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07060118CITY OF CUPEK111`4U BUILDING, DIVISION PERMIT OOO* ± BUILDING ADDRESS: 10162 JUDY AVE OWNER'S NAME: LIEM THAN & NE: ARCHITECTIENGiNEER: cd c Z LICENSED CONTRACTOR'S DECLARATION 0 m �, I hereby affirm that I am licensed under provisions of Chapter 9 (commencing m with Section 7000) of Division 3 of the Business and Professions Code, and my license is y in full force and effect. Z License Class epi Lic.it ga DatedContractor ' E m ARCHITECTS DECLARATION i a < I understand my plans shall be used as public records tyrJ m y Licensed Professional : 0 OWNER -BUILDER DECLARATION > 1 hereby affirm that I am exempt from the Contractor's License Law for the 1 in O following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to rile a signed statement ? a that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 I- (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 not more than five hundred dollars ($500). ❑ 1, 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. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of 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. if, 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.). ❑ 1, 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 docs not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Convactor's License Law. ❑ 1 am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 00 Z � r. 0.. Q :Dz UO w F, OU H � U r -y I hereby affirm under penalty of perjury one of the following declarations: I I have and will maintain a Certificate of Consent to self -insure for woftes compen- tion, as provided for by Section 3700 of the Labor Code, for the performance of the ork for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 700 of the Labor Code, for the performance of the work for which this permit is issued. ly Worker's Compensation Insurance carrier and Policy number are: arrier: Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) r less.) certify that in the performance of the work for which this permit is issued, l shall not mploy any person in any manner ;p a`s to �oytg ytbject to the Workers' Compensation aws of California. Date�— applicant IOTICE TO APPLICANT. If, after making this Certificate of Exemption, you should ccome subject to the Worker's Compensation provisions of the Labor Code, you must orthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of he work for which this permit is issued (Set:. 3097, Civ. C.) -ender's Name -enders Address 1 certify that I have read this application and state that the above information is :orcct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the ahove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. - a Signature of Applicanttcontracter V HAZARDOUS MATERIALS DISCLOSURE 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 Cork:, Section 25532(a)? C] Yes 01JNo Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? ❑ Yes V(No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Codc, Sections 25505, 25533 and 25534.1 understand that iCthe building does not currently have a tenant, that it is my responsibility to notify the occupant of the re tri mens which must be}pM prior to issuance of a Certificate of Occupancy. �.N� l 4f Owner or authorized agent Date TBD — To BE DETERMINED SERVICE UPGRAD TO 100 AMPS Sq. Ft. Floor Area Issued by Re -roofs PERMIT NO. 07060118 PERMIT ISSUE DATE SANITARY NO. CONTROL NO. BUILDING PERMIT INFO Job Description Valuation occupancy Required Inspections Type of Roof All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new n- aterials for inspection. Signature of Applicant Date All roof coverings to be Class "B" or better 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN 37511005.00 DATE ISSUED.......: 06/14/2007 RECEIPT #.........: BS000001653 REFERENCE ID # ...: 07060118 SITE ADDRESS .....: 10162 JUDY AVE SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 OWNER LIEM THAN & HUONG NGUYEN ADDRESS .......... CITY/STATE/ZIP 95014 RECEIVED FROM ....: DAN PHUONG NGUYEN CONTRACTOR .......: TBE - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBE - TO BE DETERMINED ADDRESS CITY/STATE/ZIP ...: TELEPHONE ......... FEE ID UNIT QUANTITY ZMOUNT PD -TO -DT THIS REC NEW BAL BELEC200 ------------- METERS ---------- 1.00 ---------- 29.43 ------ 0.00 29.43 0.00 BSEISMICRE VALUATION 700.00 0.50 0.00 0.50 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 ---------- 0.00 ---------- TOTAL PERMIT ---------- 175.30 ---------- 0.00 175.30 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 175.30 --------------- 175.30 VOICE ID DESCRIPTION -------- ---------------------------- 103 UFER 505 FINAL ELECTRICAL REFERENCE NUMBER #465 VOICE ID DESCRIPTION -------- ---------------------------- 304 ROUGH ELECTRICAL CITYOF CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM 07o, 0119 CPN # � Date: Building Address: ]Mailing Address (if different from building address): 1 01 6:L SUD-/ A\jE Gu9E9_TiQ0 , CA N Owner's lame: Phone #: L 1 EM r.YGv>'EN 4c $JG Contractor: C)ANJ ELEC;TP_IC/ COP,/\ -P License #: G IG ._ S4 951 U Contact: Phone: (40��9�;-69� _ Cupertino Business License#: DAA TJGv-/End Fax: BBOILER4 Building Permit Info: Bldg ❑ Elect Ld Plumb ❑ Mech ❑ Job Description: Residential 2 Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: * 710C.00 9 -- Type of Construction: Please check this box if the project is a El -1 second -story addition: efa„.icird F- T arae Fl Mai or f-1 Hotel and Motel 1 1 V ■rra. va_v- — ____ — Quantity Fee ID BAPPLOTHER :Fee Description Other Appliances Fee Group MECHANICAL BBOILERI Bo' ler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boil,;r > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 B oiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Co z. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Co:Istax — Resi/Mobile BUILDING BELEC 1000 El ,-c 600V <= l OOOA ELECTRICAL BELEC1001 E lee 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA I Investigation fee BUILDING I of 3 CITY Of CUPEKTINO CITY OF C UPERTINO PERMIT APPLICATION FORM Quantity Fee ID BMISCELL Fee Description Miscellaneous Fee Fee Group BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP N(,w Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE PblR Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK flan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Rf i e Of Fixtures PLUMBING BPSEWAGE Sewage Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Insta ll/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT I' einspection Fee BUILDING BREMACOVER A/C Unit > 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT bighting Fixtures ELECTRICAL BREMFURN Re: ocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Fleater Installation MECHANICAL BREMINHOOD InAallation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rep J, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL RRFMRFQAPP Remodel Res Appliance ELECTRICAL 2 of 3 CIWOF CUPEkTINO CITY OF C'UPERTINO PERMIT APPLICATION FORM 'Zuantity Fee ID Fee Description Fee Group BREMSIGNAD Rind Signs Add Branch ELECTRICAL BREMSIGNS Rem Adel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD ' cb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE ;>eismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP T �m orar Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC 1?lectrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plimbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING 3 of 3 CITY OF 17UPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: H O 16.`L -o} D\� ^\) E- C-R PERMTI' # d c7 O 4 G / �- OWNER'S NAME: L ietA tJ G-vyEr\) PHONE # GENERAL CONTRACTOR: oo-tj E�-Ec-,Mic: cor,nP FAX # I am not using any subcontractors: ^�� r— Si€na e Please check anolicable subcontractors and comtrlete the following information Date Owner Contractor Signature Date 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 Owner Contractor Signature Date