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08120071 CITY OF CUPERTINOa -3saz BUILDING Dlyl'ION PERMIT €CU,1Vx'x12AiCT�f3I2I1�FF`U_ SRMt�-TIO, BUILDING ADDRESS: PERMIT NO. 1333 PRIMROSE WAY E G ELECTRICAL ' OWNER'S NAME: PERMIT ISSUE DATE NE: A CONTROL NO. (408) 370-2222 ARCHIIECT/ENGINEFJt: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 (� �0, LICENSED CONTRACTOR'S DECLARATION Job Description U I bereby affirm that i w licensed under pro isions of Chapter 9(mmmeacing wits Section 70110)of0ivlaon Jaf the Boas and Pimpneadellcode nd mylice=U >>HNfalfinecami tt � GROUNDING (5) RECEPTCLS; 3 BDRM & 2 LVNGRM 'p ummec Lm.g s,p Dam Gn DECL W ARCHI'IF.CI DECL -S ARATION ` 77 1 underuanJ mY P1 Ee used u public nsmds JyU bo Lxcnsed Professional OWNER-BUILDER DECLARATION f I hertbY aHim Net I em eumpt from the Commsctors Littnm Law for the O O following mason.(Section 71313,Basil and Professions Code:Any city Or county i$ which mquims a permit on conavcL after,ftnirm,,.demolksh,m mpir any Arectme prior b its iuunm,aeo mquines the applicartfor such permit m files signed summcnm pp Nu he is licensed pursuat in the provisions of the contractors lieeue Law(chapter 9 Sq.Ft.Floor Area Valuation Y�$ (cummmmmi;with Satian 7000)aDivision Jof the Business and Professions Cnde)or Nat M ta mcmpt therefrom and the basis for the alleged eaereptim.My violation of $1100 Section 70313 by M•applicant for a permit subjects the applkant m a civil penalty of APN Number Occupancy Type not mine Neo five hundred dollars ISM I.asmvar of tiro y payw a: gee pe 36617044 . 00 ❑ propvty,rc m w 1 ah ws u ale(Sec.cam natim, will dotitswork,and the he Comas not"Lonedn Law dos am (Sec.7W.Business and arty wh ou Calc the Contrxmr.and who law nch rot apply in,through awrcs ser _ Required Inspections Property who Wildamimpmveschimprandwhd dao not Oroflafar Nm ugh his man employees,th building Improvement is improvements ear ofcmmlertdfmswner- Wilda,however.dm bulling or Impromnent ts sad within one year of completion,the owmr- buildv wiB lose tse burdcv of proving NLL IN:did not baW or Improve fm purpose of ale.). ❑1,u Macy of tk property.iso exclusively comraming wits licensed mnuenms m cdnsruct Ne project(Sec.7044.Business,add Professions Cade:)The Coomctors U. cense law dots rot apply to a ownm of property who builds or improves thereon,snd. who contracts for such projects wit aconumnKs)Ilcuued pursuant m the Conuamorf Line.law. ❑lamexcmptunderSee .BkPCfm Nisreamn Owner Dau WORKERS COMPENSATION DECLARATION I hereby aBlrm ander penalty of perjury one,of the fallowing dmlusuonc 1 haand will maintain a Cenifium of Covent m self-Wore fmWommesCompeo- onve,a provided fm by Section 3700 of the labor code.fm Na performance or dm wort for which this permit is issued. - ❑1 have and will maintain Workers Compensation InsWace,as required by Section 3700 of Ne labor Code,for dm performance of the work for which this permit is iuuel. My Workers Com eus oTmomenearricrand Policynu r am 2 Grricr. Polity No.: I��y y CERIIFIGTE OF EXEMPTION FlIOMW ERS' COMPENSATION INSURANCE (Thueeetim need not bemmplemd Ifthe permit is fmotn hundred callus($100) arluv) 1 ceru)y Nam in Ne perAunce m of Ne work for which this permit is Wood.l shall am employ any person in any mauur an as n bttamat mbjat n the Warton'Compensation Laws of California Dasa Applicant NOTICE TO APPUCANr:IL after making this Cer ificam of Exemption,you should becmne subject to ce Workers Compensation pmvisiov of the Labor Coda you muse 0 forthwith comply with such provisions m Nu permit shall be deemed revoked. z`-' CONSTRUCTION LENDING AGENCY I bemby alta.Nu deem U a mnsunath.londing agency for the arfmmarme of a> Nc work for which Nie Permit ts issmd(See 3097,Civ.C.) i21 0fenders Name jz Undoes Address ' V O 1 cmtify that 1 lase rad Bus "Resume am!sum that Nc above information Ise Lp t— comes.I agree to comply with all city and county amins„ce.and sum taws relating m .O Wildingcousuuction,arW hereby sucoum mepreacnordws or this city to cmerupon Ne r D] shove-.nuo.Cd property for Wpecuon purpose 0. (We)agree to sale,indemnify and kap harmless 037 City of Cuarfino against mF-m rn 114"Iuesjudg cots end expmw which may In my way¢era gairmwd City V z in emsuquenee o N granting of this permit ► APPLICANT YNDItRS7ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCEU ONS. Re-roofs Signaturesme Dam HAZARD / H.VJ�RDOUS MATERIALS DISCLOSURE Type of Roof dldm applicantnr fumro Wildinge.Chanutorcor and hvathanmaterial u lefincl by Ne Cupertino Municipal Cade.Chapter 9.12.sul dte Heath and Safety Code.Section 33532(x)? JJ All roofs shall be inspected prior to any roofing material being installed. ❑Yee [�No Will Ne applicant or f/.rum Wilding ompant use,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ncendous air contaminants u dinned by the Bay Area Air Quality Management all new materials for inspection. v ct? [D Yes �No I have real ardamsmamrlalsmquiremcnu undcrapmrd.95ofNeCaifor- nuHmlNksactY Savons]5503.25577 arW25514.1uedcnuml NnifNe Wilding ' docs rot curtcntiY a mnsua Nat it u my resauinility n notify In occupant of rotas mgwremcntsw ' rout be met plaint issuance ora Cmtirnam sera Signature of Applicant Date Owner ora mil agen Dam' All roof coverings to be Class'%W'or better CITY OF CUPERTINO • 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36617044 . 00 DATE ISSUED. . . . . . . : 12/08/2008 RECEIPT # . . . . . . . . . : BS000006774 REFERENCE ID # . . . : 08120071 ' SITE ADDRESS . . . . . : 1333 PRIMROSE WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : AUDREY CHEN ADDRESS . . . . . . . . . . : 1333 PRIMROSE WAY CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5229 RECEIVED FROM . . . . : EG ELECTRICAL SVCS CONTRACTOR . . . . . . . : EDWARD GORGINIAN LIC # 24831 COMPANY . . . . . . . . . . : E G ELECTRICAL SERVICES ADDRESS . . . . . . . . . . : 1170 BISMARCK DR CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 370-2222 4 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---- -------- - -- 1BREMRECEP NO. OUTLETS 1 . 00 40 .79 0 . 00 40 . 79 0 . 00 1BSEISMICR VALUATION 1, 100 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 122 . 87 0 . 00 122 . 87 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------ CHECK 122 . 87 #329 --------------- TOTAL RECEIPT 122 . 87 • :F7 21W. R -A Assessor's Parcel Number: Name of owner. Aux)ee��l e-) �Y\ (2n3 E Project address. Contact person. J)(k)AJ2-r) G 0 96 1�J t#t,3 Phone. 14o�- -FJ Fax. Net square footage of lot. Existine Pro osed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Orivacy protection planting required for the project? �N On what floor(s) is work being done? <R—, B deAcn'ption of work. ('3) VI Code editions: 2008 CBC Y N)2008 CFC (Y - N)2008 CMC (Y- N) 2008 CPC N)2008 NEC (Y - N) APPROVED Effective 1/1/08 OMMM"M IOE CO 05 �, ,nd sp;citicatons MUST its Set d pa as the i -1 times and R is UP to make any crianges or. or 3f, So= without W,ILI0 permissionhon:he tafddft DapL.. City of Cupertino. the stamping of this p;an and vecdkAms DEC 082008 • ;HALL NOT be heid to permit or,tD be ar. ,00h of the Violation of any KNOOP, . inv C71tv Ordinance of whi bw- Plan view .Process Work Book Page-8-Revised 1/1/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 -a 40UPEkTINO Building Department JOB ADDRE : PERMIT # E ©�l�DD7 OWNER'S NAME: PHONE # — GENERAL CONTRACTOR: FAX # I am not using any subcontractors: 7SigNiture D to Please check applicable subcontractor d complete 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 Tile Owner ntractor Signature late OW 001 � ' dam CITY OF CUPERTINO CITY OF • CUPEIITINO GENERAL BUILDING PERMIT APPLICATION FORM APN # Date: (pI70q • 00 - , Building Address: P Mailing Address (if different from building address): Owner's N e: Phone Contractor: Phone: ax: Contractor License#: T— 695 95 Cupertino Business License#: 2 Contact: ` Phone: 14(Z, I IJ I Fax: • Residential; Commercial Job Description: CaE()u.,�j k�)IQC Gv i WD �wm Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-13 ❑ II/IIIN-A ❑ II/III B, IV-HT, V-B Valuation: Square Footage: i l/ Project Size: Express E4--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.buildit reen.or et-3--- Revised 10/20/08 R E1 , CITY OF CUPERTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1BBOILERI 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) 1BBOILER2 Installation/relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption sys over 100,000 Btu/h 1BBOILER3 Instal lation/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 1 BBOILER5 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 ca 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 1MEETINGIHR Application Meeting B •