07080093 �ITI'OF CUPERTINO g�g���gy ��������I����,����: ;
BUILDING DIVISION �P�L<1Wi1T --
PERMIT NQ.
r EU1LD�r�a���ssBUBB RD TBD - TC) BE DETERMINED 0 7 0 8 0 0 9 3 �
pERMIT LSSUE DATS'
OWNER'S NAME:. . '
YP,NJUN HUANG
SANI ARY O. CONTROL NO.
E'.,
„ � � � � SUILDWG PERMITINFO
ARCHITECTlENGiNEER: BLDG ELECT PLUMB MECH
� � � � _
� � L�iC6NSED COMRACfOR'S DECLARATION IOU DeSCTlphO❑
n ,.,... .
�F, . {^htrcby af(irm that I am licenscd undcr provisions o(Chaptcr 9(commcncing REPLACE FURNANCE �ND A�C
U wj�Scttion 700U)o(Division 3 of�c Busincss and ProfcSsiuns Code,and my liccnsc is
� in Ypll�orcc and cf[ecl �
Z Licensc Clsss Lic.# .
� Datc' � - Conlractor
�� � . ARCHITECi'S DECLARATtON
— �.'1 undcrsiaAd my plans shall bc uscd as puhlic rccords
:J —
Liccnscd Profcssional
� OWNER-BUILDER DECLARATION
�,� I hcrchy alfrm�hat 1 am excmp�from thc Contractois Liccnsc Law for thc
O [olll�wjng rcason.(Sccuon 7031.5,Busincss and Profcssions Codc:Any city or county
;�i which requires a petmit to conswct,alter,impmve,demolish,or repair any timcwre Valuation
'y prior tn its iscuantc,alsu tcquires thc applicant for such permit to filc a signcd statcmcm ; Ft.Floor Area
?o �hat hc is li�caxJ pucsuant lo thc pmvisions of ihc Con�ractur's Liccnsc Law(Chaptcr 9 ' q' �3 O O
•o (commcncing with Scction 7000)nf Division 3 oC ihc Busincss and Profcssions Codc)or
i a0 ihat he as exempt thercfrom and the basis for U�e allegcd ezempuon.Any violaGon of �CCU 3IIC T e
Secdori 7031..5 by any applicant for a perm��sub)ects the applicant to a civil pcnalty of 3 5 6 210 5 � ;U�Number P Y YP
not�ore Nan fivc:hundred dollars(3500).
�I,as owner ot ttie propcay,or my employces with wages as their solc compensation, Required Inspections
will do.thc work,and�e stcucture is not intendcd or oftered[or salc(Sec.7044.Business
and Piofessions Code:The Conuactors License Law dacs not apply w an owner of
pmperty who huilds or improva tt�ereon,and who does such work himselC or lhmugh his
own emQloyces,providcd ihat such improvcmen�s are no[imended aro[fercd for sale.ff,
however,ihe building or improvement is sold within one year of compleuon.�he owner
builder will have the burden of proving t6at hc did not build or improvc Cor purpose of
salc.).
I�I,as owner oC tho property,am exclusively conuacting with liansed convacwrs a
tonstruct the project(Sec•7044.Business and Professions Code:)The Contractnrs Li-
ccnse Law docs oot apply to an owner of propeny who builds or improves�he�wn,and,
who contracls for such projects with a convactorts)licenxd pursuant tn�e Contrac[ors
License Law. ,g&P C for�his reason �
❑I am exempt undu Sec
Owncr t.(A !/(� '9 "�-� �a�
WORKER'S COMP SATION DECLARA170N
.I hercby��m under penalty of perjury one o(the following declarations:
❑3 have and will maintain a CeniGca�e oCConscnt to sel(-insure(or Workc�s Compeo-
sa(io�,as providcd for by Section 3700 of the Labor Code.Cor�he perfarmarKe o[thc
woric for which Uus permit is issued.
�!havc and will maintain Workcr's Compensation Insunnce,as rtyuired by Scction ,
3700 oC the Labor Codc.Cor thc performance of the work for w6ich this permii is issued.
My Workers Com{xnsation Insurance cartier and Policy number aze:
Cartier: � ... . Poliry No.:
CERTIFICATE OF EXEMPf70N FROM WORKERS'
COMPENSATION i1dSURANCE
(This scction nccd not be complcted if the permit is for one hundred dollazs(S I00) •
orlcssJ
I cenify th�!in the performance of ihe work for which�his pecmit is isaued,I shalt not
es�ploy any persan in any m r to subjee�to�he Workcrs'CompcnsaGan
Laws of Califom}�. ate
Applicabl +i "� �
NOTICE 7'O AP A :If,aflcr ing this Ccn�licatc of Ezcmpuon,you should
bccome subjcct to ihc.Worker's Compcnsation provisions of thc Lshor Code,ycm must
�z forthwith comp�Y W���Sh provisions or this pccmit shall bc dccmcd awokcd.
.� CONS7RUCTION LENDING AGENCY
a.�-� I hc�cby aCGrm Wat thcre is a constructian Icnding agcncy Cor thc perfurmance uf
a.� 1hc wark fur which this pCrmit is issued(Scc.3097,Civ.C.)
a Q Lendcis Namc
� L.cnder's Addrcss
)�
. )ccrti[y�ha�I havc rcad this application and siaic that�hc a6ove infocmauon is ,
,� cortect.1 agrce to comply with all city and county ordinances and sute laws rclaiing to
�Ubuilding conswction,and hcreby authori�e rcprescntativcs of ihis city to cnter upon thc
W abdvc-mcntioncd property!or inspccuon purposcs. ��
� � (Wc)agree to save,indcm�i(y and kccp harmless the City o(Cupertino against
y� liabilities,judgmcnts,costs and cxpcnscs�which may in any way accruc against said City � ��
)z in cortscqucncc oC ihc gran�ing of lhis permit. DSte
� APPLICANT UNDERSTANDS AND WILL COMPLY W1TH ALL NON-POINT Issued b'�:
SOURCE GUL T! NS. C//a/o, '�--
°c < Re-roofs
Signawrc o( ppf dContractor Datc
T e of Zoof
HAZARDOUS MA7'ERIALS DISCLOSURE YP
Will thc applicant or future building occupant store or handlc harardous matcriat
az dcfincd by the Cupertino Municipal Codc,Chaptcr 9.12,and thc Hcalth and Safcty
Codc,Scction25532(a)� All roof:;shall be inspected prior to any roofing material being installed.
�ycs [JdNo - _
If a roof is installed without first obtaining an inspection, agree to remove
Wilh�hc applicant or fuwre buiVding oecupant usc eyuipmcn�or Jcviccs which
cmit harardous air conlaminan�s u dcfincd by the Bay Arca Air Quality Manzgcmcnt all new�naterials for inspecsl0ll.
Disuicc?
�Ycs �No
1 havc rcad the hvarGous ma�crials requircmcnt�undcr Chap�cr 6.95 of thc Cali[or-
nia Hcalih&Safcty Codc,Sccdons 25505,25533 and 25534.1 undcrstand that if ilu building
docs not curtcntly havc a�cnan4�hat it is my responsibili�y m noufy thc occupanc nf�hc Date
reyuiremen�c which mu�t be met prioc to issuance o[a CertiTca�c ot occupancY- SigR3illI e Of Aj�pi1CST1[
� D Al]roof coverings to be Class"B" or better
Owncr or uthom.cd agcnt � D��
Community Development
� � -�. 10300 Torre Avenue
� � Cupertino CA 95014
� �• '
Telephone(408)777-3228
,�C(TY OF Fax(408)777-3333
�UPEI�TINO
Buildin De artment
JOB ADDRESS: � � Z Cf. -1 j��t b � )Z , PERMIT # c�.
Gc, �r-�,, ��-I �( S-��� �7 d��� C
OWNER'S NAME: ah �i t� �-}c,c.G,r�J° PHONE # 4v� G 8 S'
GENERAL CONTRACTOR: c. L/�)P.�C �r-i�' FAX #
I am not using any subcontractors: � L� ���`�' � r � b 7
Si;nature Date
Please check a licable subcontractors and com,�lete the followin information:
SUBCONTRACTOR BUSIl`1ESS 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
7 ITEMS OF 7 PERMI'P RECEIPT OPER.ATOR: CathyS
COPY # : 1
. Sec: Twp: Rng: Sub: Blk: Lot:
= k ,
APN . . . . . . . . . 35�21055.00
� DATE ISSUED. . . . . . . . 08/09/2007
RECEIPT #. . . . . . . . . : BS000002329
REFERENCE ID # . . . : 07080093
SITE ADDRESS . . . . . : 11247 BUBB RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
.. OWNER . . . . . . . . . . . . . YAL�JiJN HUANG
ADDRESS . . . . . . . . . . . 11247 BUBB RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4940
RECEIVED FROM . . . . : YANJUN HUANG
CONTR.ACTOR . . . . . . . : TPD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TED - 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
BREMAIRHAN NO.tTNITS 1. 00 10.26 0. 00 10.26 0. 00
BREMFURN NO UNIT 1. 00 14 .31 0. 00 14 .31 0. 00
BSEISMICRE VALUATION 300. 00 0.50 0. 00 0.50 0. 00
EP-ERMITFEE 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 R.ATE 1. 00 38.37 0. 00 38.37 0. 00
---------- ---------- ---------- ----------
TOTAL .PERMIT : 175 . 04 0. 00 175 . 04 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
CREDIT CARD 175 . 04 VS
'�'OTAL RECEIPT : 175 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------� -------- ------------------
301 ROUGH PLUMBING 303 ROUGH MECHANICAL
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY
. 505 FINAL ELECTRICAL 507 FINAL PLUMBING
�. 508 FINAL MECHANICAL
CITY OF CUPERTINO
FURr1ACE/AC
CUPEf�TINO PERMIT APPLICATION FORM --7 � �� ��
APN# � �� Z� 6 S—S� � v v Date:
�, g��
Building Address: � � � n � G e�'� � C /1 �.� �
�a r�
Owner's Name: ` Phone#: , �,�'�
�a���t,v� 1���� `-f-�� �t 7 3 �
Contractor: � �� ���, License#: ��• � S �
b
Contact: ��t ��_ u �f�Y,,� C,�o� �,.z� .�-� ��\ Cupertino Business License #:
)
Building Permit Info:
Bld ❑ Elect � Plumb L�}� Mech C�''
Job Description: Y,� C�C� �,�a�e Ct n �'� /�t'l C
Residential Q-- Commercial ❑
For Residential Installations:
Attic � 1 St floor � 2"d floor�
Adhere to min set back re uirement(�,
For Commercial Installations:
Replacement same weight � Additional weight�structural calcs) �
Structural Calculations required for new installation �
New installation Plannin A roval Re uired
Cost of Project: Type of Constniction: Occupancy group:
3 m0 �_ —
Strapped On Platform Bonded Sq.Ft. Floor Area:
New Location � Re lacement �
Qty. if
Applicable Fee ID Fee Description Fee Group
BENERGY Ener BUILDING
BREMFURN Relocation of Furnace MECHANICAL
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10, 000 cfm MECHANICAL
BREMRECEPT Rec tl, Switch& Outlets ELECTRICAL
BSEISMICRE Seismic Fee Res BUILDING
EPERMITFEE Elec Permit Issuance ELECTRICAL
/ MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbin Permit Issue PLUMBING
BPERMFEE Bld Permit Fees BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING