07010080 CITY OF CUPERTINO GTR I ( ItMAT�€�1 '
BUMDING DIVISION PERMIT.
PERMIT NO.
BUILDING ADDRESS:
1183 CRESTLINE DR J I E—DD — PERMIT ISSUE DATE
OWNER'S NAME: 01/16/2007
JIE DU
SANITARY NO. CONTROL NO.
ONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUM kfH
1 O C LICENSED CONTRACTOR'S DECLARATION Job Description
.:as C I hereby affirm that I am licensed under provisions of Chapter 9(commencing 2 0 OAMP L PGRADE
a Z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is
y in full rota and eff,
j v2 Z Lice nac ase Lic.• ,
tDate ARCHI IECII Contra; LARATION
I understand my plans shall be used as public records
�yU
LLin Licensed Professional
no OWNER-BUILDER DECLARATION
rA
`>3< I hereby affirm drat I am exempt from the Contractors License Law for the
%M O following reason.(Section 7031.5,Business and Professions Code:Any city or county
t Pi which requires a permit to conswct alter,improve,demolish,or repair any structure
'J Z prior to its issuance.also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area $1700
7 0 0 Valuation
< that he is licensed pursuant to the provisions of the Conuxtor's License Law(Chapter 9
xH (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 2 2 5 0 0:i .�l7YT' Number P Y YP
not more than five hundred dollars($500).
0 1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections
will do the work and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contrxtor's
License Law.
0 I am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
c]I have and will maintain a Certificate of Consent to self-insure for workces compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Warkees Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(5100)
or less.)
I ceniry that in the performance of the work for which this permit is issued,I shall not
employ any person in any man r so to bject to the Workers'Compensation
Laws of Cal'om'L Date
NAPPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J'Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z OZ CONSTRUCTION LENDING AGENCY
(..o►. I hereby affirm that there is a construction lending agency for the performance of
C4> the work for which this permit is issued(Sec.3097,Civ.C.)
W ALender's Name
04 L.endees Address
V zI certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
O Ubuilding construction,and hereby authorise representatives of this city to enter upon the
above-mentioned perry for inspection purposes.
>4 W (We) a LOT
o save,indemnify and keep harmless the City of Cupertino against
Hliabilities,' gments,costs and ex_ nses which may in any way accrue against said City
U zin corse nce of the grana of is per it Date
APPLI ANT 3tDERST D AN ILL COMPLY WITH ALL NON-POINT Issued by:
SOU E GU ATIOnI . I "'
— 6 . 6' 7 Re-roof;
Signatu ApplicanL'Contracto Doth T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
DYES If a roo-'is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
,nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0Yes \)� o
I have read the hazardous materials requirements under Chapter 6.95 of the Califor.
ria H cty Code,Sc uons 25505,25533 and 25534.1 understand that if the building
t cu fly have t. is my responsibility to notify the occupant of the
rI —e
men . hien r to issuance of a Cdxtittcate of occupancy. $ignatu fe Of Applicant Date
elz4 - 'r�. �� All roof coverings to be Class"B"or better
dr authari-zcd agent Datc'
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*TPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: 5- e S t,� PHONE # S/v S o/-s f/ef'
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: il r —/6 -U7
ignature Date
Please check applicable subcontractors and complete the following information:
60 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
CITY OF CUPERTINO
5 ITEMS OF 5 PERMI`[' RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Bl.c: Lot:
APN 36225003 .00
DATE ISSUED. . . . . . . : 01 /16/2007
RECEIPT #. . . . . . . . . : BS)00000214
REFERENCE ID # . . . : 07 )10080
SITE ADDRESS 1133 CRESTLINE DR
SUBDIVISION
CITY CU PERTINO
IMPACT AREA . . . . . .
OWNER JIE DU
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : SARATOGA CA, 95070
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR LIC # *OWNER*
COMPANY JIE DU
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : SARATOGA CA, 95070
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- -------
BELEC200 METERS 1. 00 29 .43 0. 00 29 .43 0. 00
BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 .86 0. 00
BSEISMICRE VALUATION 1, 700. 00 0.50 0. 00 0.50 0. 00
BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 . 00 0. 00
EPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38 .37 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 210.16 0. 00 210.16 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 210 .16 VISA
---------------
TOTAL RECEIPT 210 .16
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- ------ ---------
103 UFER 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL
CITY OF C UPERTINO M010060
OW Or PERMIT APPLI=CATION FORM
CUPE(�TINO
.,,PN# Date:
coo
Building
- /� - C
Building Address• Mailing Address (if different from building address):
Cif cv� TI ti o
Owner's Name: Phone#:
Contractor: License #:
f� e.50 L v J � L S C 7X I G
Contact: Phone(9,10)s6 - 3 ffa7 Cupertino Business License#:
P of fWMo/\j Fax:
Building Permit Info:SF,�Vr C
CF v10Cv �£ -F7�vM /O o 14.'1'1(' 7W -<<'
Bldg ❑ Elect Plumb ❑ Mech ❑
Job Description:
Residential � Commercial El
Sq.Ft. Floor Area- U Sq.Ft.:
Cost of Project: , I ✓ Occupancy Group:
Type of Construction: a200 Please check this box if the project is a
S<c U j C U/116 ,SMP second-story addition: El
eroject Size: Standard,_EIL Large ❑ Ma or ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER ether Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to lM Btu MECHANICAL
BBOILER4 Boilcr> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX construction Tax BUILDING
BCONSTAX In J/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V<= l000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elea Svcs 600V<= 200A ELECTRICAL
/ BENERGY Energy BUILDING
BENERGYADD J3nergy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF (:UPERTINO
CUPalEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Th.atrical 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 Inspection 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 Mechanical sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Plannin ;LR Comme/Multi-Fam PLANNING
PLLONGRNGR Plannin ; Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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