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07030098 77777= =77-7777777777 CITY OF CUPERTINO BUILDINS DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 10296 VIRGINIA SWAN PL HSUAN WEA WANG & I FANG LIU 07030098 OWNER'S NAME: PERMIT ISSUE DATE HSUAN WEA WANG & I FANG LIU 03/14/2007 )NE: SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH i p p LICENSED CONTRACTOR'S DECLARATION Job Description u F` I hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 7000)of Division 3 of the Business and Professions Code,and my license is ADDING SINK I N GARAGE. t=y in full force and effect. ? License Class LK-g y tp Date ARCHITECTS Dl ECLARATION 7 z< I understand my plans shall be used as public records >aU n, Licensed Professional H j OWNER-BUILDER DECLARATION 1 hereby alTirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct.alter,improve,demolish,or repair any structure Z y prior w its issuance,also requires the applicant for such permit to file a signed statement Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ;iq.Ft.Floor Area Z is (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $9000 y 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 APN Number Occupancy Type not more than rive hundred dollars($500). 31646005 V V ❑I,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 forsalc(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q p 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- ccnse Law does 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. ❑I 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 declua60n4'- - 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: Carrier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner sus m bceome subject to the Workers'Compensation Laws of Caliromi �/ _,[nf e" Applicant NOTICE TOAPPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J. 0 forthwith comply with such provisions or this permit shall be deemed revoked. Z"' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of a> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is h correct.1 agree to comply with all city and county ordinances and state laws relating to LT. v building construction,and hereby authorize representatives of this city to enter upon the a above-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 U Z in consequence of th ranting of this permit. Date APPLICANT TANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE S./ v � Re-roofs Signature of pplicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 Code,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes _ ,ETf7o Will the applicant or Cuture buildin oec�ipant use equipment or devices which If a roof i;installed without first obtaining an inspection,I agree to remove nit hazardous air contaminants hncd by the Bay Area Air Quality Management all new materials for inspection. District? / Cl Yes ��❑No 1 ve re e hazardous materials requireJ,53 Chapter 6.95 of the Califor- nia Hea & ty Code,Sections 25505,25533 annderstand that if the buildingdocs t cu fly have a tenant that it s my o notify the occupant of the req remcn which must be met prior to issu cc to orOceup y Signature of Applicant Date A .0 All roof coverings to be Class"B"or better Owner or authorized agent Date �G CITY OF C UPERTINO CUP TYOF 0 PERMIT APPLICATION FORM 1IPN# / V6 O�S Date: 3 / I 1,P 7 Building Address: , Address (if different from building address): /02�,� Ilir rn�C art Mailing Grp ar 4-1'm c� 1'a Owner's Name:� ,aa/1�4a^ Wav -kilt s ((1 Phone#L 'r Contractor: — icense #: Al ark �a n -- �1�� r�?e � -- Contact: Phone: Cupertino Business License#: Fax: 273,K3 . Building Permit Info: Bldg ❑ Elect ❑ Plumb X Mech ❑ Job Descriptio : /9 Km 51 �v�� Residential Commercial El Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: r Occupancy Group: Type of Construction: Please check this box if the project is-,a second-story addition: El -oJect� ze. a�td"'d—1mrge ❑. Majors — _ - Quantity Fee ID Fee Description Fee Grou'' _ BAPPLOTHER 0-:her Appliances MECHANICAL BBOILERI BoiL;r<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 1 OOK to 500K Btu MECHANICAL BBOILER3 Boilei > 500K to 1M Btu MECHANICAL BBOILER4 Boiler > 1M to 1.75 M Btu MECHANICAL BBOILER5 Bo ler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH P otel and Motel BUILDING BCONSTAXR Cons tax -Resi/Mobile BUILDING BELEC 1000 Elec 600V<= I OOOA ELECTRICAL BELEC1001 Elec 600V > IOOOA ELECTRICAL BELEC200 Elec c vcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Er,ergy Add Multi BUILDING BINVESTIGA Ir vestigation fee BUILDING 1 0'3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORINT CUPEkTiNO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ve;itilation Systems MECHANICAL BSCBLVD Sib Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res _ BUILDING BSPECIAL Special Inspection BUILDING BSWIM 'Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temliorary Bldg Permit BUILDING BTEMPSVCS r,emp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec.Permit Issuance ELECTRICAL MPERMFEE Mechanical sq. foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plu-nbing Fee sq foot PLUMBING PLLONGRNGC Planning Comme/Multi-Faro PLANNING _ PLLONGRNGR Planning on2 Rage-.esiydaal PLANNING ZADDCHG T address Change BUILDING 4 3 of3 CITY OF "_UPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31616005. 00 DATE ISSUED. . . . . . . : 03/14/2007 RECEIPT #. . . . . . . . . BS000000685 REFERENCE ID # . . . 07030098 SITE ADDRESS . . . . . : 10296 VIRGINIA SWAN PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : HSUkN WEA WANG & I FANG LIU ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2025 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY HSUkN WEA WANG & I FANG LIU ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2025 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BSEISMICRE VALUATION 9, 000.00 0 . 90 0 .00 0 . 90 0.00 PPERMITFEE FLAT RATE 1 .00 38.37 0.00 38 .37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 39.27 0.00 39.27 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CASH 39.27 HSAAN_WEN WANG CHANGE -1.00 --------------- TOTAL RECEIPT 39.27 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING