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07090210 -7777777777777- CITY OF CUPERTINO BUILBING DIVISION PERMIT nn BUILD V� KESS: PERMIT NO. / b� SHADOWHILL LA TBD 'IO BE DETERMINED 07090210 OWNER'S NAME: PERMIT ISSUE DATE HARRISON TUNG 09/28/2007 IONS: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION Job Description u l hereby affirm that I am licensed under provisions of Chapter 9(commencing z Uj with Section 7000)of Division 3 of thc Business and Professions Code,and my license is REPAIR FOUNDATION ON RIGHT SIDE BY FIRE PLACE. y in full force and effect. ? License Class Lic.tY B S L Fm Date_ Contractor ,J ARCHITECTS DECLAR PD 9/2-Y /2007 S a a I understand my plans shall be used as public records hyU wy Licensed Professional H OWNER-BUILDER DECLARATION } 1 hereby alTirm that 1 am exempt from Ute Contractors License Law for the ,<2 d following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to convect,alter,improve,demolish,or repair any structure ?Z} prior to its issuance,also requires the applicant for such permit to file a sighted statement < that he is licensed pursuant to the provisions of the Contractor's License Law(chapter 9 Sq.Ft.Floor Area Valuation G f (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $6500, y .. 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 p g Number Occupancy Type not more than rive hundred dollars($500). 36224055 ".'C) ❑I,as owner of the property,or my employees with wages as their 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 Contractors License Law does not apply to an owner of q 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.ff, 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 Contractor's Li- cense Law does not apply to an owner or property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑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: ,A t have and will maintain a Certificate of Consent to self-insure for WorkefsCompen- 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 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 Worker's Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (rhis 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 shall not employ any person in any man r sos con su jec to the Workers'Compensation Laws of Caliromi ate Applicant � NOTICE TO APP :If,after making this Certificate of Exemption,you should .� become subject c 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 Er►�-� 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.) Lender's Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is w ►+ correct.1 agree to comply with all city and county ordinances and state laws relating to r� U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned properly for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA 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 7J ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOURCE REGULATIONS. —2 8—2,JL4A Re-roofs Signature'or A r t/Contraclor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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. Cl Yes »II the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove .mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new rr aterials for inspection. riot? ❑Yes Nu I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534-1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify Ute occupant of the requircmenu which ost be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class"B"or better Owncr ori-rcd agent Date )902-40 CITY OF C'UPERTINO T CUPSR.iNO PERMIT APPLICATION FORM APN# _ Date: ; � 9A qo ��� © c� 2� Building Address: Mailing Address (if different from building address): s wG✓ i �,�,,�e Owner's Name: Phone#: a``I'S 0 A✓ %y -yd fl - 3 y —3 ? u Contractor: License M Contact: Phone: `>'W Cupertino Business License#: ,"D -J-0 Fax: Building Permit Info: Bldg Elect ❑ F'lumb ❑ Mech ❑ Job Description: �pPa"!- F��...-v r•�� o.v �, ,,t; s;'oe Residential K py, Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: �r Occupancy Group-- Type of Construction: Please check this box if the project is a R 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 Boiler> 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 Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Coustax—Resi/Mobile BUILDING BELEC 1000 Elec 600V <= 1 OOOA ELECTRICAL BELEC1001 E'.ec 600V> IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA [nvestigation fee BUILDING 1 of 3 CITY OF C'UPERTINO CUPS aOF PERMIT APPL:[CATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Com in. Housing Mit. Fee BUILDING BNUCOMME N,w Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP T ew Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Dift Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gw: Piping System Fee PLUMBING BPINTERCEP Incl Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plai Check Repeat Fee BUILDING BPREPIPE Ri e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM torm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Instull/Alter Water Pie PLUMBING BPWHEATER V�ater Heater/Vent PLUMBING BPWSVCS M ain Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Re location of Furnace MECHANICAL BREMFURNOV Relo Furnace> l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rerr Non-Res Appliance ELECTRICAL BREMPOLE Po le/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rcp d, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEl�F PERMIT APPLICATION FORM Quantity Fee ID 1'ee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Ven t Fan Single Duct MECHANICAL BREMVENSYS Ve atilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seiimic Commercial BUILDING BSEISMICRE S eismic Fee Res BUILDING BSPECIAL S-)ecial Inspection BUILDING BSWIM ;>wimming 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 Ele.- Permit Issuance ELECTRICAL MPERMFEE M,-chanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 )f 3 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B11:: Lot: APN 36224055 .00 DATE ISSUED. . . . . . . : 09.128/2007 RECEIPT #. . . . . . . . . : BS000002820 REFERENCE ID # : 07090210 SITE ADDRESS . . . . . : 75,34 SHADOWHILL LA SUBDIVISION . . . . . . . CITY CU?ERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . HAZRISON TUNG ADDRESS . . . . . . . . . . : 7554 SHADOWHILL LN CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1326 RECEIVED FROM . . . . : EDWARDS CONST. CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 6, 500. 00 137 .16 0. 00 137 .16 0. 00 BSEISMICRE VALUATION 6, 500. 00 0.70 0. 00 0.70 0. 00 BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 .00 0. 00 TOTAL PERMIT 244 .86 0. 00 244 . 86 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 244 .86 #6484 --------------- TOTAL RECEIPT 244 . 86 Community Development h 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPERTINO Buildiii De artment JOB ADDRESS: PERMIT # If 2 tl � OWNER'S NAME: PHONE # k- 3 GENERAL CONTRACTOR ,L D �✓is�p Cv wsT FAX# I am not using any subcontractors: nature Date Please check applicable subcontractors and co m lete the following information 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 r� Owner/Contractor Signature Date J e a 1 3 3 9 0 x i 7 -C4" :q) 3 f 5 A R e k ' r { 4 Y F {sy i I r .�..._,�..•,-�:_�,pry:..:;.,,:.:...�.—:.:;:.�,:�:::.M_,..—.-.........,,_.....�..�,..-„w....�:.�..�,�r..�•.�.,� 1 t 11 ale � ..n FAeAl f, l � 'I:^�^°•p.+aW+'ta,r iLCYxNfr.�v:�be.'eca.eu_: S ) d , SCOPE OF WORK,; f � " J } 1. SELECTED CONTRACTOR PR 3 VOLUNTARY UPGRADE ,No] SHALL REPLACE (E) RUSTED FOUNDATION PERIMETER,A (N) BARS AND TO CONNECT I2 CONTRACTOR SHALL CONN] r-;,« #4s X 8111,G. VERTICAL BARS 4" MIN. W/EPDXY . 2. CONTRACTOR SHALL BE RE! CONTRACTORS THEIR WOR 1 i I L .ro.w.,...a+w..�w.de.e,.ra.+..ns..:.sr+a:....�i.�.,.-�.rti....:::m:..,<:��.:::;�-::..:��:r�...:.•,.e.,r...�....r,..n..w.s-��•-:'.*,........ - ✓a.,._ re.uew-.nrw-..a.,rrrrm?-s..emrc,.-na.«r..v.tu•on:.w-n.. is D 6 1 4. 14 12 e me, 1,4 cAiAd014 #11 !Z yxy �L P t' .+• SCOPE OF WORK: y y. 1. SELECTED CONTRACTOR PROPOSES TO COMPLETE A VOLUNTARY UPGRADE , NO'T TO THE UBC. CONTRACTOR SHALL REPLACE (E) RUSTEI) CONTINUOUS REBAR IN FOUNDATION PERIMETER, AS SHOWN ON PLAN, WITH (N) BARS AND TO CONNECT INTO EXISTING WITH EPDXY. CONTRACTOR SHALL CONNECT (1) CONC. TO (E) WITH #4s X 811LG. VERTICAL BARS @ 16" O.C. ,DRILLING INTO (E) z 4" MIN. W/EPDXY. 2. CONTRACTOR SHALL BE RESPONSIBLE FOR ALL SUB CONTRACTORS, THEIR WORIMUNSHIP AND SCHEDULING.. CAI .1 3 C- ;f APPROVED BY: DRAWN BY SCALE: 1 j4 J DATE: REVISED DRAWING NUMBER