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04040015 (2) a CITY OF CUPERTINO BUILDING DIVISION PERMIT CON'CRe CT0R INF0'RN]`. ON h' BUILDING ADDRESS: AAAELECTRIC INC PERMIT 100404001.5 1043 OWNER'S NAME: PERMITESSURDATE BYUNG CHUM YANGSANITARYNO. CONTROL NO. ONE: ( 8899 408) 557- ARCHnECr/ENGINEER: BUILDING PERMR INFO BLDG ELECT PLUMB MECH _ 0 0 0 O I hereby affirm that am IirorocdAunder�R CONTRACTOR'S DECLARATION f Chapter 9(commencing P O JobDescri tion ALR® wife Sec0on7000)ofDrvialon Sof the Business Professions Code,and my la tmm�aClosederr«t. REPLACE ELECT PANEL (100A) APR s - 2004 Dan Cissa Lie,g Y Dem ARCHITECT'S DECLARATION I understand my plans shall he used as public menrds 30�A Licensed Professional 5 OWNER-BUILDER DECLARATION <� I hereby atRrm that 1 am exempt from Fee Communes License Law for the p o following reason.(Section 703 1.5,Business and Prefosiom Code:Any city or county $ which requires a permit m eonswc4 a@L improve,demolish,or epair any a unClUne poor to its issuance.also requires the applicant for such permit to file a signed summand tat< Fiat In is licensed pursuant othe pmvisionaofthe ComecmriLi¢nss Law(Chapter 9 Sq.Ft. Floor Area Valuation 3� (commencing with Section 7")of Division of the Business and Professions Code)or 3 that he is exempt Wemfrom and the basis for the alleged exemption.Any violation of Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of 374F24]IQtditbe100 Occupancy Type not more Nan five hundred dollars($500). 0 I.as owner of the properly,or my employees with wages u their sore compensation, will do the work,end themuctme isnot intended or offered for sale(Sm.7014,Business Required Inspections and Professions Code:The Conveciar'a License Law does not apply to m e owner of q P property who builds orimprom thereon,andwho doessachwork himself orthrough his own employees,provided that such improvements art Wuhro ided oroffued forsam.If, however.the building or improvement is sold within mw year of completion,the owner- builder will have the bother of proving dust he did not build or Improve far purpose of ula.). 0 1,an owner of the pmpeny,am exclusively convecting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Cormacuri Li. come Law dors not apply to an mosu of property,who builds or Tmprom thereon,and. who convects for such projects with a contMpr(a)licensed pursuant in the Conmuori License Law. 0 lam exempt undo Sa. ,e&P C for this mason 1371W wner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty of perjury oro of the following d"Istradom: 1 have and will maintain a Certificate of Consent to self-insure for Worker'sCampen- ion,ss provided for by Section 37M of the labor Cade,for the performance of due rk for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as expired by Section of the labor Cotle,for the performance of due work for which this permit is issued. y Worker's Compensation Insurance carrier and Polity number art: rtier. Policy Nis: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section mud not he completed time permit is forms,hundred dollars(5100) or los.) 1 trolly Lou in Ne performance of Ne work for which this Permit u issued.I shall not employ any Person in any mannerse as to become subject o the Workers Compensation Laws of California,Dam Applicant NOTICE TO APPLICANT:If. Act making this Cci ificam of Exemption,you should Women subject to the Worker's Compensation provisions of due labor Code,you must .,O Forthwith comply with such provisions or this permit shall be created invoked. „Zy CONSTRUCTION LENDING AGENCY f~ Ihereby affirm that Nem is a convection lending agency for the permersamen of C ;s' the work for which this Permit is issued(Sec,31197,Civ.C.) W 0 Lendcri Name Loualins Address U C) 1 certify that I have mad this application and tum that the shave information is - w E mi1 agree to comply wit all city and county ordinances and sum laws minting to pbuilding construction,and hereby motorize repmsenutives of this city to enter upon the L57 above-mentioned property for inspection purposes. f~d (We)agree to saw:,indemnify and keep harmless the City of Cupertino against fq liabilities.judgments.costs and expenses which may in any way acerae against said City V 7 in consequence of the granting of this Permit. r7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date (7 SOURCE REGULATIONS. Re-roofs Signuurc ofAtildleantiCoutiactor Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the a Cu(,.emor fumrc bullinge,Chapter nomor handle Health amaterial u Oehnctl l the Cupertino Municipal Code.Chepmr 9.13.and the Health end Safety one. 0 en zss33(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yu []No Will the applicant or future building exception use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it havardous air contaminants in defined by the Bay Area Air Quality Management all new materials for inspection. 7i. Oict? 0Yes UNo I have mad the hamreous materials requirements under Climax 6.95 of dm Caliror- Healon S,Safety Code,Sectors 25505.35533 am125534,1 underawnd Nat irms building rs not currently have a mrant duet it is my hexa mihility m notify the oucup m of the uimmcnu which must be met poor to issuance of a Cenificam of Occupancy. Signature Of Applicant Date ner or authorized agent Dam All roof coverings to be Class"B"or better J � ` - CITY OF CUPERTINO CUPEf�F PERMIT APPLICATION FORM o � o o APN# Date: Building Address: ID / � / Vi M A e s(if different froin building address): Owner's Name: y� (p /I�/'L� r Phone#: ContractoC/�/17��/`� License Contact:r I S Phone: _ ft— � Cupertino Business License#: Vv Fax: 6� Building Permit Info: � BldgElElectAf/ Plumb ❑ Mech ❑ Job Description: Residential �I �� ` InAe ryc ❑ Sq.Ft. Floor $/Sq.Ft.: Cost Pro' Occupancy Grou . Type o o struction: Please check this b ct is a second-story addition: ❑ Quanti Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to IM Btu MECHANICAL BBOILER4 Boiler> IM 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 WBM1TIGATC R Constax—Resi/Mobile BUILDING 0 Elec 600V ELECTRICAL 1 Elec 600A,> 1000A ELECTRICAL 0 Elec Svcs 600 =200A ELECTRICAL Ener BUILDING D Ener Add Multi BUILDING A Investigation fee BUILDING C Comm. Housing Mit. Fee BUILDING 1 of SR , CITY OF CUPERTINO CUPE(�TINO PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group 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 PbIg 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 I 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 Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Fumace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC 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 HeatingMECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Sips,Marquee ELECTRICAL 2 of 3 CITY OF CUPERTINO ' CUP TY0 PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group 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 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