04120034 (2) a• CITY OF CUPERTINO g*+�v x?tyPkt�}�'.�«y� '%'• •�f� ^"� -'y'y t vg'��`^( -
a BUILDING DIVISION - - PERMITV 'V1\Fa71C��it $' � �liylll\".yi.--
1 BUILDINGADDRESS: - GT ELECTRIC PERMIT N00'41'20034 -
21810 STEVENS CREEK BLVD
OWNER'S NAME: - - PERMRL4UEDATE -
PING TAI ' 861 WINDSON HILLS
ONE: SANITARY NO, CONTROL NO.
(408)-362-9473
.ARCHITEC(ENGINEER: - BUILDING PERMRINPO
BLDG ELIIL7 PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION . Job Description.
:
I"by affirm that I Am Ilaucd under provisional of Chapter 9(commencing P -
wCNSecdon7010)of0lvision Sof w Business anti Professions Code.anti my license la u
rej wfullforaarweffea UPGRADE ELECT. PANEL (200 AMP) &
�II License Class U..« - ' GROUNDED
9ll Dam Contractor ,
ARCHITECTS DECLARATION
1 undersand my plana thJl W used As public records , . -
�CI� q .�
3 Lid Licensed Professional
Oat I Am cUILDER DECLARATION I
I hereby.(nese on 11. ,amps from ac fico as Co License law far Ne - "-• ` - - —- -00 which
moan. cordon 7113 L3,BUJncea and Professions Code:Any city er county
$ which its iss a a permit rit)e ares dw Blur,improve,demolish,or e a sig try structure
.F i poor im==dpuJ Rttolaw Cmvilioanlforsuchpermitmmea saw summer '/
gg gzFF< wtte b ciag wi Secmnt w w provi Wo 3.t,M Bee m a LIanse law(Chapmr 9 Sq.FI. Floor Areas flit
( r , GUUS Value}q16 0 0
6� (ammencing with Secdrem And)of basis n 3af lis B cd cateaed on.My vl Cade)or - hl,� ll it#
a$ Nat beels,exempt wrUrom aM Ne bub fm w Jlcgcd eampdan.Any vloledon of
Section 7031.5 by aoy Applicator for a permit subjects w applicant to a civil penalty of APN Number-
1�:v dI� i••/ \Uj� "� P y TYPe -
not moa Nan five hundred dollar(5500). U J /^\OGC- anC
Las .357160.10 . 00 UG �'1�`7
' ❑� property, emPloyaa with"gnu wirmle cenpauUon. -
willdoamwork.and the structure is not Intended or offered for sale(Sec.7044,Buaineu - Required Inspections -
And Profaumru Code:The Conmcmes Liaise Law doss at apply w an owner of q . . P .. •..-• .-
prnpertywW Wilds or improves Merton,and wkdoeasmhwmkhimselfm Woage his - _Own employees provided Nat such improvements ammd intended oroBored forsalc if, ---- - - -
however,Ne Wilding or Improvement s mid within au year ofcompletion.the owner. • :
builder will have the Wrda of proving and he did not Wild or improve for purpose or -
k.).
u ownm of w property,am exclusively contracting with Iiceued conuaeou m _
.. Wulrvet w project(Sec.7044;Business and Profession Cade:)The Contractor's U. '^-
ceme Law does not apply m an owner of property who Wilds or improves Unman.and,
who cordnebfor such projects with aamratmgq liaised pursuant in we ConvomoYa - - -License Law. - -
❑IamexemptunderSec -.B&P C for this reason .. -
Dow
OR MPENSATION DEC -
I homby Affirm under waa ty of petjury one of the following declarations: ,
I have oed will mainWn a Certificate of Cement to ulf-Ivurt far Worker's Compen- -
-' Libor,u provided fm by Sadon 3700 of an labor Code,fm w performance of w
work for which this permit is issued.
❑I baa and will maintain Warkefs Comperisadon iverrana,u required by Section
3700 of Ne Labor Code.fa the pefmmanceafw work fa which Nu permit b issued.
My Wmkefs Compensation Inmsnce came sed Policy number Lie: _
Carver: Polley No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(IhisseNat need not kcompleted if me,permit literate hundred doltan(SIM)
or lea)
1 artily wt in the performance of the work far which this Permit Is iumd.I shill not _
employ any person in any mannerst as w become subject ww Workms'Compar alon - - - •- ----r. _ "-
-
LowsofCJimmla.Date - - - -
Applicant
NO ICE TO APPLICANT:If.after making this Certificate of Exemption.you should
become abject a the Worker's Compensation provisions of w Lahr Code,you most
veil O forthwith comply with such provisions or Nb permit W account revoked.
'Z,' CONSTRUCTION LENDING AGENCY - -
f"r I hereby affirm that Ncrt is a conslroWat lending agency for w performance of
a the work fur which this Permit is issued(Sec.31197.Civ,C.)
W 0 Leader's Name
Z Lender's Mamas
U Q 1 anifY that 1 have read Nis application and Tum Nn the move information is
cortecL I agree m comply with JI city and county aMnsnas and sum law relating to
building construction,and hereby authorize representatives Of INS city m enter uponwe
W aove-mentioned property for inspection purposes
Ly,pyr (We)agree to an.Indemnify and keep harmlw she City of Cupertino against
„y rA Iiabill0a.judgmenu,costs and expenses which may In any way stem against mid Cil
in msue.c.of the
of
V his nic.
APPLICANT UNDERSTANDSCAND WILL COMPLY WITH ALL NO INT Issued by: Date
S EOULATIONS.
I _`te --Di
Sig pdiW u ��m Re-roofs
HA%ARUOU,S MATERIALS DISCLOSURE Type of Roof
Will w applicant or futum Wilding oevpaumm or handk huardow meteriJ
As defined by the Cupenwo Municipal Code,Chapter 9.13,and the Health and Safety
coda,ScNan zs533(a)7
Yca a/� All roofs shall be inspected prior to any roofing material being installed.
❑
Will Nc applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air conominanm As defined by the Bay Area Air Quality Management all new materials for inspection.
District? {/
❑Peau
I hevc mad the hazardous materials requirement,under Chapter6.95 orae Calling.
riceHalth&SafctyCodc.ScW.25505,25533vd ZS534.lundcnwdthatifw Wilding
..to my hew a serene Nu ire b my responsihility m nail the aaPat or w
on IS watch MM W MCI poor w mumm of a Certificate of Signature of ApplicantDate
Own it ria da a Date f All roof coverings to be Class"B"or better
Community Development
COp
Cupertino 95014
r,
Telephone(408)777-3228
ciao Fax(408)777-3333
IUPEkTINO
Building Department
JOB RESS: PERMIT #
'719110 ve D lob 3
OWNER'S
GENERAL CONTRACTOR: F 2--
I am not using any subcontractors:r
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical -re- l 166
Excavation o
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 . _
wn o tragi/Yor Signature Date
i.
I t
G CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM ( Z�"��
APN# Date:
S— 6 U� 0 2 0� —200
Building Addr ss: Mailing Address (if different from building address):
2 to S- Vem cv-v-, M y
Owner's Name: I Phone#:
Pk!j% -Tou 4061-8%S-O!as: 6
Contractors . License#:
Um YY1 n C v a c ISM96EH
Contact: Phone:(F361--qf�3 Cupertino Business License#:
Fax:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description: �y� G ,w� 100 �a �o0 a.� � 't. .
Residential ® � 1' �n�� 1- 1 Commercial% ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction: Please check this box if the project is a
second-story addition: ❑
Project Size: Standard ❑ Laze ❑ Mac ❑
Quantity Fee ID Fee Description Fee Grou
BAPPLOTHER Other Appliances MECHANICAL
BBOILER1 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 Iiid/Off/Comm/ uasi 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
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CITY OF CUPERTINO
CUPEI�TINO
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
BNUCONUa New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmos herie 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 cfin MECHANICAL
BREMA]RHAN A/C Units <= 10,000 cfm 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
BREMRMIISC 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
AOL BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res A liance ELECTRICAL
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CITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM
uanti 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 Inection 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
PPERMTTFEE Plumbin Permit Issue PLUMBING
PPLBG..._ ___ . ._ Plumbin Fees foot PLUMBING
ZADDCHG Address Chane BUILDING
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