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07090127 CITE'OF CUPERTINO BUILDING DIVISION PERMIT F+ ? TI �Y' ; BUILDJ[I iff8"a0HNSON AVE DAVID A HU, JANE HU 07090127 OWNER'S NAME:: PERMIT ISSUE DATE DAVID A HU, JANE HU 10250 JOHNSON AVE 09/20/2007 .)NE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o Zp LICENSED CONTRACTOR'S DECLARATION V I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description :z uw with Section 7000)of Division 3 of the Business and Professions Code,and my license is R E I N S TA'iL GAS METER. o=y in full force and effect. r ? License Class Lic.# F p Date Contractor Lu Lu ARCHITECTS DECLARATION i K I understand my plans shall be used as public records >yU U.y Licensed Professional y OWNER-BUILDER DECLARATION j< I hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county e m Iu which requires a permit to construct,alter,improve,demolish,or repair any structure z y prior to its issuance,also requires the applicant for such permit to file a signed statement ".Rn that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area $1 O O Valuation e.l- (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 7 5 2 5 0 6 L Number Occupancy Type not more than five hundred dollars(5500). ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and thestructure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of 9 p 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors 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 Contractors License Law E]I am crept under ee B&P C for this reason Owner Dale9- r- RKER'S G SAT10N DECLARATIO I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workers 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 Section 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 No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less) I certify that in the per of the work for which this permit is issued,)shall not employ any persgrr�any man r so as to become subject to the W rs'Campe ation Laws of Cali is Date Applicant NOTICE T :If,after maki g this Certificate of Exemption,you should become subject a Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z" CONSTRUCTION LENDING AGENCY E-r rf+ 1 hereby affirm that there is a construction lending agency for the performance of (�> the work for which this permit is issued(See.3097,Civ.C.) Wfs.A Lender's Name z Lenders Address U 0 1 certify that 1 have read this application and state that the above information is U.►. correct.I agree to comply with all city and county ordinances and state laws relating to rJ- U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against 'Fy to liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date ►� APPLI DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 7 SO CE REGU TIONS. c7 Re-roofs Si o tcant/Comracto Date/ HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store a handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cede,Section 25532(a)? All roofs.,hall be inspected prior to any roofing material being installed. [3 Yes gNo , Will the applicant or future building occupant use equipment or devices which If a roof iE installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? C]Yes f]No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safer Code,Sections 25505.25533 and 25534.1 understand that if the building does not y h a tenant,that it is my responsibility to notify the occupant of the rcqui encswhich st met prior to issuance of aiCmni ficatc s&0ccopaney. Signature AApplicant Date / Dam All roof coverings to be Class"B"or better Owner authoed agent F C UPERTINO �� s s _rt CITY O CITY OF PERMIT APPLI=CATION FORM CUPEkTINO _-CPN# -� t7 0 Date: r Building Address: :Mailing Address if different from building address): Lp Owner's Name: _ Phone#: Contractor: , ,,,_.�,r License#: . Contact: 0 � Phone: Cupertino Business License#: Fax: Building Permit Info: Bldg ❑ Elect ❑ F lumb ❑ Mech ❑ Job Description: fie,•,,-&/f 6i,,r �PlPY Residential L9' Commercial ElSq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: / U0 ►, Z_ Type of Construction: Please check this box if the project is a second-story addition: El Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID :Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler-> 100K to 500K Btu MECHANICAL BBOILER3 BoiL;r> 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 In(VOff/Comm/Quasi BUILDING BCONSTAXBQ Coal. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax —Resi/Mobile BUILDING BELEC 1000 El,;c 600V<= 1000A ELECTRICAL BELEC1001 E lec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Lnvestigation fee BUILDING 1 of 3 CITY OF C UPERTINO CWOF PERMIT APPLICATION FORM CUPEkTINO Quanti Fee ID lee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Com n. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N,-w Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric 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 BPLANCKR.EP Plan Check Repeat Fee BUILDING BPREPIPE RE i e Of Fixtures PLUMBING BPSEWAGE c ewa a Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Insta II/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BR.EMACOVER A/C Unit> 10,000 cfrn 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 F eater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BR.EMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Po e/Platform Fixture ELECTRICAL BREMPOWER Powf r Device/Apparatus ELECTRICAL BREMRECEPT Rc 1, Switch & Outlets ELECTRICAL BREMRELOCA R-,location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMR.ESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF C'UPERTINO CITY OF PERMIT APPLICATION FORM CUPE1iTINO Quantity Fee ID :Fee Description Fee Group BREMSIGNAD Rnidl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS VE ntilation Systems MECHANICAL BSCBLVD �:cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Sieismic 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 Elc c Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Merh Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Plannin Lon Range Residential PLANNING 3 of 3 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37525061 . 00 DATE ISSUED. . . . . . . : 09/20/2007 RECEIPT #. . . . . . . . . : BSC00002693 REFERENCE ID # . . . : 07C90127 SITE ADDRESS . . . . . : 10250 JOHNSON AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER DAVID A HU, JANE HU ADDRESS 10250 JOHNSON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JADE M HU CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY DAVID A HU, JANE HU ADDRESS 10250 JOHNSON AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY 7.MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BPGAS OULETS 1. 00 5 .40 0. 00 5 .40 0. 00 PPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40 .79 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 46 .19 0. 00 46.19 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 46 .19 #105 --------------- TOTAL RECEIPT 46.19 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING