08100018 CITY OF CUPERTINOrk'FS+� M` a"ve
BUILDING DIVISION PERMIT CQ1�PtRACToRirtouMaTioN
BUILDING ADDRESS: PERMIT NO.
10384 PARADISE DR LEE NGUYEN 08100018
OWNER'S NAME: PERMU ISSUE DATE '
LEE NGUYEN 10384 PARADISE DR 10/03/2008
IVNE: SANITARY NO. CONTROL NO.
ARCHTTECT(ENGINEER: BUILDING PERMIT INFO
APPLY STUCCO OVER WOOD -BLDG ELECT PLUMB MECH
D e e LICENSED CONTRACTORS DECLARATION O O O O
M1hmffww Nu
eby aI w licensed under provisional of Chapter 9(commencing Job Description
with Scotian 70r)I1)ofD vision 3 of the Busineu and Professional Code.dud my license is
y in full face and effect -
3 Licence Class IJc.g
Da¢ Comae rn
7W ARCHITECTS DECLARATION
1 undcasumd my plans¢hall he used u public wccmm -
JnU
gw,I Licensed Professional
3 OWNER-BUILDER DECLARATION
F I bombs.(Srm that 1 1. uempt from the ConoactC :Am y c law Tar the
O o following moon.(Smtion co L5,Business and improve,
doeons Cock:Any city m county
3_ which requiw a Permit m construct.alar,nt form.dcmolW,a mash any ommum
Z_i prior b its issuance,p easu requiw am Applicant of for such permit m file deigned comment
< (commis twinged puwsen roam provisions of the Cmuum(andiLicense Taw OChoPmr9 Sq.Ft. Floor Area Valuation
r�$
that
with Sectionrom and the
basis f r the
the Business ecaro nd Pmrwlovi Code)or
Q`< that Section
u campy therefrom and Ne boil for bj alleged erwant to Any violation of
not
70313 by airy applicant far m(a permit abjcco Nc applicant m a civil penalty of APN Number Occupancy e
nay mom Nan fisc hundred dallan(SSW} P Y EYP
❑I,o ownv o!tiro propmsy,art mY wplayces with wages o Nevalccampewtiao,
will do lmwont.and th That Com b mtimm�ded moRercd fmalo(SIL.]Oa,Budrev
end Professions Cade mpr ves trse:mY,License law Odes nal apply lf an rough is Required IISPCCt1On5
own
property whobuildsaimproves Hereon,and who aresashwart himalfmthrough his
awn emplaym,provided Nat such improvements in .your efc moRerud fm owner.
however,the building whnpmvemmlbmid withinare yearor mmove for purpose
owner.
Indictor MB have He burden of proving that k did nm build m improve for pugmse of
ale.).
0 1.as owner of am property,am exclusively mnhacting aids licensed mnuacws m
mnsymmrt the project(Sm.70,1d,Business am Professions Code)The Comae or's U. .
cede Lace does asst apply to m Dame of pmpmty who builds or improves Hemet,and,
who contracts for such projects with a conuumr(s)licensed personal as dre conuactoes
L ce.Law.
❑Imo dem t under See .B&PC lar this muco
Owner ` � "- ENp Data to
k" WORKERS PSATION DECLARATION
I bereby+ff.under penalty of perjury arm of Ne fallowing deeWationne
1 hart and will..law.a Certificate oFCansenl in all-imure fa WorteYsCoupon,
atim,as;provkhol for by Section 3700 of the Labor Code.fm dm perfmad.of Ne
wart for which this p araft is kvred.
❑I basic and will maintain Wwtc/s Compensation Insurance.as;required by Section
TRIO of the later Code.For Ne periawano ofdm wort fmwhich this permit is issued. '
My Worker's Compensation bouton¢canis seat Policy number am:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sermon wood m t ud camp IemA ifthe permit Is per arc hummed de W n(SIM)
or Ions)
1 unify that in the perfowame of the wart fa which Nw
is Permit It Lsused.T shall my
m
employ any pesn in myon n mbeepme ahjmto Ne Wad K m m
Laws of California,Dam
Applicant
NOTICE TO APPLICANT: .afar inadd.&I,Cenffwcam of Exemption.ym shmat
become subject in the Worker's Compcmamn Provisions of Ne labor Cade.you must
.,O forthwith comply with such provisions or Nu Permit mal he mutual math.
fg 7) CONSTRUCTION LENDING AQENCY
" I hereby afrimBullNthea construction U a coction lmWing agency for live m
e perfuwuce of
C> He work rot which this pewit is issued(see 3097.Civ.C.) .
0 Unclear Name .
z Landers Adamss .
U Q I certify that 1 haw rind his application dud sum that de those infamm.is
Ib. F conco 1 agree m comply with all city ad county oMnanew and sum laws rotating m
0 building conduction.drat hereby auNodse repmsexwfws or this city to came upon the
r above-mentioned pmpeny far inspection puwp res.
(We)ages to ave,indemnify ad keep hawlrss the City of Curmlim against
w y
liabilities.judgments.cats and expenses which may in any way secnm against said City
Uz in consequence of the panting of this Permit.
..
APPLIPANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
5 UR AT,I,QNS.
f<�^—� C61 )/CJg Re-roofs
Sigvtme of Applion odracrour Data
HAt or rat bMATERIALSDISCLOSURE Type of Roof
Will Neapplicantafo�um buildingaeempatin.or hal haardensmaterial
u de.Sec io 0e Cupertino Municipal Code,Chapter 9.12,alb Ne Hca1N and Safety
Code. Oy.25532(,)T All roofs shall be inspected prior to any roofing material being Ins[al]ed.
❑Y ONO
Will the applicant or forum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it harsrdom air cmtwirdwts as dehn xi by the Bay Aral Air Qu ky Management all new materials for inspection.
UW CIT
Oyes 0 N
1 haw mad the baasams materials mqm
uimcros under Chapterti.95ofthe Caliror-
nu Health&saretycade,suctiao 25505.25573 awz 55.1 understsM Nair Ne building
docs rat(.hourly haw a¢nand that it u my responsibility m m ily the occupant of da
mom muair metpmrm waneeora'- Signature of Applicant Date
t Qu tom— / 5� All roof coverings to be Class'ns'or better
Owner a surbadred reg Dom
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35916030 . 00
DATE ISSUED. . . . . . . : 10/03/2008
RECEIPT # . . . . . . . . . : BS000006273
REFERENCE ID # . . . : 08100018
SITE ADDRESS . . . . . : 10384 PARADISE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER LEE NGUYEN -
ADDRESS . . . . . . . . . . : 10384 PARADISE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2914
RECEIVED FROM . . . . : LEE NGUYEN
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : LEE NGUYEN
ADDRESS . . . . . . . . : . : 10384 PARADISE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2914
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1STUCOAPP SQ FEET 1, 000. 00 490 . 00 0 . 00 490 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 491 . 00 0 . 00 491 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 491 . 00 1882
---------------
TOTAL RECEIPT 491 . 00
•
Community Development
10300 Torre Avenue
zN 't Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building De artment
JOB ADDRESS: 103 '0!W DIL PERMIT #
1� `? ( dd o(56/.�-'-
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: -FAX #
le
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
69 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
Ib 3 oB
e Contractor Signature Date
OWNER-BUILDER VERIFICATION
• 1. (Check one) I or my immediate family (parent, spouse or child) will perform:J
A. " All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
e3. _ I will utilize unlicensed person(s) 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' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information ( e rse side).
Property Owner's Signature: L Date: /b
Job Address: ,UJ B q- 01 - Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
• Department.
CITY OF 10300
ono f Cupertino Building Departmeng
10300 Torre Avenue
CUPS TIN 0 Phone: (408)777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer, you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensation•
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish, the U.S.Small Business Administration). For more specific information about your
obligations under state law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino •
Printed on Recycled Paper
CITY of
CITY OF CUPERTINO
CUPEr INU GENERAL BUILDING
PERMIT APPLICATION FORM
b� 1
APN # Date:
/CO
Building Address: 103?4 T� DR
Mailing Address (if different from building address): �t
Owner's Name: t.cE N. I1 J\I�_N 1 Phone#:
Contractor: Phone:
Fax: 7
Contractor License#:
Cupertino Business License#:
Contact: Phone:
• Fax:
Residential IN Commercial
Job Description: A?�Ly STt-kccb OVeK uzo
I. A TINL[+ Mac t, t_R-ice
`9 •A-pp LY &-OT cy- Chi
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type: y�y
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ❑ /
Valuation: 1� 10? MW Square Footage:
Project Size: Express ❑ Standard Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set& the sheet index.
Points Achieved:
For help, contact Build it Green at www.builditlzreen.org
Revised 7/01/08
tit
�� CITY OF CUPERTINO
CITY OF
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee . Permit Type
Group 1GENRES or
1GENCOM
i BBOILERI For the installation or relocation of ea M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw
1 BBOILER2 Installation /relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
I BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
&incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M
boiler/compressor over 30 hosepower •
to & incl 50 horsepower, or for ea
absorption sys over 1•,000,000 Btu/h to
& incl 1,750,000 Btu/h
1BBOILER5 Install ation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing& Gas Inspections P
(per hour
iMEETINGIHR Application Meeting B •