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08040091- PUB L _ LL. N � u 7 4 DL N a_ 0 y y S �, y U o m�py IfU: ti �j� ��',{ 0_ Q 2 U U 0 cn z *Q� U a a. +a H CD �' � v Lr) `� Q F Q U] O U LL) a c� a w w w d a w H J LLI `i U LLI F� z p L] --I U w J 'A a U N z (L) a L i w a � a sn as _ LO Or > E 0- :n t. W w M o Z a a u, a o co C ❑ = U H :3 w f U c l ; CL n xo a L4YI E n41 x� u fu U Q p Q U I�I li 41 L7i 13 ;L} OL OL d r xo 0 U ~ fu o n z6 a n U ICri L i— lei _ 0 O 0LO CD CD J J fest 3 -Z o �. y CL 0 Ln F- li w o CL LO J � i Z ;a. . t.�I UQ O i fu Z 0 O O 0 0 o rn Q Lei [n ❑C 07czI 'CC CD o o c o J >CD 0 LO L!3 z ,a- _? in ^ LO m F- o ti CC — — c� Z F- 0 0 0 o cr , — _ Q cn m - O 2 0 0 .0 v a`; x N xo a o xa =� a M j Q ° +a w v Ir %0 � Lo o 0 a a� a� a� U OwC m L L v z o as Q - 6 v w - o v o as �, 0.. a- =3Q LOU =1D- 0 a a -� o a- in :2 ❑- < a- U U U D- v i� - Q C CITY OF CUPERTINO 7�7y� BUILDING DIVISION PERMIT *��'O �lo :• BUIL INGADDRESS: PERMIT NO. 10471 PINEVILLE AVE DWK CONSTRUCTION 08040091 OWNER'S NAME: PERMIT L45UE DATE DAVID LU 18665 LOREE AVE 07/31/2008 PHONE: SANITARY NO. CONTROL NO. IT ARCHITECT/ENGINEER: 4"6 �� BLDG BUILD GPERMLUMBO MECH o p LICENSED CONTRACTOR'S DECLARATION tu P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description ;ZtVil with Section 70CX))ofDivision 3 of the Business and Professions Code,and my license is ADD49OSQ LV SPC,MSTRSTE&FAMRM RPLC EXSTNG FIREPLC t a a in full fora and effect . n D�rl ;nz License Class _ Lic.A n // W/ GASFIREPLC :� c Date_ Contractor T ?, �t�15 ARCHITECT'S DECLARATION i K a understand my plans shall be used as public records :,u O F-Licensed Professional H< OWNER-BUILDER DECLARATION j a 1 hereby affirm that 1 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 e m E which requires a permit to construct,alter.improve,demolish,or repair any structure _rn prior to its issuance,also requires the applicant for such permit to file a signed statement z� =O that he is licensed pursuant io the provisions of the Contractor's Licertsc Law(Chapter9 Sq.Ft.Floor zea Valuation t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $50000 R E 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 ofNumber Occupancy Type not more than five hundred dollars(5500). 3 6 9 13 0 2 1 .`bPT ❑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 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 employe¢,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 Contractors 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. C3I am exempt under Sea ,B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the fallowing declarations: ❑I h.ve 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 Ccmpensadon Insurance,as required by Section 3700 or 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: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(STOD) or Icss.) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any mann)oGbeotome subject to the Workers Compensation Laws of California.Date / b Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should becoma subject to the Worker's Compensation provisions of the Labor Coda you must forthwith comply with such provisions or this permit shall be deemed revoked. O CONSTRUCTION LENDING AGENCY -r Fr I hereby affirm that there is a concoction lending agency for the performance of Yi> the work for which this permit is issued(Sec.3097,Civ.C.) 3� Lender's Name Z Lender's Address J Q I certify that I have read this application and state that the above information is :L rr 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 W ahovc-mentioned property for inspection purposes. y (We)agree to save,indemnify and keep harmless the City of Cupertino against y Cs) liabilities,judgments,costs and expenses which may in any way accrue against said City J Z in consequence of the granting of this permit -- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signature o! pplicant/Contractor V 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 Cade,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? C]Yes �]No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes A No I have read the hazardous materials requirements under Chapter 6.95 0!the Califor- nia Health&Safety Cade,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 regtrir:m n�whieh,nn5lemustpr;ortni5st,anaOra Cer;reaLe0,"c"panry. Signature OfApplieant Date � I j�� All roof coverings to be Class" `'or better Ownce or authorized agent Date g CITY OF CUPERTINO Alf ; ADDITION/REMODEL � CITY OF CUFINO PERMIT APPLICATION FORM APN# 2/ D U Date: ll off' Building Addr s: 00l �`r�e Vi'lfe Mailing Address (if different from building address): Owner's Name;, / / , . Phone1 Contractor: l3l [—E-t Phone#: C 09 Fax #: Contractor License#: 2-o p Cupertino Business License#: Contact: [r Phone ' Fax #: Building Permit Info: Bldg. X1 Elect. Plumb. Mech.N Hillside ❑ Jot) Description: 1 Addition(adding s footage): �(/( GS-�or -C(, •� — Add 4y�U _ ,��`Jr v� ,pGtC GL / '�cz�{' ' _�1 Y-00r" l � What is being remodele ? S� � Remodel Includes Re-Roof: Yes ❑ No , If yes list number of squares Remodel Includes Structural: Yes ❑ No Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath Other Type of Construction(Usage Class): Occupancy Type: 1 FR, 11FR ❑ 11, 111, V-lHR ❑ 11, 111, 1V V-N 3 Valuation: Please check this box if the project is a second-story addition ❑ Green Building Che&list must be completed and Green Building Points Achieved: attached to the plans. 'For Office Use Only*** Over-the-Counter ❑ CITY OF CUPERTINO ADDITION/REM[ODEL CITY OF CU PEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD PLLONGRNGR Long Range PL Planning/Residential 1R31NSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat B Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1R3HINSP Dwellings Hillside B inspection 1R3HPLNCK Dwellings Hillside plan B check 1R3HREINSP Dwellings Hillside B Repeat Inspection 1R3HREPLNC Dwellings Hillside B Repeat Plan Check 1R3ALTINSP Dwellings Alternate B Materials Inspection 1R3ALTPLNC Dwellings Alternate B Materials Plan Check 1PCESS Cesspool P 1PPRSEWG Ea. Private Sewage P Disposal System 1PRSEWER Sewers P 1BPSPRINK Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P 1BSEISMICRE SeismicResidential B DECKS 1R3SFDADD OR 1R3SFDREM 1DECKWOOD Deck (Wood)-Each B (Each) 1DECKRAIL Deck Railing-Each B (Each) u; Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CLIPEkTINO Building Department JOB ADDRESS: PERMIT # lob / Ave- oj-6 ep,,00,f OWNER'S NAME: W PHONE # 6 g GENERAL CONTRACTOR: FAX # (4,'089) ,6/, 86 erf, OR I ,gym not using any subcontractors: � Gr � �f Signature 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 Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date