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08010052 (2) CITY OF CUPRRTINO BUILDING DIVISION PERMIT Ow� 1OT.'09"a T uOnRM' A*zT9'I.V°�L\ PERMIT NO. ""`1'66W!' S'NTA CLARA AVE CHAO YI AND INGRID 08010052 OWNER'S NAME: - PERMIT ISSUE DATE CHAO YI AND INGRID 10081 SANTA CLARA AVE 01/10/2008 E; SANITARY NO. CONTROL NO. ARCHTEC/ENGINEER: BUILDING PERMIT INFO REPLACE EXSTG PANL W/125 AM BLDG ELECT PLUMB MECH 3 0 th LICENSED CONTRACTOR'S DECLARATION O O O O F I hereby"m Our 1 am Iloo ecd under previsions of Chapter 9(commencing Job Description with Section 7")of Division 3 of the Business and Professimu Code.and my license is ^ in full fans and ellen. g? Llteosa Clans Lk. Dam Gm DdEecluC m e ARCHI'IECTSDTION i 1 understand my plans"I bt used As public mcmrda y �a Licensed Pmfcuional 3 OWNER-BUILDER DECLARATION ContrON a 0 I herby (sect oat 1 1. exempt from the lm n.Co e:Any Law for the p O following won.(Section 103mm Business and `M.dosi000 Cade:Any city or county $� which requires a pmmit w crnsuu-L alcor,impraw.dcmnl W,rr rtpvir any swnuro _ prior to its issuance,also requires the applicant farsech permit to Rk asigned statement e that he is licensed pursuant toOne Provisions ofthe CoamAkrelL.icenseLaw(Chapter9 Sq.Ft. Floor Area Valuation (commencing with SacL m 70M)of Divcl of the Business and Prnfevions Code)or than M is cumin oemfmtn and the bss4 fm the alleged exemption Any violation of Section 7031.5 by any appliesm fa a permit mb*u the applicant to a civil penalty of APN Number Occupancy Type not mart man liw hundred Odium($5001. P Y YP 0 I.u owner of the pmpwy,car my emplaycu wire wgu u melt sole eompeoomm, will An OcaMk and thesuucture Ism,intendW or offered Imsam(Sec.7W,Busincu Required Inspections and Professional Code;The Canoacmis Lixnse lav dao con apply m an swat of q P propeny who builds or impmws dmreon,aM who ductsuch work himself or through his own employees,provided Out such Improvements art not intended oroRemd rehash.if. howaver.the building or impmwmem is mid within one year of compledon,the owner- builder will love the bumm of proving that he did am lmW w improve for purpose of sale.), 0 1,a owner of the propenY,am uclue iwlY conumting with licensed commmmrs m t - -- mnnmct On project(Sec.10".Business aM Pmfeulam Code:)The Commew's Li- cove law does not apply As an owner of property who build,or improves thereon,ad, who contracts for such projects whit a mntemmrtn3 licensed paramount An the Canuactots Uttme law. ❑1...mapt dfS ,B k P C for this Tram Owner Data D^d W -R OM A CLARAT70 1 hereby aDhm under peulry of perjury,aro of the following declarations: ham and will maintain a Certificate of Consent m self-tmum for WarteYs Continue- n,As provide4 fm by Scotian 3100 of the Labor Code,fm the performance of On wort for which On permit is issued. 0 1 baw and will maintain Workces Compensation Imtvance,As required by Section 37M of the labor Cade.for the performance of On wart for which this permit is intend. ' My Worker'.Crmpmsmoa Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This seNm need not xecroplemd If the permit 1,Intern hundred dollen(SIM) or leu) I cv^;fy that in On performance m the wee m which this permit�yssued.I shsil nm employ any person in anymann um me subject mac /Peri Compeosadon Laws of California.Dam Applicant NOTICE TO APPLICAh f, ler m nS t B Ce cite o • cmpdo you should become subject m the Wa T1s Compensation provtsi000 of the Latta Code,You most 0 Z forthwith comply with such Provisions or mu permit Mall be accrued ntmled. „zy O CONSTRUCTION LENDING AGENCY [-+ IWmbyaRnn Wt them lsaconntmctinn lending agunq fm the pelremtamc of !x> the wort for which dos permit ts issued(Sac.3097.Civ.C.) Q fames Name z Lenders Addw tJ 0 1 crrdfy that 1 haw mad this application and some dual On show,information Is ECSJ' carrtcL I agree m canplY with sit city and county ordinans¢ and state laws relating In ... .0 Wilding cam action,and hereby O.A.rtpnsmudws of this city menmr upon the [r7 ahow-momoncd property for inspection purposes. (We)agree to saw,indemnify and loop harmless the City of Cupcnino against rn liabilities,judgments.core end cartoons which may In any way Amountagsioon said City V z LIICANT UNDERSTANDS AAt. I APPLICANT ipm ND L COMPLY WI L NON-POINT Issued by: lM'�UW Date /l�F' SOURCE REGULATIONS. � � Re-roofs Agnuum of Appbcater Data HAZ HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or forum building ampatsmm reh ardaw material As deMetl by the Cupertino MunicipalMunicipalCade.Chapter nod the 9.11,and ate Health and Safety Code,Section 25132(e)7 All roofs shall be inspected prior to any roofing material being installed. a Wilding Will me applicant or future a [_]Y.es ceupant use w equipment devices which If a roof is installed without first obtaining an inspection,I agree to remove t haurdrus air conuminau u defined by the Bay AMA Air Quality Management all new materials for inspection. R 1 ❑Yes I haw mal the haramousmaeriNrtquiremew undorchapter6.95 attire:CAlifor. ria Hcalthk SdmyCode,Secv 5f15,25533-d1 ,534. nlnMllunifftbuildi.g docs not currently hew atm t It ts mY MAW t __crytic occopann of the requirements wh' m prior to I tedr'facaworor Lgnature of Applicant Date Ownorm and ag t -Dam' All roof coverings to be Class"B"or better CITY OF CUPERTINO ® 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32625035 . 00 DATE ISSUED. . . . . . . : 01/10/2008 RECEIPT # . . . . . . . . . : BS000003656 REFERENCE ID # . . . : 08010052 SITE ADDRESS . . . . . : 10081 SANTA CLARA AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHAO YI AND INGRID ADDRESS . . . . . . . . . . : 10081 SANTA CLARA AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1212 RECEIVED FROM . . . . : GOLD STATE INVESTMT CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : CHAO. YI AND INGRID ADDRESS . . . . . . . . . . : 10081 SANTA CLARA AVE CITY/STATE/ZIP CUPERTINO CA, 95014-1212 TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------- ------------- ---------- ---------- ---------- ---------- ---------- IBSEISMICR VALUATION 200. 00 0. 50 0. 00 0.50 0. 00 1ELECINSP HOUR 1. 00 122 .38 0. 00 122 .38 0. 00 1EPERMITFE FLAT RATE 1. 00 40 .79 0. 00 40.79 0. 00 1TRAVDOC 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 ----------------- --------------- -------------------- CHECK 204 .46 #3937 --------------- TOTAL RECEIPT 204 . 46 O9ol oo > - �-�� CITY OF CUPERTINO CURIVINO GENERAL BUILDING • PERMIT APPLICATION FORM APN# 2 l0� 6b 55 6 () I Date: Building Address-/,0,4,W/ T.vv 7 i/L Mailing Address (if different from building address): Owner's Name: Phone#: Ae—&0Aj CA-1,110 Contractor: 0773Phone.- Fax: hone:Fax: (e�—o >��� Contractor License #: Cupertino Business License#: • Contact: � / � _ / C� Phone: Fax: AFD 7 —moo Residential Commercial Job Description: ` Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1 FR, I IFR ❑ I1, 111, V-1HR ❑ 11, 111, 1V V-N [2-1 1 Valuation: Square Footage: Project Size: Standard ❑ Large ❑ Major ❑ CITY OF CUPERTINO CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM 1BTEMPPER Temporary Building 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 & incl 100,000 Btu/h 29.3kw 1BBOILER2 Installation/relocation of ca M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption sys over 100,000 Btu/h 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 to & incl 50 horsepower, or for ea absorption sys over 1,000,000 Btu/h to & incl 1,750,000 Btu/h 1BBOILER5 Installation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption sys over 1,750,000 Btu/h 1BAPPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. 1ELECINSP Other Electrical Inspections (per hour) E 17MECHINSP Other Mechanical Inspections (per M hour) 1PLMBINSP Other Plumbing & Gas Inspections P (per hour • IMEETINGIHR Application Meeting B CITY OF CUPERTINO PE TING GENERAL BUILDING APPLICATION Cu R FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM ACOUSTICAL REVIEW IACOUSFDW SFDWL/Duplex New B IACOUSRESAD SFDWL/Duplex-Addition/Alteration B IACOUSCOM Multi-Family/Commercial B CHIMNEY'S 1CHIMNEY Chimney B 1 CHIMNEYR Chimney Repair B FENCES 1FENCE>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 ft in height) B 1MODUSTRU Modular Structures B FOUNDATIONS 1FOUNDREP Foundation Repair B 1PILECAST Pile Foundation Cast in place concrete B 1PILEDRN Pile Foundation Driven (steel,pre- B stressed concrete 3 of 5 CITY OF CUPERTINO CUPEI�TINO GENERAL BUILDING APPLICATION . FEE SCHEDULE Quantity/Sf Fee 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 1RETSP10 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 1SIDEST/13K Siding, Stone &Brick Veneer B interior/exterior 1SIDEOTHER Siding all other B SKYLIGHTS 1SKYL<l0 SF Skylight less than 10 sf B 1SKYL>10SF Skylight greater than 10 sf or B structural ISTAIRS Stairs-first flight/ea addt'l B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 so B 1 SRACKS>8 Storage Racks over 8' high(up to 100 B st 1STUCOAP Stucco Applications (up to 400 so B additional stucco application 4of5 �L~ CITY OF CUPERTINO CUPEI�TINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM 1 WINREP Replacement windows/sliding glass B door (ea 8 windows ` IBSEISMICR Seismic Residential B 1BSEISMIC0 Seismic Commercial B IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P lELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMPLNCK Stand Alone Plumbing Pin Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourly-stand alone 1TRAVDOC Travel &Documentation B . 1BUSLIC Business License B • 5 of 5 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 rUPEkTINO 40 Building De artment JOB ADDRESS: PERMIT COO (bC,S�Z OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # IrV I am not using any subcontractors: —/D r 'bignattire 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 • Owner/Contractor Signature Date