The URL can be used to link to this page

05090002 (2) CITY OF CUPERTINO %,4Y77 7 BUILDING DIVISION PERCO�ll(A�C, OR, NkQl'QN : BUILDING ADDRESS: PERMIT NO.Q 5 0 9 0 0 0 2 22 3 OW NER'S NAME: PERMIT ISSUE DAM ONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BO , ELECT PLUMB MECH O �oo .LICENSED CONTRACTOR'S DECLARATION lob Description F I hereby sfOrm that 1 em licensed under provisions of Charter 9(commencing P with Section 7M Sof the Business and Profcssinm Code,and my license is jigIn full force and effect. REPLACE W Thr R LIKE) License Clue Cart �`�` ® p Data CanlDEC L r❑U<y ARCHITECT'S DECLARATION n IundcrsunJ my pima ahsilWusedupuMic rttnrds t,� 7 C 5OG Licensed Professional NOV I — 2005 g OWNER-BUILDER DECLARATION gi 1 hereby affirm that I am exempt room the Conlecta's License Law tar the p yo following moon.(Section 7131.5,Bumness and Professions Code:Any city or county k$I which Omahas a permit o contract.alter,Improve,demaflah.M reply my structurenIKI 2 Q Q Q WF40 prior lis its issuance,else requires the applicant for such permit to file a signed statement F11 11 p G that he is licensed pursuant in the provisions of the Conrucmrs License Law(Chapter 9 Sq. Valuation y F❑$ (commencing with Section 7000)of Division 3 of On Business and Pmressions Carta)or 3 that he b exempt themfmm and Ne bu4 for Ne alleged exemption.My violation of Section 7031,5 by any applicant for a permit objects the applicant in a civil penalty of 3 APW XURFef 0 0 Occupancy Type not more Nan five hundred dollars($500). ❑L as owner of the propmty,M my employees with wages as Mmtr ole compeatsadon, will do the work,and On sometime is not intended or offered far sale(Sm.7044,Business Required Inspections and Pinfeather,Code:The Conuactoh License Law des not apply m e ns an owner of q p property who bui Ida or impravu thereon,and w ho dots such work himself M through his own employees,provided that such imprenmentsie not intended or offered Amanda.If, however,Ne building or improvement is vital within one year of completion.Ne owner. be!Ider will have Ne burden of proving this W did ant build M Improve for purpose of aalc.). ❑1,u owner of the propeny,am uelulvcly eomacting with licensed commerce,he comarm,the project(Sec.70sa,Business and Profraemns Code:)The Canbacmrs Lb cense law does not apply to an owner of property who Wilds or Improves thereon,a of who contracts for each projects with a com mtor(s)licensed pursuant o do Connector's Lonse law. ❑lam uem under Sea .B&^PCf thisrwon Owner''— / sT Dam—1 ( O✓ WORKER MPENSATION DECLARATION 40 1 hereby affirm under penally of perjury sum of the following declaetions: ❑I have and will maintain a Certificate of Consent to ulf-Imure for Warner Compen. sation,as provided for by Section 3700 of the fiber Code,far the Performance of the wok:for which this permit is intend ❑1 ham and will maintain Workers Compensadon Insuranm,u required by Section 3700 of the Labor Code,for the perform em of the work for which this permit is Issued. My Worker's Compensation Insurance artier and Policy number tie: Carrier. Policy No,: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE miss,section need ant W completed if da:permit is fornan hundred dollars($100) M mts.7 T cenify Met in the performance of the work for which this permit Is issued,T shall not .ploy any pectin in any giver se as m become subject to the WorkcK Compemadon Laws Applim Csilforia.�— ( -q q Applicant ''ll�/f� NOTICE TO APPLICANT:If,after ma this Ccolmificof Facraption.you should become$Object m the Workers Campensmion provisions of the labor Code,you must .JO "with comply with such provisions or this permit shall W dcemed reveled.zCONSTRUCTION LENDING AGENCY [.r 4 l hereby affirm that them is a construction lending agency for Ne perform lam or the work for which this permit is issued(Sec.3097.Cin C.) W� Q lenders Name r7^j. Lenders Addrass U Q 1 certify that 1 hem rod this application and state that the above information is B.P Cotner.1 agree m comply with All city and county onlinames and same laws misting to O U building construction,and hereby amharim representatives of this city to enter upon the W above-mcmioncd property for inspection purposes ry (We)agree to saw,indemnify and keep harmless Ne City ar Cupertino against to Ilabilides.judgmcals,costs and expenses which may In my boy renin against aid City t.1Z In consequence of the treating of this permit r-1 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCEREGULATI NS. r 1/ din Re-roofs $ItNIYR O(AppIIQHAZARDO /�] Dem HAZARDOUS Eoce.pr DISCLOSURE Type of Roof Will the a Caperton or future building e,Chapter rmm ar handle HaAou material u dented Section the 32(1)?no Municipal Cade.Chapter 9.11,real the Health real Safety cak. 0Yeszss3z(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ON. Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit meardaus ai r comomimms u defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes ❑Nu I ham mad lheha?a i)usma¢dalsmquimmcnuun&rClupmr6.95oflheCaliror- niaRealLh&SafciyCadc,Sccduu25505.25533an 25534.lund nm ftirdx Wilding does not currently ham a mnant,that it u my responsibility st amity the occupant of the requimmanta which must be met priori issuance or a Certificate of Occupancy. Signature of Applicant Date i ownerori d a,f a Dale eel All roof coverings to be Class"B"or better CITY OF CUPERTIN# • CUPEI,TINO PERMIT APPLICATION FORM APN# 3 570 � D 7g Date: Building Address: Mailing Address (if different from building address): 213to e-rno �1r� Owner's ame: Phone#: elb.ua L1`�'1 40'?- 973 Contractor: TB D License#: Contact: , � -- Cupertino Business License#: //C�t L-1/1 � ffOl�- -(80 Building Permit Info: I V/rdcW r-9e(acek4 erz+of 4Xrs-h✓: ke,f r Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential 221 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: K Occupancy Group: Type of Construction: Please check this box if the project is a AWL second-story addition: ❑ Project Size: Standard ❑ Laze ❑ Major ❑ uanti 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 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/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 �P,4 31 � �3 1 of 3 7r 3 � ° CITY OF CUPERTIN40 CUPEfIiTINO PERMIT APPLICATION FORM QuantityFee 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 Pb1g 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 Pian Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures 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 BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BRENLAIRIIAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation ofFumace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BRENIMISC Misc 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 BR.EMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 OTY OF CUPERTINO CUPERItvo 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 PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Chane BUILDING 3 of 3 sblaLs trMaa. 9, u 81 sl u os u 86 fbl 91 U at s! ZL 81 01 W 81 C1 BY 9E ZI wlmvuncq �'F jT,,� SFP 0 ,� L7 • ��y n V 0 `vJ O 9E W 01 W 9E 6 m w e [ W L F6 W 9 ER ux s ZL V > ZL 81 81 E Bt Z 01 al ql 91 8Y •1 u1nWf1 It F y • Z V1096 VD ouivadnDa Ladva CITY OF CUPERTINO m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35709078 . 00 DATE ISSUED. . . . . . . : 09/01/2005 RECEIPT # . . . . . . . . . : 31043 REFERENCE ID # . . . : 05090002 SITE ADDRESS . . . . . : 22213 QUINTERNO CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LIN CHUA ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2749 RECEIVED FROM . . . . : THOMAS CHAN CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BPERMFEE VALUATION 12 , 000 . 00 191 . 16 0 . 00 191 . 16 0 . 00 BSEISMICRE VALUATION 12, 000 . 00 1 . 20 0 . 00 1 . 20 0 . 00 BPLANCHK PERMIT FEE 1 . 00 83 . 16 0 . 00 83 . 16 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 310 . 38 0 . 00 310 . 38 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 310 . 38 VISA TOTAL RECEIPT 310 . 38 • Yut��,.� ,uin� Hµ nrt s;#.+.`i[j t it:•, i+• t^ i.9 e3'�#rC'�1!"1 c ,�?'�4,3,E C 9 k�i T"O ztT IVC�'t r I?�Tk n u �y , R d. �'�� ' He saF ��'� , iv�,�;�' y-.. ® CCS I2ESI'JAS PROJECT COtVER SHEET CUPERTINO Assessor's Parcel Number: 3570�07� Name of owner. ( X2,,4 Llr-) Project address.,2�2,2- 1 3 �� ✓i / to eDl t'Y Contact person. Phone. 62,q 7j �y6 g Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N Is privacy protection planting required for the project? Y N On what floor(s) is work being done? �2 S Brief description of work. 5 fade JbY. �tL2� Code editions: 2001 CBC (Y -1`1)2001 CFC (Y - N)2001 CMC (Y- N) 2001 CPC (Y - N)2001 NEC (Y - N) 46 Effective 11/1/02 G� Plan Review Process Work Book Page-B-Revised 4/28/04 CITY OF CUPERTINO 71xu BUILDING DIVISION PERMIT CONRACOR INFrO'R.,1ktATION„ BUILDING ADDRESS: PERMIT110.0 5090002 OWNER'S NAME: PERMIT ISSUE DATE LIN CHUA 09/01/2005 E: SANITARY NO. CONTROL NO. ARCHITECTAENGINEER: jf iaUll.DINO PERMI'r;INF BL t t LEGS j PLUM MECH ( 0 0 �oo LICENSED CONTRACTOR'S DECLARATION Job Description y 1 hemby affirm that 1 am lirenecd under provisions of Chapter 9(commencingr'r 7 wiLhSadan7=).f DiWit..3.f tite BuJ..d Pmfcsalun Codc.and my Bcenseta (lif}I/ inmufineeeneeHa REPLACE WIDNOWS (LIKE FOR LIKE) YvV � 2005 j zO DamurmClw sac.e t Date ConfI g ry p 55ggtttf��fyyy-y{1gf ARCHRECrS DECLARATION g6RfrVLpf,If gYdpll'fjppSC7 ^�^�/ � i undunderstandtand my ptau NJI M Codd a pas used u publk reeorde y O�u G Licensed Pmfrseianal Oat I am exempt from mDECLARATION I I greasy axion that 1 I.S.exempt from tin Canuacmfs License law for Nc i .0 following reason.Permit i 7(131 ,almrta and Pronae.denoli Cade:Any em or county $� which require;a permit u conslntel.aloe improve.demnitsh,m repair any structure $12000 f Z�' prior in its I=..a,atmmaim.lhrapplieant for such permit a Ille•aigncd suumem FF than he is licensed pursuant the provision of the contractors license Lsw(Chapter 9 Sq.FI.Floor Area Valuation Y�S (commencing with Section 70(s))of DivxlonJof NeBmincsaanu Fofwiom Code)or UM that he is exempt therefrom and the basis for the alleged assumption.Any violation of Section 7031.5 by a"applicant for a permit mbjccm Lite applicant to acivil penalty of g Occupancy Type set mart than rive hundred dollars(5300). ❑L.n Owner of the properly,or my emplayeu with wgu u their mlc compensation, will do the worked the structure is out intended aroffered fonale(Sec.7044,Business 'Required Inspections unit Profession Code:The Consumer Liana Law don not apply u an Owner or q P property who builds in improve,ther a m.and who does such wart himself or through his own employes,provided Natmch Improvements not not Intended or offered foraale.If, however,the building Or impmvement in mid within can year arcompletion.Ne owner. builder will have the burden of proving that he did not build or Improw for purpose of sale.), ❑1,as owner of the Property.am exclusively contracting with licensed comrmton u construct the project(See,7014,Business and Professions Code:)The Comrmmfs Lb cense Law doss not apply in an owner of property who builds at improves human,and who contracts for such projects with a contractor(s)licensed pursuant in the Contractor's Lkena Lew. ❑1 ore exam under Bee. B&PCF f thl moon owner"n r l�Dam�f f D✓ WORKER MPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following undulation: 1 saw and will maintain a CeNficalo of Consent to salbinuea for Worker's Compere nation,an provided four by Section 3700 of Ne Labor Cade,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Inurana.as required by Section 3700 of the Labor Cole,for the pertormenee of the work for which this permit is issued. My Workees Compensation Insurance cater and Policy number sue: Canis: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE most mcllon mind not becc mpleted time permit is foonc hundred dollus($100) or no.) 1 certify Nal in the performance of the work for which this permit is issued,I thall not cmployanypermnlnanyannermumbecomembjwttoft Workeri COmPenadon Laws of California.D Applicant , 9 /f / Ail NOTICETOAPPLICANT:If.aOerm thisCiniO teof emption.you should become subject u the WOAafs COmpevation provisions of the Label Code.you mus 0 O Forthwith comply with such pruvision o this Permit 0111 be accrued revoked. Z"" CONSTRUCTION LENDING AGENCY �. [—� kforwichde WrmitIt lisim uaeul(See 30 len ding agercyfor tits performance of a Newark fu whits this pemsil ts tatuW(Sec]097,Civ.C.) 4 Q lender.Name z lander.Add. .. u 0 1«Nry that I have read Oda appliation and mum that the mow InfomNun u LU h corm.I agora to comply with JI city ad county oNbmnces and state law relating to 0 building construction.and hereby authorim represenudees of this city to enter upon the Wabove-mentiored properly for inspection purposes. (9r.)agree m save,indemnify and kap harmless Is,City of Cupertino against f..i fa'jI Iiebilitimi judgmenu.eoms and expenses which may In my way accrue agJntuid City U 2 in LI A APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RECULATI NS. h �� 4/" Re-roofs Signuurt of AppllunVC RDOUDam xATAroom building stem or Type of Roof WIII the applicant or room building occupant team u handle Health nd material u defined by the Cupertino Municipal Code,Chapter 9.12,seri the HnIN and Safety Code.Sadanz353xw7 All roofs shall be inspected prior to any roofing material being installed.❑Yes ❑No WIII the Applicant Of future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove h bavallous air conmminanu an defined by the Bay Asea All Quality Management all new materials for inspection. 11110,0 ❑Yes ONo I have mad the huumammuteriala requirements undcrChap cr6.93of the Califor• nix Hachh B:Safety Cade,Secuon73503,75533 and 75334.1 understood Not lithe building don not.tarmdy haw a¢rima Net It is my responsibility to mully the occupant of the requirements which must be mel prior N issuance of a Ccnincam of occupancy, Signature of Applicant Date i Owner or eta ariacde em Dau All roof coverings to be Class"B"or better