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