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04090236 (3) CITY OF CUPERTINO - aAN �"§ ""`$ a BUILDING DIVISION PERMIT <CLINTA2AC`TORrIN'�'URMA" ION, BUILDING ADDRESS: ANNA HWANG PERMITN004090236 10840 W NEWS NAMC: PERMIT ISSUE DATE ANNA HWANG ONE: SANITARY 2 1 CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH t� 0 = 0 �Oo LICENSED CONTRACTOR'5 DECLARATION �m I hc¢by affirm Nat l em lhemecd under provisions of Chapter 9(commencing & lob Descrlptl0�I DALE Z� wide Scnlon lIXNq ofDivieion Sof NO Business and Professions Code,end myliccnse is ' a�? in full force and effect. REMODEL (1) BATH ADD A/C . /� License Class Lic.g N Dau Contractor ^� ARCHITECTS DECLARATION gym I undcnamd my plena shall be ueai republic,aorta 2004 U ot, LlttnscJ Professional 3 OWNER-BUILDER DECLARATION BUILDING 0 I naso ,affirm that 1 1. exempt from the Contns Co Licenu ly for the ❑O fallowing meson.(Section)1131.3,Business anti pndcssiam Code:Any city or wunty X.m fi which requires a permit m construct.alter,improve,demolish,or repair any structure ,a; prior a its issuance,rdmic vires tW.pplicant forsuch permi t.file.signedsuumem �U< that he is licensed purauenuothe provisions ofthe ContractuhLicenuLaw(Chapter 9 Sq.Ft. Floor Area Valuation �$ (commencing with Section 7000)of Division 3 nfthe Busineasand Professions Code)or .- Nat he i,exempt Ocmfmm and thea basis for the alleged a mandlon.Any violNon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3�K�I Nukatlbeane t0 0 Occupancy T e not marc Nan five hundred dollars(5500). P Y YP El 1,as owner of the prepvsy,or my employees with wages as Nair sole compensation, will da Ne work,and the mecum Is not intended or offered formle(See.7044,Business and Professions Code:The Contractors License Law does not apply m an owner or Required Inspections Pmpenywha Wildsorimproves thenen,and whodassuch work himulfarNmugh his own employees,provided that such Improvements me not intended of offered for sale IL however,the building or improvement is sold within one year of completion.Ne owner builder will have the burden of proving Oat he did not Wild or improve for purpose of arda.). t7 1,as owner of the proper,am exclusively contracting wide licensed contractors to consumer Ne project(Sec.7064.Business and Professions Cade:)The Comeacmr's LL . cense Law does not apply to an owner of property who builds or improve themon,and who contracts for such projects with a conwctor(s)licensed pursuant to the Contractors License Law. �}I am exempt under Sec l .B At P C for this usson Data /, WORKERS COMPENSATION DECLARATION 1 hereby OR.under penalty of perjury ane of the following drabro timbe ❑I have and will maintain aCenlBcau of Comenl to elf inure for Workers Compete cation,as provided for by Section 3700 of the Labor Code,for On pe,fmmen is of the .,it for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 37W of the Labor Code.for On performance of the work for which this permit is Issued. My Workers Compnnatioa Insuna.carie,and Policy number art: Cartier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE t (Thissection need notbecompleted If the permit is for one hundred dollars(SI00) less.) 1 cenify Nat in the performance of the work for which this permit is issued,1 shall not employ any pcnon in an anneruaz bemmespbjec0othe Workers Compensation NOTICLaws C,TOlpmia.Dau II NOTICE T APPLICANT:IT.after making this Ccsitins of Labor you should become subject m the such Worker's Coons or this emus shat of the mail r Code,you mute .JQ (oMwith comply wide such Previsions or Nis permit shall Wdeemed resolved. 'Z,,.' CONSTRUCTION LENDING AGENCY t-a 4 I hereby.Mi.Oar them i,it mnnruetim lending agmtcy for Oa Performance of Q:> the work for which this permit is issued(Sec.3(97,Civ.C.) tV Q Lender's Name Lenders Address 2 V Q I certify Out 1 have mad this City and coup and sure that Ne above ws nearing is (~ cortdingco rttmComply and Willallcity and countyordinancesand sou lawssr upon ge QU abovengconsocidproend heubysuthom.,.a.merivrs of this city to cnurupon dee ahovw(W tiagreproperty forinspection keepha. (We)agree m save,indemnify and keep harmless Ocw City of Cupertino against fq in consequence of the cogs and ealsenscsm it. may in any way acerae against raid City 1\ C)z in conuqucnce of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S4t(2� Date URCE REGULATIONS, !%' A Re-roofs Si new sof ApdiamyCmOi mr Date . HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant atom or handle Wisadous material as refined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety Code.Section 25532(a)7 �Yce 6No All roofs shall be inspected prior to any roofing material being installed. ( Will the applicant or future Wilding ocaupam use equipment ordcvice which If a roof is installed without first obtaining an inspection,I agree to remove emit hmardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Diatrict7 ❑yes ON. 1 have read Ne harardous materials tequirements under Chapter 6.95 of Ne Califon 'a Health A Safety Code,Scctimu 25505.25533 it 2 534.1 undcmund dear if Jte Wilding not currently haw a mart.Nat it is my responsibility to nobly the occupant of the requirements whit n be met poor to aganec of a Certificate of Occulay. - Signature of Applicant Date I`�s//�, L/' All roof coverings to be Class"B"or better Owner or authorind agent Data OFFICE COPY S 21 j j . APPROVE 1 to ACCORDANCE WITH THE 'FX PF.. 1 IN 0 ES AN tfA14f I_.,, y/t1x: A7E �r SIGNED 1A NtP This set a and specifications MUS - )a kept on t e job at all times and it is un lawful to make any changes or alteration, on.same without written permission fmn. the building Dept., City of Cupertino. The stamping of this plan and specificatibul SHALL NOT be held to permit or to be ar approval of the violation of any pra OM, if anv City Ordinance or Mate taw. OWNER-BUILDER VERIFICATION 1. (Check one) I or/my immediate family (parent,spouse or child) will perform: • A V All the work authorized by this permit B. _ A portion of the work C. _ None of the work If B or C is checked,complete 2 or 3 below. d 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work(complete section below) Contractor Address/City. Phone #. State License # Type of work to ' - be mut vauacd 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be _performed . .......................................................:............................................................................................................................. I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner'sSignrre: �//tii �/ '�� Date: 9/z/ Job Address:.40 SGw fa Teresa Ov. Permit# 0 4 0 9 ,P236 AM changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. • City of Cupertino Building Department Torre Av CITY OF Phone:(408)777-3 CUPERTINO Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself,you may protect vourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as, contractors or subcontractors,then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding,federal social security taxes,workers compensation insurance,disability insurance costs,and unemployment compensatioo contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building pernit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may, be obtained by contacting the Contractors'State License Board in your community or at 1020 N Street,Sacramento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly.y°urs, Building Department, • City of Cupertino Printed on Recycled Paper CITY OF CUPERTINO CUPERT.0 INO PERMIT APPLICATION FORM ` ° �� 2 APN# - Date: 9/2-11 f Building Address: Mailing Address (if different from building address): /0940 Sak4A (-e/ese- CA �jS of Owner's Name: Phone#: 4P K HWCAMA= 4o gz? s u 6 Contractor: License#: ��11Y10.. � 1•'l�c�lt��( � ' Contact: A VILA k-1 (tile Phone: 3 ZZ�`� Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect ❑ Plumh-Q Mech ❑ Job Description: Residential X q 9� Corn4erciat02 C� Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: <2n Occupancy ro`p Type of Construction Please check1hirburV the project is a second-story addition: ❑ Project Size: Standard ❑ , Large ❑ Major ❑ Quantity 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 Dee 600V> 1000A ELECTRICAL, BELEC200 Elee Svcs�600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add.Multi BUILDING BINVESTIGA Investigation fee BUILDING I of3 �— WCIT CITY OF CUPERTINO CUP I�TINo . PERMIT APPLICATION FORM qw 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 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 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/Alter 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 BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL . BREMBUSWAY Remodel Busways ELECTRICAL . BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL . BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BRE OLE 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 CITY OF CUPERTINO CUPERTPERMIT APPLICATION FORM Quanti Fee ID Fee Description Fee Grou BREMSIGNAD Rmdl Sips 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 Insection BUILDING BSWIM Swimming Pool BUILDING BTEMP TemDorary Power ELECTRICAL BTEMPPERM Tomnnrnry Rldp Permit BUILDING. BTEMPSVCS TemD Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC_ Electricals foot ELECTRICAL EPERMITFEE Elec Permit Issuance := " . _ ELECTRICAL MPERMFEE Mechanicals . foot , - _ MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL .PPERMITFEE t Plumbing Permit Issue PLUMBING PPLBG Plumbing Fe sq foot ___. PLUMBING _ZADDCHG . Address Chane _''___ _. BUILDING 3 of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADQRW: CA 9Sa ht PERMIT # /03 C) A .rese-- 0r. b Zf v 9 02-3 6 OWNER'S NAME: )1 n R I tN ar PHONE zZ 6 GENERAL CONTRACTOR: Ao k L' FAX # I am not using any subcontractors: /�� �1� "" l Signature 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 • oe Owupr-f nirrzic- r Signature t7 Date