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09010012CY OF CUFEKI LINU BUILAING DIVISION PERMIT )ING ADDRESS: IOWNER'S NAME: )N FARCHrrECr/ENGINEER: pCLICENSED CONTRACTOR'S DECLARAT[ON �my affirm that I am licensed under provisions of Chapter 9 (commencing Z m00) of Division 3 of the Business and Professions Code, and my license is d cft'ect. v� 2 License Class Contractor y Date ARCHITECTS DECLARATION -� I understand my plans shall be used as public records W` O y Licensed Professional 4 OWNER -BUILDER DECLARATION e X I hereby affirm that 1 am exempt from the Cantraaors License Law for the E2O following mason. (Section 7031.5, Business and Professions Code: Any city or county ,t m 0' which requires a permit to construct. alter, improve, demolish, or mpair any structum prior to its issuance, also requires the applicant for such permit to file a signed statement 2 < that he is licensed pursuant to the provisions of the Contractor's Uccnsc Law (Chapter 9 YF (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 not more than five hundred dollars (5500). 0 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 and Professions Code: The Contractor's License Law dors 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 tinct 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. , B & P C for this reason 0 1 am exempt under Sec. Owner _ — j� Date WORKER'S OMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: Q z� mr :Dz UC V. F O C: U2 I have and will maintain a Certificate of Consent to sel"nsum for Worker's Compen- ation, as provided for by Section 3700 of the Labor Code, for the performance of the Bork for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section i700 of the labor Code, for the performance of the work for which this permit is issued. 4y Worker's Compensation Insurance carrier and Policy number are: airier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE INC. REEROMM PERMIT NO. PERMIT ISSUE DATE A CONTROL NO. BUILDING PERMIT INFO BLD? EO PLUMB MECH � Job Description REPLC GAS LINE FOR FURNACE Sq. Ft. Floor Area 35913018.00 ('itis section need not be completed if the permit is for one hundred dollars (S 100) ,r less.) certify that in the performance of the work for which this permit is issued. I shall not m to an rson in anmanner so as to become subject to the W_orkcrs' Com enation aws of California. Date 1 w L 4 kpplicant ._ T " QOTICE TO APPLICANT: If, after making this CcrtiOcare of Excmpiion, you should )ecome subject to the Worker's Compensation provisions of the Labor Code, you must 'arthwith comply with such provisions or this permit shall be deemed revoked. 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.) Lender's Name Lcndees Address [ certify that I have read this application and state that the above information is conccL I agree to comply with all city and county ordinances and state laws relating to building convection, and hereby authorize representatives of this city to enter upon the 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 in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS Da Signature of ApplicanpContractor HAZARDOUS MATERIALS DISCLOSURE 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)? 0 Yes No Will the applicant or future building occupant use equipment or devices which .t hazardous air contaminants as defined by the Bay Area Air Quality Management .,.strict? ❑ Yes ((No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safcty Codc, Section 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant. that it is my responsibility to notify the occupant of the _..... , m : m m„ M mem ndor to issuance of a Certificate of Occupancy. Owner or authorized Required Inspections Issued by: Re -roofs Type of Roof Occupancy Type Date /—� ,/- All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant All roof coverings to be Class '%`` or better Date 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN 35913018.00 DATE ISSUED.......: 01/05/2009 RECEIPT #.......... BS000006902 REFERENCE ID # ...: 09010012 SITE ADDRESS .....: 10489 BONNY DR SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER LOTUS F Y CHEN ADDRESS 10489 BONNY DR CITY/STATE/ZIP CUPERTINO CA, OPERATOR: patg COPY # : 1 95014-2907 RECEIVED FROM LOTUS FOUNG Y CHEN CONTRACTOR PATRICK TSAO LIC # 29932 COMPANY EVERSPRING CONSTRUCTION INC. ADDRESS PO BOX 700130 CITY/STATE/ZIP SAN JOSE, CA 95170-130 TELEPHONE (408) 446-8398 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ---------- THIS REC - NEW BAL 1BSEISMICR VALUATION ---------- 4,000.00 ---------- 0.50 0.00 0.00 0.50 61.19 0.00 0.00 1PGASRES OUTLETS 1.00 1.00 61.19 40.79 0.00 40.79 0.00 1PPERMITFE FLAT RATE 1.00 40.79 0.00 1TRAVDOC FLAT RATE ---------- - ---- - ------0_00 ---------- 143.27 0.00 143.27 0.00 TOTAL PERMIT METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 143.27 --------------- 143.27 VOICE ID DESCRIPTION -------- ---------------------------- 505 FINAL ELECTRICAL 508 FINAL MECHANICAL REFERENCE NUMBER -------------------- #1130 VOICE ID DESCRIPTION -------- ---------------------------- 507 FINAL PLUMBING CITY OF CUPERTINO FURNACE/AC CUPS TING PERMIT APPLICATION FORM APN # _ 0 L., L1 Date: / — � ci `, Building Address: Owner's Name: Contractor: Contractor License #: Contact: Building Permit Info: Elect ❑ Plumb Residential (A Job Description: %2 c - For Residential Installations: Attic ❑ Phone #: Phone #: Fax #: Cupertino Business License #: Phone #: Fax #: Mech ❑ Commercial ❑ 1 st floor 19 2nd floor ❑ Adhere to minimum setback requirement U For Commercial Installations: Additional weight (structural calcs) ElReplacement same weight Structural Calculations requiF]red for new installation ❑ New installation Planning Approval Required ❑ Cost of Project: Type of Construction (Usage Class): VE Strapped ❑ On Platform El ❑ New Location ❑ Replacement Project Size: Valuation: Standard or Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Kevisect o/ l om6 01F CUPEkTINO CITY OF CUPERTINO FURNACE/AC FEE SCHEDULE Group AIR CONDITIONING FURN/AC 1BCAIRHAN Commercial A/C Units <= IOk CFM B 1MCRAA Commercial Mech Repair/alt/add M 1BSEISMICO Seismic Commercial B 1PGASCOM Commerical for ea gas piping System 1-4 outlets P 1 PGASRES Residential for ea gas piping system of 1-4 Outlets P 1BPGAS For each gas piping system of 5 or more per outlet. CommfResid P 1BREMAIRHAN Residential A/C units <= 1 O CFM B 1MRR.AA Residential Mech Repair/alt/add M 1BSEISMICR Seismic Residential B IEP ERMITFEE Electric Permit E 1MPERMITFEE Mechanical Permit M 1PPERMITFEE Plumbing Permit P / 1 TRAVDOC Travel Documentation B 1BUSLIC Business License B Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 xCIV OF Fax (408) 777-3333 WEkTINO Buildin De artment JOB ADDRESS: PERMIT # OWNER'S N PHONE # —Cd GENERAL CONTRACTOR: ye v ,� FAX # I am not using any subcontractors: Signature 7• _7_l. __L-��L�..L..-... ,,-A ,. ,..lo+o +ho Fn11n'Tering infnrmafinn* Date Owner/ Contractor Signature Date 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