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07080061 -77 CITY OF CUPERTINO y�77����77� BUiLiSiNC;DIV1S10N PERMIT PERMIT NO. PBUILDIT61fFS:MICHAEL CT TBD — T 0 BE DETERMINED 07080061 PERMIT ISSUE DATE NAME: EN JU SA ARY N CONTROL NO. NE: BUILDING PERMIT INFO FTFCTO(),)T/ENGINEER: BLDG ELECT PLUMB MECH (_� (-� ZLICENSED CONTRACTOR'S DECLARATION Job Description Ucby affirm that I am licensed urhdcr provisions of Chapter 9(commencingU 7000)of Division3oftheBusinessandprofessionsCode,andmylicenseis ADDING NEW SWITCHES, RELOCATE. ADD NEW LIGHT and effectLie.tf FIXTURES EXTENDING EXISTING GAS LIVE ss -- --ContractorARCHITECTS DECLARATIONerstand my plans shall be used as public reeor s :J ti Licensed Professional OWNER-BUILDER DECLARATION -3 1 hereby affirm that 1 am exempt from the Contractor's License Law for the lo following reason.(Section 7031.5•Business and Professions Code:Any city or county z which requires a permit to construct,alter,improve,demolish,or repair any structure Valuation N prior to its issuance,also requires the applicant for such permit to file a signed statement Sq.]~t.Floor Area that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 $1400 m (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of A��l Number Occupancy Type Section 70313 by any applicant for a permit subjects the appltcartt to a civil penalty of 3 6 9 3 6 0 c 5 . V U not more than five hundred dollars(5500). C]I,as owner of the property,or my employees with wages as their sole compensation, ReGUlred 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 owrrcr- builder will have the burden of proving that he did not build or improve for purpose of sale.). gyf 1,as owner of the property,am exclusively contracting with licensed contractors to Construct the project(Sec.7044.Business and Professions Code:)or Mic COnrlaproves �s Li- cense Law docs not apply to an owner of property pursuant Contrtctoes who contracts for such projects with a contractors)licensed p License Law. B&P C for this reason i am exempttun�der Se Owner U" Date WORK ,S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: tJ I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Workers Compensation Insurance,as required by Sechon 3700 of the labor Code•for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Carrier. Policy Nn.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Ibis section need not be completed if the permit is for one hundred dollars($100) or less.) 1 certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner asp as IQ bet tic-b' to the Workers'Comlimnation Laws of California.Daft'+—r7�=. ld Applicant 1��0�' NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you shou become subject to the Worker's Compensation provisions of the Labor Code•you must Z forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY --h I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097.Civ.C.) a Q Lender's Name Z Lender's Address I 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 stale laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. (wt-)agree to save,indemnify and keep harmless the City of Cupertino against n !� y r%j liabilitiu,judgments,costs and expenses which may in any way accrue against said City Date Zin consequence of the granting of this permit. r-+ APPLICANT UNDERSTAND WILL COMPLY WITH ALL NON-POINT Issued f ly: SOURCE REGULA ONS. Re-coot's Signature of Applicant/Conua Dam Type of Roof HAZARD S MATERIALS DISCLOSURE yP Will the applicant or future building occupant stoic 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 malarial being installed. s ❑Yes 3d If a roc f is installed without first obtaining an inspection,I agree to remove Wilt the applicant or future building occupant use equipment or devices which all rev, materials for inspection. emit-hazardous air contaminants as defined by the Bay Area Air Quality Management District? El Yes No or- 1 have read the hazardous materials requirements under Chapter 6.95 of the Cal dg nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently a tenant that it is my responsibility to notify the occupant of the Date require Coto whit m be met prior to issuanu of a Certificate of Occupancy. Signature of Applicant 7 All roof coverings to be Class"B" or better Datc Owner or authorizeagent CITE' OF CUPERTINO PERMIT APPLICATION FORM (CUPEkTINO C)1 LPN# 2� Date: Building Address: Mailing Address (if different from building address): 20310 A�:cinge i�nu �.b I Owner's Name: Phone#: �- 4u 9- _ k 7 6- License #: Contact: (/ Phone: Cupertino Business License#: Fax: he�,a SWcl�a.�, �( Q 0Ca P kLO���c tI a �eW I2� k W1. Building Permit Info: f�dd�Z�-� , �v`k Bldg ❑ Elect Plumb ❑ Mech ❑ Job Description: Residential RCommercial El 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: roject Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER ether Appliances MECHANICAL BBOILERI Bciler<= 100,000 Btu MECHANICAL BBOILER2 Boilcr> 100K to 500K Btu MECHANICAL BBOILER3 Boi:er> 500K to 1M Btu MECHANICAL BBOILER4 Boilc;r> 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 Cc nstax -Resi/Mobile BUILDING BELEC 1000 E lee 600V <= l 000A ELECTRICAL BELEC1001 1E;lec 600V > 1000A ELECTRICAL BELEC200 Ele,-. Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 Community Development F 10300 Torre Avenue is Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ';UPERTINO Buildin De artment JOB ADDRESS: PERMIT # cv�%cti�,�� c G ��G, C IA 41 Sal ��v G / OWNER'S NAME: r F•v '��� PHONE # qc: i b GENERAL CONTRACTOR: Q FAX# I am not using any subcontractors: Date Si,nature Please check a licable subcontractors and com Clete the followin information SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical rm ZE Y J" Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering2'y � � Plumbing n 4 i j a "7 ? b '' Roofing Septic Tank Sheet Metal Sheet Rock Tile A- Owner/ Con cDate tor Signature CITY 0:7 CUPERTINO 8 ITEMS OF 8 PERM:CT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: BLk: Lot: APN . . . . . . . . . 35936025.00 DATE ISSUED. . . . . . . : 03/07/2007 RECEIPT #. . . . . . . . . . B3000002291 REFERENCE ID # . . . : 07080061 SITE ADDRESS . . . . . : 2 )310 MICHAEL CT SUBDIVISION . . . . . . . CITY C'JPERTINO IMPACT AREA . . . . . . . OWNER K.EN JU ADDRESS 2 )310 MICHAEL CT CITY/STATE/ZIP . . . : C'JPERTINO CA, 95014-4423 RECEIVED FROM . . . . : KN JU CONTRACTOR . . . . . . . : 73D - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : 73D - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 .86 0. 00 34 .86 0. 00 BPGAS OULETS 1. 00 5 .40 0. 00 5 .40 0. 00 BREMFIXT NO. FIXTURES 2 . 00 2 .40 0. 00 2 .40 0. 00 BREMRECEPT NO. OUTLETS 6. 00 7 .20 0. 00 7 .20 0. 00 BSEISMICRE VALUATION 1, 400. 00 0.50 0. 00 0.50 0. 00 EPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38.37 0. 00 MPERMITFEE FLAT RATE 1. 00 38.37 0. 00 38 .37 0. 00 PPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 165 .47 0. 00 165 .47 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 165.47 1087 --------------- TOTAL RECEIPT 165 .47 OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. _ All the work authorized by this permit B. — A portion of the wrk C. None of the work If B or C is checked, zomplete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. All of the work B. _ A portion of the iA ork (complete section below) Contractor Address/City Phone # 4State License # Type of work to be performed enc L3 �� 40ff- L� 8 �I�� «< 7? 0t �7a-a 7 SGIr T; 11(7 3. _ I will utilize unlicensed person(,,) 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' cc mpensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be erformed .......................................................................... ............ I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse sid Property Owner's Signature: Date: Job Address: 2410 M"C LaeQ CA. 111t:2* J- rtz, C/A � N2 1>` Permit# Any chanes to the information provided )n this form shall be submitted to the City of Cupertino Buil( Department. 71 WMM - CUPEkTI NO �w Assessor's Parcel Number: — Name of owner. ' ' Contact person N _� Phone. Fax. Net square footage of lot. }--� E�ssting Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N Is privacy protection planting required for the proj ect? Y N On what floor(s) is work being done? J�V_—sit 4—e- 4-qA VC Brief description of work. `� rr to c r C 'fi i c4 e c1d �� Code editions: 2001 CBC d-N)2001CFZ -N)2001 CMC (Y-N) 2001 CPC `1-1)2001 NEC -N) APPROJj t iN ACCORDANCE S ANDGR tNANCES Effective 1I�tKZIMG CGDE )ATNEU_.--�---- �-�-- Vcutiuns U �.�,1�1 CAtll., J� lin nesSet '.trlas i kept oii t",: p " , K,.. or attest+er. L� l t0 lawfu nn same v�'til;:u� wl«' ci Cx pert no- k C'ry ;:n�cp ctitcat;or +ne building L`,� :, e a� of h�'�P U pe,:r,;:t or t� he The stamp g t� �NALI. NOT be violatte approval of the nr n ofTpktp u r ,Anv City i>',tt;n�ncP Plan Review Process Work Book Page-8-Reused 8/22/05 iy I LT 4 a C�ciora y _` mss C.,.. �` �� Lr h`✓�°�,. o",e 1, ct a { i i� Ow � I,�j 00, 7-40 je g 1 r r 1 CD 1 LUI� �'If'.L r"'+'.i -- y31C) ,! s � r4 YM { 1 i oc j "c . .