06100056 777777777777777=.,
C CUPERTINO
ioijt"L,Li�G DIVISION PERMIT PERMrr NO.
BUILDING ADDRESS: CALIFORNIA SKYLIGHTS 06100056
22354 CARTA "RI-ANCA ST PERMIT ISSUE DATE
OWNER'S NAME:
YOUNG LU & HELEN ING 2 2 5 0 C PARAMIL-12— _J n/, ni�2nnr,
SANITARY NO. COMMOL NO.
NE:
(408) 866-6759
BUILDING PERMrr INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
Wz R'S DECLARATION
LI ENSED CONTRACTO Job Description
P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
'z with Section 7000) fDivision 3 ofthc Business and Professions Code,and my license is
in full force and effect. SKYLIGHT INSTALLATION 3 TUBULAR SKYLIGHTS
License Cl
Date Contractor C;/_;t�dFC4 4�ltl
ARCHrrhUI-5DKLARATION
I understand my plans shall be used as public records
LU
Licensed Professional
rA
4`1 11 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
ns Code:Any city or county
00 following reason.(Section 7031.5,Business and Professio
which requires a permit to construct,alter.improve,demolish.or repair any structure $54SI
prior to its issuance,also requires the applicant for such permit to rile a signed statement
that he is licensed pursuant to the pitivisions of the Contractor's License Law(Chapter 9 q.Ft.Floor Area Valuation
(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
nalty
Section 7031.5 by any applicant for a permit subjects the applicant to a civil PC of 00 Occupancy Type
not mom than five hundred dollars(S500).
0 1,as owner of the property.or my employees with wages as their solc 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 Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,providcd 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 die burden of proving that he did not build or improve for purpose of
sale.).
[1 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 does not apply to an owner of property who builds or improves themon.and.
who contracts for such pmjects with a contractor(s)licensed pursuant to the Contractor's
License Law.
C]I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DEC—DFRATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insum for Workees Compcn-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
2M 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 am:
Carrier��/7tf& 4E�^�,P Policy No.: t2 V—'2 6
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if ft permit is foronc 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 manncrso as to become subject to the Workers'Compiensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Workces Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked,
0
z� CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
Lendces Name
CL, Lcndees Address
�:)z
U 0 1 certify that I have read this application and state that the above information is
V.0-0 correct.I agree to comply with all city and county ordinances and state laws relating to
CD 17' 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 keep harmless the City of Cupertino against
rA liabilities,judgments.costs and expenses which may in any way accrue against said City
UZ in consequence of the granting of this permit. Date
APPLICA 14T UPIDERSTANDS AND WILL C' Y WITH ALL NON-POINT Issued by:
S LATIONS.
Re-roofs C7
Signature OfApplicant/Corfiactor 'Date
HAZARDOUS MATEZALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle ha7Ardous material
as dcfiocd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
0 Yes [Z�_No If a roof is 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 Erg.—
I have mad the ha7ardous materials requirements underChaptcr 6.95 ofthe Califor-
nia Health&SafctyCodc,Sections 25505,25533 and25534.I understand thaLifthc building
does not currently have a tenant,Lha t i's my ms 'bllity to notify the occupant of the
requircM9,"hich must be met prior to i c of a Certificate of Occupancy. Signature of Applicant Date
4,46 All roof coverings to be Class"B"or better
Owner or authorized ag�t Dai
A-�
7
C-- IL f W-
hN ACCORDANCE WITH THE CITY Ut
CUPERTINO CODES AND ORDINANCES
)ATE d(�
AGNED
this set 0# p'ans ?rid specifications MUST
ae kept on th'e j�ib at all times and it is un
lawful to make amy changes or altmtion-,
:)n same with.,ut w1titten permission frort.
he buildi�ng Npl , City of Cupertino.
Lh- s4mpigg-W4 iis;plan and specificafions
X: ;HALL NOT be h M to permit or to be w.
pproul W the v 041ioa of imy waymms
-75
inv totv Onim sitce (w 'scate L?m.
OFFICE Copy
AA
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CC-
VA
1014
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............
ell
f7,
Comm Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
CITY OF
r
,UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
:-,j�Cayto f5 1eqnce5i a. No I C005 u
OWNER'SNAME: 1 V)oa PH0NE #40@-02(V(Q—(4e-7,5T—
GENERAL CIDNTRAMR- #
am not using any subcontractors: A, r
qgnature/ '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
L.andscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plaste:6.
.. ing
Plumbing
Roofing
Septic Tank
Sheet Metal
Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
AM 1 of PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32613040 . 00
DATE ISSUED. . . . . . . : 10/10/2006
RECEIPT # . . . . . . . . . : 36362
REFERENCE ID # . . . : - 06100056
SITE ADDRESS . . . . . : 22354 CARTA BLANCA ST
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : YOUNG LU & HELEN ING
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . :
RECEIVED FROM . . . . : CALIFORNIA SKYLIGHTS
CONTRACTOR . . . . . . . : TERRY KIYAMA LIC # 26844
COMPANY . . . . . . . . . . : CALIFORNIA SKYLIGHTS
ADDRESS . . . . . . . . . . : 2250C PARAGON DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95131
TELEPHONE . . . . . . . . : (408) 866-6759
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- -- - ---- -- -- ---- - - ---- - --- - ----- - --- ------- ---------- ---------- ----------
BENERGY PERMIT FEE 126 . 36 60 . 65 0 . 00 60 . 65 0 . 00
BPERMFEE VALUATION 5, 451 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 5, 451 . 00 0 . 60 0 . 00 0 . 60 0 . 00
BPLANCHK1 PERMIT FEE 126 . 36 83 . 16 0 . 00 83 . 16 0 . 00
-- - ------- ------- --- ---------- - --- ----- -
TOTAL PERMIT 270 . 77 0 . 00 270 . 77 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- ---- - ---- - ---- - - ----- ------- ------ ----- -------
CHECK 270 . 77 1821
TOTAL RECEIPT 270 . 77
CITY OF CUPERTINO 0010005W
CM Of PERMIT APPLICATION FORM
CUPEkTINO
APN Date:
?2u IS-04-0 /0Z
Building Address: Mailing Address (if different from building address):
---2 3 S-4
Owner's Name: Phone #:
(tLo 8') -7 �t- Z
Contiactor': License#:
75"- 4-J!q31f-7-,S 23 F I
Contact: I Ph6n-e: q4?-71d,-1)7 Cupertino Buisiness License#:
:!�;C 07-77 1A-_)16A4 X Fax:
Building Pennit Info:
Bldg 0' -V Elect El Plumb El Mech 1:1
Job Descn*ption:— 77.�J c,.r- �3�-.) r
Residential q S:r-Li L 1(�If T IAJ75�Ftct�+T/fAf Commercial El
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction: Please chek this box if the project is a
second-story addition: El
Project Size: Standard B' Large El Major 0
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILER1 Boller<= 100,000 Btu MECHANICAL
BBOILER2 Boller> 1 OOK to 5 OOK Btu MECHANICAL
BBOILER3 Boller> 500K to 1M Btu MECHANICAL
BBOILER4 Boller> I M to 1.75 M Btu MECHANICAL
BBOILER5 Boller> 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 Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V <= I OOOA ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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