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07050095 77 77 CITY OF CUPERTINO BUILDING DIVISION PERMIT +C11r►�TIA+�T+QITI�Ns DDPERMIT NO. BUILD1 349 JUDY AVE TBD — T O BE DETERMINED 07050095 PERMIT ISSUE DATE OWNER'S NAME: 05/11/2007 WANG, EMMA SANITARY NO. CONTROL NO. VE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: ADD A/C UNIT IN ATTIC BLDG ELECT PLUMB MECH i p p LICENSED CONTRACTOR'S DECLARATION O escription V P I hereby affirm that I am licensed under provisions of Chapter 9(commencing ^^^- ^^^^ Z with ilunders Rmy of the Business and Professions Code.and my license is a in ful j z LicenLic.8 O DateContrat Olt is HITECTS DAR 1 .� id hall be used aslic rec 'u.H Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 00 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 u"y prior to its issuance,also requires the applicant for such permit to file a signed statement $q Ft.Floor Area Valuation -Z e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ts- (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 Occupancy Type Section 7031.5 by any 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 Required Inspections and Professions Code:The Contractor's License Law dos 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 Conttacutes 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. ❑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: LJ 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. ❑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 Workers Compensation Ins mita=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 Icss.) I certify that in the performance r o thi it is issued,I shag not employ any person in any mann Workers'Compensation Laws of Cal'fomia.Date Applicant NOTICE TO APP CA .1, ing th Certificate of Exemption,you should become subject to the r 's Compensation provisions of the Labor Code,you must forthwith comply with s or 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 (1: the work for which this permit is issued(Sec.3097,Civ.C.) Lf)QLender's Name az Lender's Address 1 certify that I have read this application and state that the above information is U correct.I agree to comply with all city and county ordinances and state laws mlating to 0 building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and p harmless the City of Cupertino against liabilities,judgmcn�s,costs and expenses ch may in y way accrue against said City V'Z in consequence of the granting'b is it Date APPLICANT U N AN ILL C LY WITH ALL N N-P NT Issued by: SOURCE ONS - / Re-roofs Sign ureo Applican o r D T Of Roof AR OUS MA ALS DISCLOSURE Type Wil applicant or uture building occupant store or handle hazard us material as defined by the Cupertino Municipal C pier 9.12,and the Health and Safety Code,Section 25532(a)? All roofs Shall be inspected prior to any roofing material being installed. ❑Yes If a roof i3 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? ❑Yes ' I have read aha-72rdouss requirements under Chapter 6.95 of the Califor- nia Health&Safety25533 d 25534.I un d thal-ifUhG building docs not cu my ponsihil y to no fy the occu t of thercquircm wh' iuu oCaC ica gfOccupan Signature of ApplicantDate All roof coverings to be Class B or better O cr o au rizDatc CITY OF CUPERTINO 8 ITEMS OF 8 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk . Lot: APN 37508049. 00 DATE ISSUED. . . . . . . : 05/:_1/2007 RECEIPT #. . . . . . . . . BS000001287 REFERENCE ID # . . . 070 )0095 SITE ADDRESS . . . . . : 103,69 JUDY AVE SUBDIVISION . . . . . . CITY CUPERT INO IMPACT AREA . . . . . . OWNER WAN(,, EMMA ADDRESS 103,69 JUDY AVE CITY/STATE/ZIP . . . : CUPHRTINO, CA 95014 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 A40UNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34 .86 0 . 00 34 . 86 0. 00 BREMAIRHAN NO.UNITS 1.00 10 .26 0 .00 10.26 0. 00 BREMRECEPT NO. OUTLETS 1 .00 1.20 0 .00 1.20 0 . 00 BSEISMICRE VALUATION 3, 000 .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 MPERMITFEE FLAT RATE 1 .00 38.37 0 .00 38 .37 0 . 00 PPERMITFEE FLAT RATE 1 .00 38 .37 0 .00 38 .37 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 268. 93 0 .00 268 . 93 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 268. 93 1677 --------------- TOTAL RECEIPT 268 . 93 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 505 FINAL ELECTRICAL 508 FINAL MECHANICAL CITY OF CUPERTINO FURN ACE/AC CUPEkTINO PERMIT APPLICATION FORM � rlo5ool5 APN # Building Address: r T (�C 14�� Owner's Name: L/ J Phone#: Contractor:, , License#: Contact: Cupertino By 'ness License #: a,�j) Building Permit Info: Bldg ❑ Elect Plumb C�� Mech Job Description: Residential Commercial ❑ For Res' ential Installations: Attic1St floor ❑ 2"d floor ❑ Adhere to min set back requiremen For Commercial Installations: Replacement same weight ❑ Additional weight(si ructural calcs) ❑ Structural Calculations required for new installation ❑ New installation Planning Approval Required Cost of Projec :3 Type of Construc.ion: Occupancy oup- OBD 5'/n, / Strapped ❑ On Platform Bonded Sq.Ft. Moor Area: New Location Replacement ❑ Qty. if Applicable Fee ID Fee Description Fee Group BENERGY Energy BUILDING BREMFURN Relocation of FgMace MECHANICAL BREMACOVER AJC Unit(�_10,000 cfn MECHANICAL BREMAIRHAN AJC Units<= 10, 000 cfm MECHANICAL BREMRECEPT Zec tl, Switch& Outlets ELECTRICAL BSEISMICRE Seismic Fee Res BUILDING EPERMITFEE 31ec Permit Issuance ELECTRICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING BPERMFEE E;ld,g Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 C"OF 4"UPERTINO Buildin De artment PERMIT # JOB ADDRES :!�5C. �C L OWNER'S NAME: g PHONE# GENERAL CONTRACTOR: � Ji2ature rFAX# � � o Z'J / I am not using any subcontractors: D to Please check a licable subcontractorscom tete the followin 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 b er/ContraDate ctor Signature