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07050154 CITY OF CUPERTINO BUILDING DIVISION PERMIT PERMIT NO. BUILf1�rT ff" �MSFORD DR TBD — 'I O BE DETERMINED 07050154 OWNER'S NAME: PERMIT ISSUE DATE GU, SHANNON 05/16/2007 SANITARY NO. CONTROL NO. JNE: ARCHITECT/ENGINEER: BUILDING PERMIT INFO INSTALL 2 TUBULAR SKYLIGHTS BLDG ELECT PLUMB MECH i p p LICENSED CONTRACTOR'S DECLARATION Job Description U )= 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ZM with Section 70W)of Division 3 of the Business and Professions Code,and my license is <0- in full fora and effec j DCA Licenac CI : Lic.of g(o7 23 0 3 t—p Date Contractor scan M�DaU lAn� ARCHITECTS DECLAR ON a< I understand my plans shall be used as public records �yU GH Licensed Professional 5 OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the Cp O following mason.(Section 7031.5,Business and Professions Code:Any city or county t which requires a permit to construct,alter,improve,demolish,or repair any structure Z r prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q ut— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 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 five hundred dollars(5500). ❑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 for sale(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.). ❑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 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 declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. [ I 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 Workces Compensation Insurance carrier and Policy number ate: Carrier. S;C fl raI✓A Policy No.: f 8 V l'l1 S 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 so as to become subject to the Workers'Compensation Laws of California.Date 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 forthwith comply with such provisions or this permit shall be deemed revoked. z ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction(ending agency for the performance of (x the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name aLender's Address U 0 1 certify that I have read this application and state that the above information is LL 1-r correct.I agree to comply with all city and county ordinances and state laws relating to Vbuilding construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against nF,a to liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date �+ APPLICANT U DE STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE R LATIONS. gllr.4 19 Re-roofs Si ure of Applicant/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 E hall be inspected prior to any roofing material being installed. ❑Yea 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? f ❑Yes ❑Nu 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 if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements whi ust be met prior to issuance of a Certificate of Occupane. Signature A Applicant ieant Date All roof coverings to be Class"B"or better §wneo uthorized agent Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . : 36209015 . 00 DATE ISSUED. . . . . . . : 05/16/2007 RECEIPT #. . . . . . . . . : BSC00001352 REFERENCE ID # • • . : 07C50154 SITE ADDRESS . . . . . : 1152 ELMSFORD DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : GU, SHANNON ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : SAN JOSE CA, 95120 RECEIVED FROM . . . . : JIN. MCDONALD CONTRACTOR . . . . . . . : TBE - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBE - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 83 .16 39. 92 0 .00 39. 92 0. 00 BPERMFEE VALUATION 1,498 .00 83 . 16 0.00 83 .16 0. 00 BSEISMICRE VALUATION 1,498 .00 0. 50 0 .00 0 .50 0. 00 BUSLIC FLAT RATE 1 .00 107. 00 0. 00 107 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 230.58 0. 00 230 .58 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 230.58 DISC --------------- TOTAL RECEIPT 230.58 CITY OF C UPERTINO C Ty OF PERMIT APPLICATION FORM CUPEkTiNO .PN # Date: 3�--Q — C i—C/5 SIit,A) Building Address: P✓Iailing Address (if different from building address): 1%SZ f- .sFot1.n n- Owner's Name: Phone#: S WW►!a./ Cv /-foe) 9161- o1clk Contractor. License #: 'T%, au SV723o Contact: Phone: Ltog-gay.-cofrCupertino LBusine s License#: Fax: qo8-g+r--uoS`7 Building Permit Info: Bldg L4.,' Elect ❑ P[umb ❑ Mech ❑ �"' C> t`' Job Description: tsu- -n�� su.�rv4 �-' p` N [ff Commercial ElResidential Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancyoroyp; l4°t Y �- Type of Construction: Please check this box if the project is a t�,srnw�nv� civ Z -r-JY--02. second-story addition: El -w Project Size: Standard ❑ Large ❑ Maier ❑ Quantity Fee ID lee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boner<= 100,000 Btu MECHANICAL BBOILER2 Boiler > 100K to 500K Btu MECHANICAL BBOILER3 Boilcr> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ on. Tax for BQ Zone BUILDING BCONSTAXH ]hotel and Motel BUILDING BCONSTAXR Cor stax—ResWobile BUILDING BELEC 1000 Elcc, 600V <= l OOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADb7 Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF C UPERTINO c�no PERMIT APPLICATION FORINT CUPEBkTINO Quantity Fee ID Vee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKF'LOW Atmos bene VacUum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE B Ida Permit Fees BUILDING BPFIXTURE Pblg 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 Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Law:l S rinklerBackflo PLUMBING BPSTORM S-:orm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT AL of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C lJnits <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY R-,model Busways ELECTRICAL gREM'IXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relc Furnace> l OK btu MECHANICAL BREMHEAT Beater Installation MECHANICAL BREMINHOOD Ing tallation of Hood MECHANICAL BREMMISC Vlisc Apparatus ELECTRICAL BgEMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Po]e/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc 11, Switch.& Outlets ELECTRICAL BREMRELOCA R,,-location of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 t z CITY OF C UPERTINO F PERMIT APPLICATION FORM CUPERTINO 'Mantity Fee ID lee Description Fee Group BREMSIGNAD Rind Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR The itrical Lighting Fix ELECTRICAL BREMVENFAN Vert Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSFISMICOAI Sei;knit C=(rHn mer ciaJ - - I FJII,DI�tTC - BSEISMICRE 'Seismic Fee Res BUILDING BSPECIAL S)ecial Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC B usiness License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE M,-chanical sq. foot MECHANICAL MPERMITFEE Mec h Permit Issuance MECHANICAL PPERMITFEE Pluribing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING PLLONGRNGR PlanningLong Range Residential PLANNING ZADDCHG .address Change BUILDING 3 A3 10300 TORRE AVENUE ACCOUNT# CUPERTINO,CA 95014-3255 TEL(408)'7,77-3221. FAX(408)777-3109 NEW Li CITY OF CUPERTINO BUSINESS LICE YSE APPLICATION RENEWAL 13 .ME OF BUSINESS Sv. %-t6bu-r Cv✓c-��r LOCATION OF BUSINESS 11 O Lipo-rg A& STREET ADDRESS 9505 PHONE(408 ) 844-00El CITY STATE ZIP MAILING ADDRESS IF DIFFERENT THAN ABOVE NATURE OF BUSINESS �c�8wawt_ StG�t,�� HOURS OF OPERATION lu- 3 IF YOU ARE OPERATING AN APARTMENT COMPLEX,PLEASE STATE NUMBER OF UNITS SQUARE FOOTAGE OF YOUR BUILDING SPACE IN CUPERTINO LEGAL STATUS OF BUSINESS CORPORATION PARTNERSHIP SOLE PROPRIETOR START DATE OF BUSINESS IN CUPERTINO (MONTH/DA OYEAR) fir,!Lo-I STATE EMPLOYER ID NO. FEDERAL TAX IDNO. Stf- 21 fp c(I 7(0 STATE BOARD OF EQUALIZATION TAX NUMBER ,WNER/OFFICER NAME T%.14 DRIVER LICENSE# Cgo7-C¢C l`( STATE 1252 woao%--4w--j PNS, C'"'wr.•-u C'A' cks 6t PHONE(qoE) LL%-(+S-YY STREET ADDRESS CITY/S'TATE/ZIP OWNER/OFFICER NAME DRIVER LICENSE# STATE PHONE( ) STREET ADDRESS CITY/S'TATE/ZIP OWNER/OFFICER NAME DRIVER LICENSE# STATE PHONE( ) STREET ADDRESS CITY/S TATE/ZIP *HOME BUSINESS APPLICANTS PLEASE COMPLETE REVERSE SIDE* TO THE BEST OF MY KNOWLEDGE,THE ABOVE INFOIAIATION IS TRUE AND CORRECT. I AM AWARE THAT SOME OF THE INFORMATION IS AVAILABLE TO THE I UBLIC. APPLI T'S SI A DATE FOR OFY CE USE ONLY ZONING APPROVAL _ DATE APPROVED DATE PROCESSED !J '�� 07 RECEIPT NUMBER AMOUNT /G 'I INITIALS _ C ~/ 0/.454-f Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Cin OF Fax(408)777-3333 "-UPEkTINO Building Department JOB ADDRESS: <; i I sZ Az. PERMIT# OWNER'S NAME: S PHONE # fig) 86 1— o Iq GENERAL CONTRACTOR: ���.� M �,,,,`p FAX # I am not using any subcontractors: Si€nature Date Please check applicable subcontractors and com lete 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 Owner/Contractor Signature Date