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07090208 7777777777-, CITY OF CUPERTINO �T c BU[LDING'DIVISION PERMIT � T � Z� RTI . PERMIT NO. BUILgjI`(Qei�[ lbRAIG CT MP3 MASCNRY 07090208 G U�j / PERMIT ISSUE DATE OWNER'S NAME: STANLEY CHEN 4530 FAIRVIEW RD 09/28/2007 SANITARY NO. CONTROL NO. NE: (831) 63i-6663 BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH 0 O LICENSED CONTRACTOR'S DECLARATION Job Description V I hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z wiUm Section 70(10)of Division 3 of the Business and Professions Code,an y license is RE PA IR(E) MASONRY CHIMNEY F RM SHOULDERS t a. in full force an �t ' �' �v�Z License Lam•# Date Contr � ARCHITECTS DF�LAR i d< l understand my plans shall be used as public records )aU U.l- Licensed Professional a OWNER-BUILDER DECLARATION j a 1 hereby alTirm that I am exempt from the Contractors License taw for the 'no following reason.(Section 7031.5,Business and Professions Code:Any city or county w which requires a permit to construct,alter,improve,demolish•or repair any structure prior to its issuance.also requires the applicant for such permit to file a signed statement �' Ft. Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 `'q $2485 C F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 4 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 3591501 E- .qp Number Occupancy Type not more than five hundred dollars(SSW). ❑I,as owner of the property,or my employees with wages as Ureir sole compensation, will do the work.and the structure is not intended or offered for sale(Sec.70".Business Required Inspections 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 parpoac 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 Contraetues 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 Conuactoes License Law. E]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 ❑I have and will maintain a Certificate of Consent to self-insure for Workees 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 Worker's Compensation Insurance carrier and Policy nu er are: Cartier.�22Y ,44,A.0 Policy No- �Q 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 performance of the work for which this permit is issued.I shag not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California Date Applicant NOTICE TO APPLICANT:If•alter making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code.you must O forthwith comply with such provisions or this permit shall be deemed revoked. Z CA CONSTRUCTION LENDING AGENCY .-. 1 hereby affirm that there is a construction lending agency for the performance of ¢� the work for which this permit is issued(Sec.3097,Civ.Q W Q Lendces Name Lender's Address U O I certify that I have read this application and state that the above information is U.m- correct.I agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorize representatives of this city to enter upon the U ahove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against H�to liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date �+ APPLIC UNDERSTAN WILL COMPLY WITH ALL NON-POINT Issued by: SOUR R GU ONS U Re-roofs sig um of Applicam/Con to Da1C 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)? �fuu`ml All roofs ;hall be inspected prior to any roofing material being installed. ❑Y� If a roof i;installed without first obtaining an inspection,I agree to remove Will theapplicant obuilding occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes eNu 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 75534.1 understand that if the building nl� vc a ten Um it is my resporrsibitity to notify the occupant of the u, must n to issuance of a Ccnificatc Signature of Applicant Date "' All roof coverings to be Class"B"or better Owner or authorized agent Date 07 CITY OF C UPERTINO CUPS r PERMIT APPLICATION FORM R CPNDate: # llqlaz� Building Address: Mailing Address (if different from building address): l�G.S6�1 Gi- Owner's Name: Phone#: Contractor: License#: Contact, Pho :P31,,3j7.6 3 Cupertino Business License#: Fax: g Building Pe rt Info: BldgY Elect ❑ F'lumb ❑ Mech ❑ Job escription: 61.o-nWej Residential Commercial ❑ Sq.Ft. Floo Area: Sq.Ft.: Cost of Project: Occupancy Group: S-— --3 Type of Construction: Please check this box if the project is a second-stor addition: ❑ rroject 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 Boilor> 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 IncUOff/Comm/Quasi BUILDING BCONSTAXBQ Cosi. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC 1000 Eloc 600V<= l OOOA ELECTRICAL BELEC1001 Klee 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V<=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD ):anergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF C UPERTINO CUPEI�F PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Com-n. Housing Mit. Fee BUILDING BNUCOMME Nc:w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N,-w Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atrzospheric 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 BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Rf pipe Of Fixtures PLUMBING BPSEWAGE Sewage Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM S torn/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER W iter Heater/Vent PLUMBING BPWSVCS M rin Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREIVIAIRHAN A/C 1Jnits <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY R--model Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rele Furnace> I OK btu MECHANICAL BREMHEAT Beater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC -Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Re pair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF C'UPERTINO CUPEkTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmcll Signs Add Branch ELECTRICAL BREMSIGNS Rem Adel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD S cb 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 'rem Dist Svcs ELECTRICAL BUSLIC E usiness License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE M,-chanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Pluuibing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 cf3 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN 35-1115016 . 00 DATE ISSUED. . . . . . . : 0928/2007 RECEIPT #. . . . . . . . . . BS000002818 REFERENCE ID # . . . : 07090208 SITE ADDRESS . . . . . : 20657 CRAIG CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER STANLEY CHEN ADDRESS 206)57 CRAIG CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2912 RECEIVED FROM . . . . : MP's ENTERPRISES CONTRACTOR . . . . . . . : PA�'RICIA GERE LIC # 27197 COMPANY MP's MASONRY ADDRESS . . . . . . . . . . : 45: 0 FAIRVIEW RD CITY/STATE/ZIP . . . : HOLLISTER, CA 95023 TELEPHONE . . . . . . . . : (8;;1) 637-6663 FEE ID UNIT QUANTITY AMOUNT PD—TO—DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 2, 485. 00 83 .16 0. 00 83 .16 0. 00 BSEISMICRE VALUATION 2, 485. 00 0.50 0. 00 0 .50 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 83 .66 0. 00 83 . 66 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 83 . 66 #3313 --------------- TOTAL RECEIPT 83 . 66 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 514 FINAL PUBLIC WORKS Community Development 10300 Torre Avenue �K" Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -,UPEkTINO Building Department JOB ADDRESS: I PERMIT # 19 OWNER'S NAME: PHONE # 3/-6,3 7— GENERAL CONTRACTOR: �- FAX # P-3,1-to--3,7- I am not using any subcontractors: Si;;nature Date Please check applicable subcontractors and co m Mete 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 � e Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date