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04010003 (2) CITY OF CUPERTINO _ sulLomc%rvlsioN - PERMIT - 1�,ONiTRACTQR IN�'ORMATJ0�N,N� BU ILDING ADDRESS: SONES MASONRY PERMITN04010003 f;9 TTPTnT;. TAT OW NER'S NAME: PERMIT ISSUE DATE DANNY LIN ONE: SANITARY NO. CONTROL NO. 4083777512 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECr PLUMB MECH I� 0 3oO LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that l am licensed under provisions of Chapter 9(commencing Job DESCHPPIN M Scnlo 71)(g) I'D Division 3 of the Business and Prufc�fteuinns Codc.antl mylicenu is ALE® in full fosse ff °;°sea Licenu LIc.T 0 ? CHIMNEY SAN 1 3 ZOO4 ,"o %ave Cum r t. ARCHITECTS% C RA ION -' awU understand my planeshall be medas public records 6 ;u. Licensed Professional gO OWNER-BUILDER DECLARATION BUILDING 9 M O 1 hereby a(0rm Na,1 1, exempt from we Contractor's C e:Any c Law for the p O following meson.(Section]ID LS,Business and Profeaairns Crede:Any city nr county EMO m E which requires a permit to construct,eller,improve,demolish,or repair any structure Lia poor to its issuance.also requires the applicant for such permit to file a signed statement yo that he islicemcdPer s.amrothepowisimmsnf the Commuter's License aw(Chapter9 Sq.Ft. Floor Area Valuation h$ (commencing with Section 7")of Division 3 of the Business and Professions Code)or . �.- that he is exempt therefrom and Uw baso for Ne alleged exemption.Any viDlatton of Section 7031.5 by any applicant far apemah,rubjeca for applicant Ir a civil penalty of 35P�3�I�l9t�et00 Occupancy not mora man raw hundred dollars(sero). p y Type ❑1,as owner of the property,or my employees with wages a their sale campxninalon, will do Ne work,and the someone is not inwndwd or offered for sale(Sec.7044,Business and Professions Code:The Cmumetor's License Law docs nos apply of an owner of Required Inspections property who builds or Improves chorion,and who does such work himself orderough his own employers,powided that uch improvements are not inwndW oroBercd forsale.If. however.to building or improvement is sold within one year of completion,Ne owned builder will have the burden of proving Nat he did not build or improve for purpose of sale,), ❑I,as owner of Ne property.am exclusively convecting with licensed indicators w consumer the pa ject(Sec.713,4.Business and Professions Cade)The Contractor's Li. cense Law docs not apply to an owner of property who builds or improves themon,and who contracts for such pmjeca with a ermranor(s)licensed potation to the Convenors License law. ❑I sum exempt under Sea ,B&P C for this reason Owner new 1371WWORKER'S COMPENSATION DECLARATION I hereby of ton under penalty of perjury one of the following declarations: I have and will maintain a Certifmw of Consent to re fdmu a for Workers Compcm ' an,an provided for by Section 3700 of Ne labor Code,far Ne peRmmmoo of,he rk for which this Fermi,is issued. El I have and will maintain Workers Compensation Insurance,m acquired by Section - of Ne labor Code.for Ne performance of Ne work for which Nis permit is issued. bar's CnmstensetioV N tem carie Pol cy Noind r number a Cyr: CERTIFICATE OF EXEMPTION PROMWO COMPENSATION INSURANCE (This auction need not he completed if the Permit is farrow hundred dollars(;Iri _ ales..) . I cir ify Nan in the performance of the work for which this Permit is iuued,1 shall not employ any person in any manner se,as w become subject to the Workers'Compensation Laws of California.Dave Applicant NOTICE TO APPLICANT.If,after making his C.i incaw of Exemption,you should _ become subject to the Worker's Compensation previsions of the Labor Code,you must Oforthwith comply with such provisions or this Permit shall he deemed franked. z� CONSfRUCT10N LENDING AGENCY _ H Ihcrehyafnrm that there is a comum[,ion lending agency for Ne Fcrformanmof tx > Nc work fur which this permit is issued(Sec.3097,Civ,C.) Wti m lenders Name Lender's Address V 0 1 certify Nat 1 hers tad this application antl nate that Ne above information is w F correct.l agree to comply with all city Md county ordinances and slaw laws missing to - O V building construction,and hereby authors representatives of Nis city to enter upon the LT) ahow-mentioned property for[retraction purposes. //1 L},t,Z (We)ague m ave,indemnify this and keep burettes the City of Cupertino against 1 f..,y Iiabili,iws.judgments.costs and expenses which may in any way accrue agalm,said City Uz in consequence of granting of this permit. 7/ t-t APPLICANT UND RSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: Date e SOU Eau ONS. - 0 Re-roofs Si re Of AploudidUtoomithir D HAZARDOUS MATERIALS DISCLOSUke Type Of Roof Will the applicant at future building occupant arore or handle haralloos material as defined by the Cupertino Municipal Code.Chapter 9.12,and she Health and Safety crde.srwen 25532(a)+ Yet All roofs shall be inspected prior to any roofing material being installed. ❑r Will the applicant or future building occupam use equipment or dcvicm which If a roof is installed without first obtaining an inspection,I agree to remove ,Incendous air contaminants as defined by the Bay Arca AuGi ali,y Managemcn, all'new materials for inspection. and, �,( ❑Yrs S! 1 have road Ne hasaNnusmawriala rcyvircmena under ChaPwr6.95 of thr Wlifnr- his Hmlth&Safety Codc Sections 25505,25533 and 25534.1 undersand Naz if the building docs nut currently haw a to 4 the,it is my responsibility to m ally the .uPam,of the Mquirakin4s whit mus,be men prior w issuance rfa C 'ncate f rt w Signature of Applicant Date 0 march i.sd ager d„e All roof coverings to be Class "B" or better I ' C+Q CITY OF CUPERTINO CITk PERMIT APPLICATION FORM INO CUPEI�T APN # 35 cl * a0 ( /� Date: J l _I x.7-30-03 Building Address: /c$52 T�n Cl/)O Owner's Name: ( 1,� Phone#: Contractor: License#: -� 39o3s9 Contact: �o7reS Cupertino Business License#:a�20� uilding rmit Info: i Bld [a Elect ❑ Plumb ❑ Mech ❑ o scription: Residential [c]�j— '� Commercial ❑ Sq.Ft. Flo o Area: \ $/Sq.Ft.: Costof roject: 3oon.00 Occupancy Group: _ Type of nstruction: a�., A.0 Ijroa�d Quanti Fee IDEiler Fee Descri tion Fee Group BAPPLOTHEROther A liances MECHANICAL BBLDGFEEld Permit s . foot BUILDING BBOILERl <= 100,000 Btu MECHANICAL BBOILER2 r> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M 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 BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Ener BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING 1 of 13? qL CITY OF CUPERTINO CITY PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPL CHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING Ask BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rick erBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pipe PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN 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 BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 2of3 lil as CITY OF CUPERTINO ` C]"OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Group 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 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 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 MPERAIFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING Pp Plumbing Feesq foot PLUMBING ZADDCHG Address Chane BUILDING 3 of 3