08120069 CTTY OF CUPERTINO
' BUILDI,'G DIVISION PERMIT CONTRACTOR�INFORMATION
BUILDING ADDRESS: PERM"NO.
10460 FA
OWNER'S NAME: HOMEWORK PERMIT ISSUE DATE
.0 SAMQ& CONTROL NO.
ARCHrIEC IENGINEEW. BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
REPLACE 5 WINDOWS LIKE FOR O O O O
30o LICENSEDCONRLACfOR'SDECURATION LIKE 'NON—STRUCT Job Description
ZE I bunchy aRlm this 1 am licensed under pmvisiou of Chapter 9(commencing
<tJ wish Section 70110)of Di 7of die Busnrss uM Pmfudolu Cade.sndm emu
W
full rotes and effect _G'G a C/
n i License Clara Lie g
nF Dav: �a�L� RECI'S IDEC;MAMN
I understand my plans shall be used as public records
3�U
40m Lkentard Professional
5 OWNER-BUILDER DECLARATION
ray1 hereby Arm that I am eaimpt from the Contactors License Law for the
io yOAffirm following reason.(Section 70715,Btemess and Proksm ns Code:Any city or county
which mqulres a Perth m fnrllWet,alto.b-PmeV'.der--huh.or Rpnll my attcure
prior to its issuance.aim require the applicant for such permit to file a signed statement
that ho is liccrused pursuant to do,inovskons of ft Contractors Liconse Law(Chapter 9 Sq.Ft.Floor Area Valuation
YFC (commencing wish Section 7000)x(Division 3 of the BusinessaM Pmfe¢ions Cade)or
9 that he u exempt due efro a and the hast for she alkgW exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant he a civil penalty of APN Number Occupancy Type
ooh mart than five hundred dollars IS500).
I,u owner of the phopmy.m my employees wish wages u dusir mk eampenudon,
will do the work and the structure isnot intended or offered for sale(Sec.7W.Boainess ns Required Inspections
and Pmlesdans Cade:The Os.ttacWrana roow.Lilaw does' t apply an owof q p
pmpemployc WiWsorim thatsuhimpre mentsaototimenrs hivuelfedtluuugh hu
oweemployee.pmvited Natarchimprovementsartnot intendedre koharl fhamustle. f.
however,shebuildingorb.pmvemmt4soldedidnot Setofcompletion,theowucr-
Ad..). MB have the burden of proving Wan k did not build m improve for puryose of
uk.1.
L as owns of the property,aro exelusivaly contracting with IIRNad mntnnan W
column dx project(Sec.7044.Batmets wail Pmfeull.Code:)The Cmtrrmrw Li.
nue Law docs not apply W an owner of property who builds err improves distant.and,
who contracts for such pmjem with a emtaclor(s)licensed puraunt W the Contracou'e
License law.
❑I An exemptunder See .B&P C for dos reason
Ow.el Date
WORKERS COMPENSATION DECLARATION
y am un
1 herebffider penalty of perjury am of the following declarations:
[have and will maintain a Cercifie sof Consent m self-insure fm Workch Compen-
sation,as provided for by Section 3700 of the Labor Code,for she Performance oldie
woh for which this permit is issued.
W1 have was will maintain Workers Comwnsurance
pedon I ,u requited by Seen..
017 of the labor Code.for the performance of the work fun which this permit is issued.
My Workers Compensator huurance emu tad Policy number are:
6rtier:ff'TGTy AL
1 Po1ky No.:70 —�'l07/0
CERTIFl ATEOF ESLEMFn0N FROM WORKERS
COMPENSATION INSURANCE
(Thu mmlim coed not beconpleusd If the permit u for.huMmddollars(5100)
or ksa)
1 ca.ifv that in the perfom.of We work for which Nis permit is issued,l mail net
employ any person in any msnneran u W become subject to the Workers'Cmnpensatm
laws i f Califomiw.Daus
Applies.,
NOTICE TO APPLICANT:If.Aur making this CcnifhoW of Exemptan,you should
become subjen W the Worker's Compensation pmvisions of the tabor Code,you mine
.J O forthwith comply with such provisions or this permit shall be dmmed noted.
z` CONSMUCTION LENDING AGENCY
[—i I hereby at.tut there is a ennsruetun lending agency for tm Performance of
Lx > nus wart for which thus permit he issued(Sec.3097,Civ.C.)
QLanders Name
Undue,Md.
U O 1 certify that I have read this applieuim and sous that nus above Woon.6m u
ty ^ cortat 1 agree W comply with all city turd county onlinuces and mute nuns totaling W
p rV^ building convection,and hetes,authorite mpresenutises of this city W enter upon We
GL7 ahove-mmtioned property for inspection purpnas -
(We)agree to save,indemnify and keep handless de City of Cupertino against
rajS
liabilities.judgments.casts and expenses which may in any way accrue Mainsl said City
U Z inconsequence.f the Starting of this permit.
APPLICANT UNDE STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date —
SOURCE REGU
Re-roofs
SignsursofAppicandUCantractorDOU Daus
HAZARDOUS MATERIALS DISCLOSUREType of Roof
Will the applicant or forum building occupant so=or handle huaNaus metrial
u teRrcd by she Cupcnina Municipal9.pal Colic.Chapter 9.13,and the Health and Safety
Cale,Section 35533(.)7 1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes N.
Will she applicant or future Wilding occu ant etc cqulpmm,or&A.which If a roof is installed without first obtaining an inspection,I agree to remove
emit hrxdou air cmumim as as d6und by the Bay A.Air Quality Management all new materials for inspection.
Dimic,7
❑Yes IQ No
1 have mass the hualduu materials equitomem under mler 6.95 fthe Calif.,
nu Hmlth&Saicry Cade,S.6.35505.35533 atal35534.1 undcutand tbatif tK Wilftg
dna no oily have.tum. it u my responsibility W rodfy dun occup.nt of de
Mqui ntswhie x t.armimcruc. accrifica' 9rm . Signature of Applicant Date
Ownergr anthamcd agent , Dole All roof coverings to be Class'%¢."or better
• ['�, Community Development
10300 Torre Avenue
i�✓ Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
.,UPEkTINO
Building De artment
JOB ADDRESS: la )1Vr,11op PERMIT #
2do��f
OWNER'S NAME: o PHONE # —la
GENERAL CONTRACTOR , FAX # /
I am not using any subcontractors
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
4 r
Owner/Contractor Signature Date
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36928016 . 00
DATE ISSUED. . . . . . . : 12/05/2008
RECEIPT # . . . . . . . . . : BS000006771
REFERENCE ID # . . . : 08120069
SITE ADDRESS . . . . . : 10460 FARALLONE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHEN CHING-HUANG
ADDRESS . . . . . . . . . . : 10460 FARALLONE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3128
RECEIVED FROM . . . . : KITCHEN WORKS
CONTRACTOR . . . . . . . : PRELL, LARRY LIC # 17457
COMPANY . . . . . . . . . . : KITCHEN WORKS INC/DBA HOMEWORK
ADDRESS . . . . . . . . . . : 615 IRWIN ST
CITY/STATE/ZIP . . . : SAN RAFAEL, CA 94901
• TELEPHONE . . . . . . . . : (415) 456-4696
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ ----------- ---------- ---------- ---------- - ----------
IBSEISMICR VALUATION 6, 500 . 00 0 .70 0 . 00 0 . 70 0 . 00
1WINREP EACH 8 1 . 00 367 . 00 0 . 00 367 . 00 0 . 00
-------- -- ------ -------
TOTAL PERMIT 367 . 70 0 . 00 367 . 70 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-- --------------- ------------
CHECK 367 . 70 7611
---------------
TOTAL RECEIPT 367 . 70
•
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APPROVE
IN ACCORDANCE WITH THE CTfY Ob
CUPERfiNO MS AND ORDINANCEIS
fhle set of p.a Dec fications MUS,
no kept on the I times and it is un
taWfUl to ma; njes or alteration
m me With I, n pe,mission fron
e- -M uilding ug ,, c ,) i Cupertino.
fhe NOT oI kh,Lo;d p.n enn specification,to btfons RE
SHALL NOT he held to pe mit or r be or CEIV
'nD►ovel of the vlolatlon of any proWew, ED
Mv Mtn nrm 4nre or %tMe Lnw DEC 0 52008
By;
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CITY OF CUPERTINO
T
CUPEING
R GENERAL BUILDING
PERMIT APPLICATION FORM
�l 2 Z�OLD�I
APN # a� 6 Date:
Building Address:
/gybe
Mailing,Addr _ (if different from building address):
�} 4 de
Owner's Name: h/ e cin y C Phone
Contractor: /�i Phonr:1i q
615- �� �5�� �� d� YDv Fax:
Contractor License #:
Cupertino Business License #: ( Q19AJ
Contact: —�� P one:&16-j
G/ !✓ ` "rp Fax:
Residential Commercial
Job Description: " e /aG'L G/jn d a l/f
G i fG/�
Building Permit Info:
Bldg-'& Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ IUIII/V-A ❑ IUIII B, IV-HT, V-B
Valuation: 6 Square Footage:
Project Size: Ex resi- Standard ❑ Large ❑ Major F]
Green
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
Oto 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
ZIFCITY OF CUPERTINO
CUPEI,TINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1 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 Instal I ation/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 Install ation/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
I BBOILER5 Installation/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.
1 ELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1 PLMBINSP Other Plumbing& Gas Inspections P
(per hour •
1MEETINGIHR Application Meeting B