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07030123
.7777F— CITY OF CUPERTIN0 BUILDING DIVISION PERMIT Cif`T' ZR �ION PERMIT NO. BUILDjNT ADDRESS: ESUTHERLAND AV TBD — TO BE DETERMINED 07030123 l — PERMIT ISSUE DATE OWNER'S NAME: LIN GARY K AND SI-MEI 2 7 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: REPLACE 2 WINDOWS (LIKE FOR BLDG ELECT PLUMB MECH i ed LICENSED CONTRACTOR'S DECLARATION Job Description W I hereby affirm that I am licensed under provisions of Chapter 9(commencing ';'u with Section 7000)of Division 3 of the Business and Professions Code.and my license is t=y in full force and effect. $Z Z J 8 6 )M z License_Clpss I Lie.■ Date_, Contractor F'w ARCHITECTS DECLARATION ,,-j I understand my plans shall he used as public records )0.0 'w f- Licensed Professional o.A OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the C O following reason.(Section 7031.5,Business and Professions Code:Any city or county <m Pi 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 file a signed statement Ft.Floor Area Valuation ?e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. t= (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 Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number not more than five hundred dollars(5500). ❑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 a Required Inspections 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.). ❑I,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 Contractor's License Law. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: /� -1 Carrier-.)A,;;�4�On&101ft'rcy No.:S 1�JeCi l ( r v CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for ante hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California.Dale Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z� CONSTRUCTION LENDING AGENCY E-t CA I hereby affirm that there is a construction lending agency for the performance of R! > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name az Lender's Address U QI certify that 1 have read this application and state that the above information is f' correct.I agree to comply with all city and county ordinances and state laws relating to Jbuilding construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City o[Cupertino against Hliabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. dd� Date ►+ APPLICANT UNDENDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE / Re-roofs / Signature ofAAppplicant/Conlracltx Date Type of Roof MATERIALS DISCLOSURE yP Will the applicant or future building occupant store or handle hazardous material as defincd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs-hall be inspected prior to any roofing material being installed. ❑Yes MNP If a roof iE installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which nit hazardous air contaminants as defincd by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does notcurrently nt have a tc that it is my responsibility to notify the occupant of the requirements w}lich met prior w issuance of a Certificate of Oc� /©� Signature :)f Appl scant Date l/ All roof coverings to be Class"B or better Owner or authoriz agcn0 Datc „-,.,..�....� . . . . . . . . . . ti.aJ — 1V DD LL' 1L'iCllilV L'1J CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35617057. 00 DATE ISSUED. . . . . . . : 03/16/2007 RECEIPT #. . . . . . . . . BS000000707 REFERENCE ID # . . . : 07030123 SITE ADDRESS . . . . . : 11138 SUTHERLAND AV SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LIV GARY K AND SI-MEI ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4731 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY kMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1.00 34.86 0 .00 34 .86 0: 00 BPERMFEE VALUATION 2, 000. 00 83 .16 0 .00 83 .16 0. 00 BSEISMICRE VALUATION 2, 000 .00 0.50 0 .00 0 .50 0. 00 BUSLIC FLAT RATE 1.00 107.00 0 .00 107. 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 225.52 0.00 225 .52 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 225.52 VISA --------------- TOTAL RECEIPT 225.52 Community Development �W ;a 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 17UPEkTINO BuildinLr Department JOB ADDRESS: PERMIT# ► I 32 5C�,ki,e/-( c.e-\ c\ V- �l6301,�3 OWNER'S NAME: (,-,c;•, ,n PHONE # i r, S GENERAL CONTRACTOR: ; � ; FAX # I am not using any subcontractors: Si;;nature Date Please check applicable subcontractors and 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 Rock Tile "4� _ Owner/Contractor Signature Date 3 � � + CITY OF C UPERTINO c�TYOF` PERMIT APPLICATION FORM CuPEkTira0 PN# Date: Building Address: :Mailing Address (if different from building address): Owner's Name: Phone##: � ( L) Contracto License#: z I S Contact: Phone: Cupertino Business License#: ur %^ Fax: `� LS Building Permit Info: Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: <j i r\/ A r.-,e ,1 t��' �,�, �,�,1 -- -.1, , L_,tea. �',r L6<eZ, Residential Q (- (--, „ - r L),xr Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition, ;j&� Size: Standard ? --Larges-G--- -Major El quantity Fee ID Fee Description _ _ _ Fee Group BAPPLOTHER C ther Appliances MECHANICAL BBOILERI Bol:er<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Bc iler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind'Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Con 3tax-Resi/Mobile BUILDING BELEC 1000 Ele: 600V<= 1000A ELECTRICAL BELEC1001 Mee 600V > 1000A ELECTRICAL BELEC200 Elec ;1vcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA I:ivestigation fee BUILDING 1 cf3 Z - CITY OF CUPERTINO CUP TYOF 0 PERMIT APPLICATION FORM Quantity Fee ID Fe� Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP Nevi Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLO_W_ Atmo3pheric Vacuum PLUMBING-----,. BPCESSPOOI, Cesspool _ PLUMBING BPERMFEE Bld s Permit Fees BUILDING BPFIXTURE PbIR Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind A ante Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Re eat Fee BUILDING BPREPIPE Re i ie Of Fixtures PLUMBING BPSEWAGE Sem age Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn Sprinkler/Backflo PLUMBING BPSTORM Stor.n/Rain Water PLUMBING BPTRAP Kachen Trap _ - _. PLUMBING BPVENT Alt o:�Drain & Vent PLUMBING BPWATER InstallbUter Water Pie PLUMBING BPWHEATER - Water Heater/Vent PI IJMBING BPWSVCS Main Water Service- —_ _ — PLUMBING BREINSPECT Reinspection 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 Ligl-ting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> IOK btu MECHANICAL BREMHEAT Heati,r Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem No-i-Res Appliance ELECTRICAL BREMPOLE Pole/P:atform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Reloc ition of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 25 P S", °z E nay uty Windows Inc. dba BAY CITY CONSTRUCTION,License#745721 ��D `.. a 3030 Osgood Court,Fremont,CA 94539 OWnCly 6 Phone:(510)353-1600 Fax:(510)353-1616 ff Res.Phone Q 33 Date Carty L1 h Btu.PhoiieC Saryet ..J Existing Windows o ❑ City State,Zip e11) � ��fJ/� F Ic Wood uminum Steel Other . Brand .. / Class Job - d�J / (.Gat L— -- Job t Job > ne E-ma Address a: CZv # Approximate Size width iteipbt Style Location Color Glass Grids Comments L 0 _ . . 0 v r 4 X x r� D t/{. c3 vc:cat�t c S I c% u lv Gc' 9-A PicAL-4 This Contract must be accepted by an owner or manager of Bay City Windows,Inc. ACCEPTED.Contractors are required by law to be licensed and regulated by the Contractors State Lit:ense Board,which has jurisdiction to investigate complaints against contractors if a complaint regarding a patent act or omission is filed will in four years of the date of the alleged violation.A complaint regarding a latent act or omission pertaining to structural defects must bat!filed within 10 years of the date of the alleged violation.Any questions concerning the contractor may be referred to the Registrar,Coitractors State License Board,Post Office Box 26000,Sacramento, California 95826. In the event the Contractor deems it necessary to file;t mechanic's lien to secure payment of the money due under this contract,or in the event it becomes necessary for the Contractor to file shit to collect any money due under its terms or to collect damages for violation of any of the provisions of this contract,the owner agrees to pa✓all Contractor's costs of litigation including a reasonable sum incurred by the contractor for attorney's fees. All discounts have been g ven at time of signing nd accepting contract by customer. We hereby contract for the manufacture and installation of the above specif e d ( -7-e, V-� for the sum of / AA/AL'),M A7 _fit Payment as follows: 10%down payment$ Final measmWproduction$ L4 Balance Dae Upon Completion$ Start of material comdel pletion deet tailatiom tP cgmme�ce n or about(date) TL' 4 � Approximate completion doe I "t'C / ew W(-rk to begin ays I5°m � contract. Bay City Windows,hoc is rwt responsible for ti a delays due to manufacturer material error exulting in product�derdate specified on the All material is guaranteed to be as specified. All work to be completed in a prole:sional manner according to standard practices. Any alteration or deviation from above specifications or unforeseen repairs due to local building codes involi ing extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry all necessarytypes of homeowners insurance. Our workers are covered by Workmen's Compensatio i Insurance and Public Liability insurance. Homeowner to pay for any necessary building permits. Work does not include painting and/or staining. Upon completion of the work under this Contract,Contractor shall rem vc from the site all temporary structures,debris and waste incident to his operation and clean all surfaces,fixtures,equipment,a c.,relativ tot rforman of t is Contract. Authorized Signature ,�� `"ItZ=gistratioa Number ACCEPTANCE OF CONTRACT. The above pricx;.s,s •ificutions 'conditi,ns are satisfactory and are hereby accepted. You are authorized to do the wort:as specified. Payment will be made as outlined abov . Date of Acceptance t'•� ^2CG7 Signature _�~_ _ Signature You the buyer,may cancel this transaction at an time prior to midnight of it c third business day after the date of this transaction. See the"Notice of Right to Cancel"on the back for an explanation of this right. Any cancelli tion received beyond 3 working days is subject to a 50%(of contract) cancellation charge. Your signature acknowledges that you have read and understood all parts of this notice and agreement office copy YELLOW-salespersc n copy PiNK-customer copy a CITY OF CUPERTINO c, oFii PERMIT APPLIC XTION FORM CUPEkTINO Fee Description Fee Grou Quantity Fee ID BREMSIGNAD Rmdl S gns Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent IIan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING ------- -T _ Sei!.mic Fee es BUILDING BSEISMICIZE BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary BldgPermit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Ele:trical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mec lamcal sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LJ2 Commef-Multi-Fam PLANNING PLLONGRNGR _ Planning-Long RangeResidihtial PLANNING - -. ZADDCHG Ac.dress Change BUILDING 3 cf3