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04120093 (3)CITY OF CUPERTINO " BUILDING DIVISION pE ,10I�TIT1tACTOI2INF0'R1V6N, %INTERNATIONAL BUILDING ADDRESS: WELKIN IND I MITNcb4120093 I.D260 PHAR LAP DR ERS NAME: PERMITLSSUBDATE WEI-SHIN CHOU 19925 STEVENS CREEK PHONE: SANITARY NO. CONTROL NO. (408)252-3396 ARCHLTECDENGINEER:. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 LICENSED CONTRACTOR'S DECLARATION lob Description 1 hereby affirm the, 1 am 11crosed under moulsi.os of Chapter 9 (commcncin{ with Section 7(1(11).( Division 3af Use Businees and Profc slum Code. and my license I. ' infall force and effect. REVISION -CONVERT POWDER ROOM License Class Comror Contru Dam TO FULL BATHROOM ARCHITECTS DECLARATION I undcrsund my plans shall M used u public mends ppp� Lkenud Professional OWNER -BUILDER DECLARATION ��W �I' I hereby affirm Net I am exempt from tho Contractor's License Law for too a £■1`d - following mason. (Section 7W 1.5, Business and profession Com: My city or county which mqulms a Permit to construct, alter, improve, demolish, or repair soy structure prior to but issuance. also requires tie epplic+nt for such Permit to rile asigned statement- mMl M is 11"o di pursuant to the provisions of de Conva1-cm.Ys lJcu law (Chapter 9 Sq. Ft. Floor Area j-� al p (commencing with Section 7000) of Division 3 of the Bueinest and Proresetoos Coda) or Nat M is exempt therefrom and 0e basis for IM sAcgod eumption. My violation of APN Number u m' Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of nal more Nen five hundred d.Rm (MOO). 32639027.00 ' ❑ I, as owner of tM property, m my employees with wages M their sole compensation, Required Inspections will do the work, and IM structure is not Intended or offend for ails (See. 704A. Business feseo s Cod. TCommissars License Law docs not apply to an owner of and PmM ntr prope ny who bu llds or i m proves theouon. and who does such work himself or through his own employe . provided that such improvements me not Intended oroamed(COSMIC. If. ' however, the building or improvement is sold within ane year of completion, N. owner - Milder will have the burden of proving that M did not Mild or Improve for porion of " sale.). I, +s no, of IM property, em coclusively Contracting with liaesed Contracmrs to Construct the project (Sec. 70th. Budnen and ProrcWoes Code:) TM Cmntiactar'a U. - c sue Law does not apply to an owner of pmpeny who Wilds or improm Ramon. and. who canasta for such projects with a comractor(s) licensed pursuant to the Convenors License Law. ❑tem cmmptu See .B&P C rnf Nla neon It D+te� � WOR 5C0 NSATIOND R O - I hem y efRsmn under of perjuryaro afti�me Ila g declvWomts: ❑ I have and will maintain aCcNfiamofConum m self -Insure fru rkers Compen. - satian, u provided fru by Section 37M of the labor Cock, fru de r(ormamc of the - work for which this permit is broad. ❑ 1 have and will maintain Wokets Compensation losunnce, u required by Section 37M of the Labor Code. for the performance of the work for which this permit is Issued. My Worker's Compensation Insurance artier and Policy number are: Carrier: Polley No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Cnisseellon need not Weampined i(IM Permit b formic hundred dollars (SIM) .ties") 1 coolly Nat in the performance of the work for which this Permit is issued, 1 shall not employ any person in my Insurer an as to become subject o tie Worberi Compensation - Lars or California. Dem Appllesnt NOTICE TO APPLICANT: If, after making this Cenificam Of Exemption, you should became subject In the Worker's ComPensstion provisions of tie labor Cade, you most forthwith comply with such provisions at this Permit shall be deemed evoked. I r CONSTRUCTION LENDING AGENCY I hereby Orion Net Nem is a construction lending agency for the performance of ' the work for which this permit Is issued (Sec, 3097, Cl, C.) jLendee, Name Lender's Address I certify Nel I have read this application and sec NIn nif information"("hng to t and assn laws relating to cortecl. l th comply with ill oily and county ordinances and ��---- building construction, and hereby authorise representatives of this city m cnterupon the ahow-mentioned property for Inspection purposes. (We) ages to ssw, indemnify tib keep harmless tie City of Cupertino against I Iiabilides,judgments,costs and expenses which may in any way acerae agemstsald City in consequence of the granting of this Permit. a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT r Issued by: Date / SOURCE RE LATI Re -roofs Type of Roof < nmso o pplianUCantra em HA2AR Will the applicant or future building occupant emrc or handle hr�ous material ebMATERIA ata dcMcd by Nc Cupertino Municipal Code. Chapter 9.12. and TOM Hallo and Safety de, Section 25532(a)T ....JJJJ C] Yes XNu All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which cMl hazardous air conuminann as &flood by tie Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes �Nu 1 hew read the hmardnus materials requiromemu under Chapter G95 of the Califor. nia Health &Safety Calc, Sections 25505,25533 and 25534.1 understand Nal lfthe Wilding does not currently how a tenant. that it u my responsibility in notify the occupul of Ne 'myulrtmc hich tMmelpdomi ancc0accotIca 0 cap.nc_y. Signature of Applicant Date - 16 All roof coverings to be Class "B" or better wnc .uthorircdagcnl Dote C� be is City of Cupertino Plan Check Transmittal Permit# Project- Address. Owner Description 04120093 Control# Plancheck# 1 FileDate 12/15/2004 REVISION 10260 PHAR LAP DR WEI-SHIN CHOU CONVERT POWDER ROOM TO FULL BATH Plan Check Status (attach comrhents and return to Building with plan set) Plan Dept check# Date Due Date Staff Comment Date Approval? 12/15/2004 91 O Buildin 1 2/15/200112/29/20041 POH Assessor 1 k2/15/200112/29/20041 SENT 12/15/2004 r,. Additional Plan Check Fee ❑ Hours Plannino Fees Housing Mitigation Fee Amount Heart of the City Specific Plan Fee Amount " GFt7(�;4ht"J •CITY OF CUPEI-TING 04 •CITY OF CUPERTINO• PERMIT APPLICATION FORM - f( O -D �< - APN # ,�O� l Fee Description Date: rl /` i J / Building Address:/ MECHANICAL BBOILER1 Addr i r di Brent fro b ilding ddress): / Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu Owner's Name: BBOILER4 Boiler> I to 1.75 M Btu Phone #: 4 &X- 4#6 -4¢ o .�-- Contractor: Boiler > 1.75M Btu MECHANICAL Li e Construction Tax BUILDING , BCONSTAX 1 BUILDING BCONSTAXBQ Contact: Fhon :off' -b o44 Cupertino Business Licensel: BUILDING Fax Constax - Resi/Mobile BUILDING S Building Permit Info: ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL Bldg ❑ Elect ❑ Plumb ❑ - Mech Job Description: BENERGYADD Energy Add Multi BUILDING BINVESTIGA Residential El BUILDING COerci Sq.Ft. Floor Area: Cost of Project: jLV 74 L 0 fcupancy rou . ype of Construction: Please cheex t ' ox if ject is a second-sto n: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description 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> I 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 1 of 3 04 L ON CUPERTINO *CITY OF CUPERTIN* PERMIT APPLICATION FORM 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/After 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 BREMARUiAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL • BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Mise 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 CC� CIT OF CUPEkTINO *ITY OF CUPERTIN09 PERMIT APPLICATION FORM 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 ZADDCHG Address Chane BUILDING 3 of 3 1, •