08100182 CITY OF CUPERTINO
BUILDING DIVISION PERMIT $CONTRACTORI�NFOR.MATIOIY
BUILDING ADDRESS: PERMIT NO.
7588 ORANGE BLOSSOM DR CHUNG
OWNER'S NAME: PERMIT ISSUE DATE
NE O. CONTROL NO.
408) 985-9289
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
-BLDG MECH
u o o LICENSED CONTRACTOR'S DECLARATION lob Description
f U 1 herebun
y affirm Nal l me licensed der provisionsof Chapter 9(commencing
with Section 7")of Division 3 of thc Business and Profession Code.and my licenx u
_:sT mhtBfomoandelr t d � g Bv.PP-f 1 UPGRD ELEC PNL TO 200AMP, REWIRE WHOLE HSE& INSTL
ypz uon=GT n
„q Dim Yoi»io,v Canmswr eiZg r 4r 7 8X4" RECESS LIGHTS IN LIVNGRM
n` W ARCHRECI'S DECLARATION
;y
a
U I understand my plans stall W reed u Phil,records
swot;Liamed Professional
iOWNER•BUILDER DECLARATION
I hereby mairm Nat I am exempt from the Contractors License Law for the
p O following mason.(Section Tin I.S.Business roof Professions Cade:My city m tummy
I1 9! which m,td.•permit to m,curmt,alter.improve,demolish,or holm,my swclum
Z.4 p^.m its issuance.sma requires Oniteplkmt for such permit m file a signed summmr
gn that Ise is licensed pm,wntwNepetv(aionofthe ContraaarsUa�uw(Chapter 9 Sq.Ft. Floor Area Valuation
yt-$ (commencing with Section 7")of Division J of the Business and Pmfessiou Codc)or
that W is exempt Nesef.W the:basis for tW anegcd asmption My ridl.tlon of 59000
Section 70713 by any applicant for a permit subjects the applicant ro a civil penalty of APN Number Occupancy
nn home than BK bundndd dollen ISM P Y Type
01,"came,of the pmptstr.or my employees with wage u Ncir sole compensation, 36611059 . 00
who do the work,and the snot em unm bonded or offered for sale(Sec.TIA4.Bonnets
ns
and Profeesimcode:The Communes License Law dote ret apply m an moor of Required Inspections
property who WildsoimlaovesOnce andwnddonaaehworthimuifnNmughhis
own employees,provided Nnsuch improwmmu are not intended orohrered rentale.IL
however.the Wilding.knprovernmet is sold within arc year of wropledon.the owner-
Wilda will have the Wrden of paring Nat he did rot Mid or impure for purpose of
❑1.as owner of the Taoism,am nelusincy contracting with licensed contractors to
moonset the pmjcd(Sec.70ds,Business and Profession Code)The Ca rnmaces Li- _
terve law don not apply to an owner of property who Wilds or impaves thenar.and,
who mnuam for such projects with a eontraetar(s)licensed pmuam in the Comment ,
Imo,Law.
0 lamaxempundersee .BkPCf.Nismsson
Owner Date -
WORKER'S COMPENSATION DECLARATION
1 hereby aRm under penity of perjury,one of the following trmlarWwc
1 havens will maintain aCnifiate of Consent to self-haw-fu Wmtrra Comped
ion,u provided for by Senior 3700 of the Ichor Code,for the performance of the
wok for which on;permit is issued.
❑I have and will mums n Workers Compensation I...u mgmred by Section
17(10 of 0m Labor Cade.for the prformsenz of Ne work I.which this pe.I,is issued
My Workers Compensutian Inmrmce artier and Policy number and:
Cartier. 5*7,47E Polity Na.: /77,PdM-2'K
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectlon neW ml W completed If rhe permit is Insane hundred dollars(SIM)
m less)
1 crtifv Nat in the,performaae of the work for which this permit is issued(shall not
employ any person in my mmnerm as b become subject to the Workers'Compevadm
Laws of Califomis.Dam _
Applicant
NOTICE TO APPLICANT:If,after making this Cmiftam of Eacmpion,ym Nould
became subject to the Woftes Compensation provision of the labor Code,you most
.J0Mwith Bic
fawith comply h provision m Nu permit shall W dcrecd revoked.
?'r CONSTRUCTION LENDING AGENCY
[—i Iherwhich thi Net Nem iaated(Sm 0lending agency for Ne Performance of
gG tiro wart for which this permit is issned(Sec.7097.Civ.C)
W�Q Lenders Name ,
7 Z L<ndera Ann...•
U O 1 sonify Nat I hate real this application and state Nat tW above information is
it, F caneeL I agree to comply with all city and chanty ordinances and Bum lava relating to
,QU Wilding consmucmanand hereby mthorin representatives of this city to enmrupm the
a Wve-mentioned property for Inspection purposes,
(We)agree to save,indemnify and keep hamlets Ne City of Cupertino against
i,i liabilidn,judgmenstcosu and expenses which may in my way accrue against said City
U Z in nom sphenx of the granting of this permit.
y:
/,(' l
^" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b Date f/ /L✓
SOURCE REGULATIONS. 2t
4 Re-roofs
Signature of ApplicartlCodirsochor Dam `v
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will f applicant.forum Wilding occupant mom mhmdlc hanardou material
u def nod by tiro Cupenioo Municipal Cade.chapter 9.11,and Ne Health and Safety
Code. 25552(a)7
CY. E9 No All roofs shall be inspected prior to any roofing material being Installed.
Will Ne.ppliant or mm re Warding occupant mac Nulpmml or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hauammus air a ameninnu as;defined by me Bay Ana Air Quality Managemcm all new materials for inspection.
tsmicl7
❑Yo ON.
I have mad the hanNwsmamriaHmquvcmems under Clupmr6.95 of the Glifo-
meRealNkSafmyCadc.Section 75505.15535 aminS C.I understood Natif Jho Wilding
does not cuncndy haw a moms all Bis my responsibility N mit,dm occupant of f
roquherem.which mum be met pool to in..of.Dmdfic2m of Occuthow, Signature of Applicant Date
A Pay' ro/Slj�P
All roof coverings to be Class'A"or better
Owner onulhatmed apcm � Dam
Assessor's Parcel Number:
Name of owner.
Project address. 7s-,?,? z2o-,q-v4x 0-ee-: ,Y ,fi,c
Contact person. Phone. e'a0d'-i 3A<00
Fax. r<404) "W— 4e1-per
Net square footage of lot. 4V-2)V
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
e there at least two 10 foot by 20 foot clear spaces inside the garagg?----Y— N
Is privacy protection planting required for the project? Y N
On what floor(s) is work being done?
Brief description of work. /,,, lldq ' -;rle Seo WA� e
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Code editions: 2008 CBC All NZW8 CMC (Y- N)
N
2008 CPC 2,E
CD� 5,
� 5-9, * 3
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Effective 1/1oz D
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Mm SHEET
Plan Review Process Work Book Page-8-Revised 1/l/08
Community Development
10300 Torre Avenue
:Y Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
16UPEkTINO
Building De artment
JOB ADDRESS: PERMIT # U / o U
7Sooe GWANdz BGostaf/ 2k, 41:wtYyiva d
OWNER'S NAME: '7i-v - PHONE # fid'-
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork eyK
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
• 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36611059 . 00
DATE ISSUED. . . . . . . : 10/29/2008
RECEIPT # . . . . . . . . . : BS000006485
REFERENCE ID # . . . : 08100182
SITE ADDRESS . . . . . : 7588 ORANGE BLOSSOM DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TING LI-CHUNG AND TENG LI-TEH
ADDRESS . . . . . . . . . . : 7588 ORANGE BLOSSOM DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5225
RECEIVED FROM . . . . : CHUNG Y WONG
CONTRACTOR CHUNG YIN WONG LIC # 23900
COMPANY . . . . . . . . . . : CHUNG YIN WONG
ADDRESS . . . . . . . . . . : 1049 SITKA TER
CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086
TELEPHONE . . . . . . . . : (408) 985-9289
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ------- -------
1BREMFIXT NO. FIXTURES 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
1BSEISMICR VALUATION 9, 000 . 00 0 . 90 0 . 00 0 . 90 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1ERT2001K UNITS 1 . 00 61 . 19 0 . 00 61 . 19 0 . 00
1TRAVDOC FLAT RATE 1 ..00 40 . 79 0 . 00 40 . 79 0 . 00
-------- ----- ---------- ----------
TOTAL PERMIT 204 . 86 0 . 00 204 . 86 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 204 . 86 VISA
---------------
TOTAL RECEIPT 204 . 86
•
o U/ �a
CITY OF CUPERTINO
• CUPEIITINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # ! U F� ' O Date:
Building Address: \l
7.r?-o OAW'✓!t E 3LoS1'or( DP-
Mailing Address (if different from building address):
Owner's Name: Phone #:
% i L/ '-(.`f/K.ti '
Contractor: Phone: 4 oo0—Io EPPPP
Fax:
Contractor License#:
Cupertino Business License#: 17Pc
Contact: Phone: eon 3e6 3y��
• / Fax:
Residential Commercial
Job Description: /LrQ
��./ K'c�✓r�Lr (vii•-C � 7"'<I� .
31 Z.�!'J.et� ..1 i(�t /��c E)'r t.;<y7�i',�f' �.1% Z r✓/.v4: �/'(,ce,`-/.
Building Permit Info:
Bldg ❑ Elect Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, I-B ❑ II/IIl/V-A ❑ II/III B, IV-HT, V-B acN*C
Valuation 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.builditgreen.org
Revised 10/20/08