"or better Community Development ' 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 JPCITY OF ERT�NO Fax(408)777-3333 rG IV Building Department JOB ADDRESS: A)1 -75- ry�eClare� p/ PERMIT# OWNER'S NAME: t,(J, / p I PHONE # 0?Sa GENERAL CONTRACTOR UpnFAX # t/cam X53 I am not using any subcontractors: Q 3 Signa Date Please check applicable subcontract sand complete the followinginformation: 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 Shee Rock • T• e 1 ld no2/a 5 Owne C ctor Signature Date CITY OF CUPERTINO I� 1 of 3 PERMIT RECEIPT OPERATOR: seem COPY # 3 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 31621049.00 DATE ISSUED. . . . . . . : 10/21/2005 RECEIPT #. . . . . . . . . : 31691 REFERENCE ID 4 . . . : 05100176 SITE ADDRESS . . . . . : 10175 MC LAREN PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WILLIAM KAO ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2335 RECEIVED FROM . . . . : CUPERTINO PLUMBING CONTRACTOR . . . . . . . : CARDIA, FRANK L LIC # 612 COMPANY . . . . . . . . . . : CUPERTINO PLUMBING ADDRESS . . . . . . . . . . : 10297 S DE ANZA BLV CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 253-0618 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPFIXTURE UNITS 11.00 99.00 0.00 99.00 0.00 BPWATER UNIT 1.00 9.00 0.00 9.00 0.00 BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00 BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BSEISMICRE VALUATION 0.00 0.00 0.00 0.00 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 MPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 268.76 0.00 268.76 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING • (L � CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM N # 6qq o;2 Building Address: Mailing Address (if different from building address): PL , Owner ��l arl-) !�/G�l d me: Phori/60) ZSZ X71 SZ Contrac or: 11 License #: -t-lno vlL ZyC/dy Co ct: �^ ( Phone: ZSR 6018 Cupertino Business License#: Fax: L5 ZLCie-t a Building Permit Info: Bldg ❑ Elect E� Plumb Mech ff?/ Job Description: Copper Repc�p6, jx,Jafer Ne.:Id-er, I,�Ja��a- S�T� 1CC Residential Commercial ❑ Sq.Ft. Floor Area: Ofq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ 0o•ect Size: Standard ❑ Large ❑ Ma or ❑ Quantity Fee ID Fee Descri tion Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 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/ 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 BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy AAA Multi BUILDING BINVESTIGA Investi ation fee BUILDING 1 of 3 Fes- CITY OF CUPERTINO CiTM°F PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BNUSCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMIvIE New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comma 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 Cheek Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBOiG BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tra PLUMBING BP`✓ENT Alt of Drain &Vent PLUMBING / BPWATER Iustall/Alter Water Pi e PLUMBING BPWHEATER Water Heater[Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Annlinncp Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREA'IFURN Relocation of Furnace MECHANICAL BRE 2V Relo Furnace > l OK btu MECHANICAL BRENUMAT Heater Installation MECHANICAL RENU HOOD Installation of Hood 1\�CHAiVICAL BREIv MISC Misc A aratus ELECTRICAL BREMNRAPP Rem Non-Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL Power Device/A aratus ELECTRICAL REMRECEPT Rc t], Switch & Outlets ELECTREMRELOCA Relocation of Hood MEREMREPALT R air/Alter HeatinggiBREMEPOWER REMRESAPP Remodel Res A liance ELECTRICAL 2 of 3 id CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Si, s, Marquee. ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan ISin le Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUU DING 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-Fa m PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3of3